Professional Documents
Culture Documents
Basics
Leah Taylor
Western Kentucky University
Doctor of Physical Therapy
Program
Common Causes of Arrhythmias
Cardiac Conditions
MI: >90% experience some type of arrhythmia
CHF
Cardiac Surgery
Ventricular Aneurysm
Cardiomyopathies
Pericarditis
Myocardial Contusion
Pulmonary Conditions
Any acute conditions causing PO or pH (*Tachycardia)
COPD (*Atrial Tachycardia)
Pulmonary Emboli
Pulmonary Edema
Pneumonia
Common Causes of Arrhythmias (contd)
Sudden Hemodynamic or Metabolic Changes
Hypovolemia, Hemorrhage, Hypotension (*Tachycardia/Bradycardia)
Acidosis (*Tachycardia)
Alkalosis (Associated with K+ levels)
Electrolyte Imbalances
K+ (*Bradycardia)
K+ (*Tachycardia)
Ca (*Decreased contractility)
Drugs
Digoxin Toxicity (*Bradyarrhythmias, Ventricular Bigeminy, Ventricular Tachycardia, Ventricular Fibrillation)
Myocardial Depressants (*Bradyarrhythmias, Ventricular Tachycardia)
Myocardial Stimulants (*Tachyarrhythmias, Premature Ventricular Contractions)
Common Causes of Arrhythmias (contd)
Neurologic Conditions
Intracranial Pressure (*Sinus Bradycardia, Premature Atrial Contractions, Junction Rhythm, Ventricular
Tachycardia)
Parasympathetic Response - vagal stimulation (*Sinus Bradycardia, Bradyarrhythmias, Asystole)
Sympathetic Response (*Tachyarrhythmias, Premature Ventricular Contractions)
Normal EKG Pattern
P Wave: Atrial Depolarization
PR Interval: Propagation of the cardiac AP from the
atria through the AV node into the ventricles
QRS Complex: Ventricular Depolarization
QT Interval: Variable with heart rate
T Wave: Ventricular Repolarization
U Wave: Variable, Insignificant to PT
R-R Interval: Duration between peaks of QRS-QRS
Q Wave: 1st negative deflection off baseline
R Wave: 1st positive deflection off baseline
S Wave: 2nd negative deflection off baseline
R Wave: 2nd positive deflection off baseline
S Wave: 3rd negative deflection off baseline
https://upload.wikimedia.org/wikipedia/commons/thumb/3/34/EKG_Complex_en.svg/2000px-EKG_Complex_en.svg.png
Normal Sinus Rhythm
Sinus Bradycardia
<60 bpm
Normal in children and well-conditioned athletes.
PT Implications: Monitor for dizziness and fatigue; caution with exercise.
Exercise may increase heart rate to return to normal sinus rhythm.
Sinus Tachycardia
Narrow QRS, shorter R-R Interval, less distance between P wave and Q wave, P wave may
merge with T wave
100-150 bpm
Normal response during exercise; stress.
PT Implications: Monitor for fatigue, pale coloration, anxiousness.
Use Karvonen HR calculation for determining exercise intensity.
Sinus Arrhythmia
PT Implications:
In otherwise healthy patients: Often benign.
In patients with comorbidities: Monitor for potential progression to atrial fibrillation or atrial
flutter.
May indicate an underlying cardiac disease.
Atrial Flutter - Sawtooth Waves
Absent P wave, AV junction passes every second (2:1) or fourth (4:1) impulse
Atrial rate of 240-340 bpm (type I), 340-440 bpm (type II).
Ventricular rate may be increased, decreased, or normal.
PT Implications:
Patients have an increased risk of thrombus formation in the atria.
Often degenerates to atrial fibrillation.
Atrial Fibrillation - Irregularly Irregular
Atrial rate >350 bpm; ventricular rate may be normal, increased, or decreased.
PT Implications:
Patients have an increased risk of thrombus formation in the atria.
If new: report immediately for anticoagulation therapy and clot prevention.
If chronic: monitor for fatigue and loss of atrial kick to ventricles.
Watch for: heart palpitations, SOA, chest pain.
Abnormal Ventricular
Rhythms
Normal Sinus Rhythm with Premature Ventricular Complex
May be benign
A PVC every second complex is called ventricular bigeminy.
Every 3rd - ventricular trigeminy.
PT Implications:
Can indicate decreased oxygen saturation.
Ventricular Tachycardia
Absence of RS complex
>100 bpm with at least 3 abnormal heartbeats in a row.
PT Implications:
Often results in hemodynamic compromise (due to minimal ventricular filling time and the
absence of atrial kick).
Decreased cardiac output and blood flow to peripheral musculature.
Decreased consciousness, hypotension.
Often progresses to ventricular fibrillation, asystole.
Ventricular Fibrillation
Coarse Vfib is noted when the amplitude of the rhythm is equal to or more than
3 mm.
Fine Vfib is less than 3 mm in height and signifies less electrical energy within
the myocardium - less opportunity for a successful defibrillation.
PT Implications:
No cardiac output while in Vfib.
Abnormal Innate Pacemaker
Rhythms
Supraventricular Tachycardia
170-230 bpm
PT Implications:
Can be exercise induced - monitor HR.
Decreased cardiac output; decreased blood pressure.
Normal Sinus Rhythm with 1 Atrioventricular Block
Prolonged PR interval
Normal heart rate.
PT Implications:
Usually asymptomatic.
2 Atrioventricular Block Type I (Wenckebach)
One or more QRS complexes are dropped with PR intervals that do not change
41-100 bpm
Common following MI, cardiomyopathy.
PT Implications:
Can rapidly progress to either asystole or ventricular tachycardia
Sinus Exit Block (Sinoatrial Block)
Results from blocked sinus impulses - impulses not getting through to depolarize the
atria. While the sinus is firing on schedule, the tissue around the SA node is not
carrying the impulse.
Each pause is equal to a multiple of previous P-P intervals.
PT Implications:
Severity is dependent on frequency and duration of arrest.
Heart skipped a beat.
May be asymptomatic.
Sinus Arrest (Sinus Pause)
Pause is NOT equal to the multiple of P-P intervals seen in Sinus Exit Block.
Often an escape pacemaker such as the AV junction will assume control of the
heart.
PT Implications:
Severity is dependent on frequency and duration of arrest.
Heart skipped a beat.
May be asymptomatic
Wandering Pacemaker
40-60 bpm
Originates from the AV junction (AV node and Bundle of His).
PT Implications:
Can cause decreased cardiac output when combined with bradycardia.
Typically asymptomatic if >50 bpm.
Accelerated Junctional Rhythm
60-100 bpm
Results from enhanced automaticity, increased sympathetic nervous system
activity (catecholamines) or ischemia.
PT Implications:
Typically asymptomatic.
Junctional Tachycardia
>100 bpm
Results from enhanced automaticity, increased sympathetic activity
(catecholamines) and ischemia.
PT Implications:
Abundant urine output after rhythm ceases.
Can be normalized by massage of the carotid artery.
Normal Electronic Pacemaker
Rhythms
Paced Atrial Rhythm