i/25/ 2013 s/a3f2033, | ] Dysrhythmias | Dysrhythmias + Abnomal cardiac of he hears thecal ystom oe tems (The Basics of Arrhythmias) Dysmytimas + Promat assessment of dystnythmias & the PATIENT'S response to the rhythm is CRITICAL | hythmias | pyeae Cardiac Cells + Disturbance ues * corde anccal mple omaon “omy oes nie wore & “onan een sorson «Becta + Causes Sfmt decay sted ary eases (especialy CAD) + Conducty 1 Abit anamt an imps along @membrane Inancrdery maner + Contracity + Eleceoye imbalances ‘Changes in ongenaton soaaeed + Abit fo respond mechani tan irpulse Conduction System Diagram | Cardiac Conduction System Know WSR Know Stes , will be on dest .1/22/2013 Nervous System An Ele¢ ram Control of the Heart ecard, ‘Autonomic Nervous System (ANS) + Graphic acing of Se electrical mpulses Sieg onter cea produeesinthe « Parasympathetie Nervous Syetem heart * Fight ana vagu eve fora + EKG or Eco ‘"pemercectopun vtec, ert teeta + sympathetic Nervous System Telemetry * Inreaes rte f pie, seed of conduct, Srengiesconeacion # Normal Sinus Rhythm Normal Sinus Rhythm + Normal conduction pattem ofthe cardiac cycle + Impulse originates in the SA node Electrophysiologic Mecha | ‘Types of Dysrhythmias Dysrhythmias = + Sinus Bradyeard + Disoers of 1 Sus Tecyeara formation + Premature Atl Contraction (PAC) Absolute F ‘+ Supraventriculer Tachycardia (svt, svn) Reiatey I Taal ruts pees + Atrial Fibritation Refrecory + ear Boss Period Then oe oneness Leeann1/22/2013 Types of Dysrhythmias 5-Step Method of Analysis (continues) + Premature Ventricular Contractions Is the speed ofthe rhythm between 60 - 100? 1 + Ventricular Tachycardia 2. Isitregular? + Ventricular Fibrillation 3. Is the complex rarrow? + Asystole 4. Isitpreveded by a Pavave? 5. Doall the comalexes look the same? vernteaig-ercon/tot ion Determining Heart Rate x Sinus Bradycardia + Count the # of smaloxes Between 2 waves or2P «= Sinus Node Fires <60 bpm Smvon ond da bo 100 * Can be a narmal rythm in Aerobicaly Trained ean Ahietes and during sleep + Countthe Hof Ror Pwaves ina 6-second stip and ‘mull by 10 (el park and good for regular ryt) L a Steus Brastycardta: | Sinus Bradycardia **Clinical Associations: + Conus in response fo + Clinical Significance: ‘Dependent on Symptoms *Carotid Sinus Massage 100 bpm Sinus Tachycardia * Clinical Associations ‘hasocites wth physiologic svestos: +Bxercise +Pain *Hypovolemia + Myocardial ischemia +Heart failure (HF) “Fever Sinus Tachycardia | + Clinical Significance ‘Dizziness snd hypotension due todecreases CO + Increases myocardial ongen Consumption may lead to angie | Atrial Fibrillation + Total disorganization of atrial electrical activity due to multiple ectopi foc! resulting in loss of effective atrial contraction + Most common dysrhythmia + Prevalence increases with age adnum shaler, blood goals, clot Army GN cou pradiy pracaxa1/22/2013 | Atrial Fibrillation | | Atrial Fibrillation [iafehepoaeeeer| "£00 acing of anormal heat styth, Ce hati xaton the acy showe hy. neg “lion? ‘waves tebvoen Pearseale. The yim sire and era, Clinical Associations: + Uevaly occurs wih Underlying Heart Disease + Such as rheumatic heart disease, CAD Cardiomyopathy SHE + Pericarditis Atrial Fibrillation * Clinical Associations: + Often acutely caused by Atrial Fibrillation * Clinical Significance: + Can rent in decrease in CO cue o intectve + Thyrotoxicosis ‘atial contractions (loss of atrial kick) and rapid *Alcohol Intoxication ‘ventricular response + oo = Thoigy orm naan eet 7 + Ebolus may develop and wave: Electrolyte Disturbance Embolus may develop and revels Cardiac Surgery | At Fibrillation Atrial Fibrillation Treatment: Treatment ‘+ For some patients, conversion to Sinus Rhythm + Goa nav becosiored + Decracee vetcular response + Preventembolus + Drags for ata conta: *paarrgetcoars + Long tm anteoagulaton: Coumadin atin "Anya drugs used for conversion: ‘amedarare + Prepalenone + DC earioversion maybe used to convert tel focaton to nermal snus myth,1/22/2013 | Atrial Fibrillation «Treatment atient has been in atial fibrillation for >48 hours + Anticoagulation therapy with Warfarin is recommended fr 1 310d weeks before cadoversion 14108 weeks ater success cartoversion | Atrial Fibrillation Treatment *Radiofrequency catheter ablation ‘Maze procedure ‘sModifications to the Maze procedure * Use of cald(eryoabiton) + Use of heat (igrintensiy RS complex + Types: MuttocalUnitcal inoase BeTiny issse Trgeminy pups Tipe, 2 {Ren phenomena ce Premature Ventricular Contractions Premature Ventricular (Pvc's) Contractions + conan ng Gu x tw as vencecs peaaiaaa Beds + Premature occurrence of a wide & distorted 1 sf LL st deb p Lt) nes Premature Ventricular Contractions + Clinical Associations: «Stimulants: Caffeine, alcohol, nicotine, ‘aminophyline, epinephrine, isgproterencl Digoxin + Electrolyte imbalances Hypoxia +Fever + Disease states: Ml, mitral valve prolapse, HF, CAD Premature Ventricular Contractions * Clinical Significance ‘In normel heart + Usually benign + In heart disease1/22/2013 _ AAA NOVA AOU Ventricular Tachycardia bh Ventricular Fibrillation + Severe derangement ofthe heart rhythm characterized on ECG by: * regular undulations of varving contour & ampituse + No effective + Contraction +O occurs start CPRE Ventricular Fibrillation Ventricular Fibrillation * Clinical Associations: ‘Acute Ml, CAD, cardiomyopathy “VE may occur during cardiac pacing or cardiac catheterization “VF may cecur with coronary reperfusion after Tornoe therapy + Accidental electrical shock Hyperkalemia Hypoxia Acidosis, + Drug toxicity Ventricular Fibrillation «+ Treatment heen Automatic External Defibrillator (AED)1/22/2013 Asystole Pacemakers | + Electronic device used to pace the heart + Batley poweree AEA pitt potent tea chiag. on paunakers