ARRHYTHMIA/DYSRHYTHMIA

Are the disorders of the formation or conduction (both) of the electrical impulse within
the heart. This disorder can cause disturbance of the heart rate, the heart rate rhythm, or
both.

Epidemiology

Sudden cardiac death (SCD) and arrhythmia represents a major worldwide public health
problem, accounting for 15-20% of all deaths.

Normal Electrical Conduction

The electrical impulse that stimulates and paces the cardiac muscle normally originates in
the SA node, also called the sinus node, an area located near the superior vena cava in the
right atrium.

In the adult, the electrical impulse usually occurs at a rate of 60 to 100 times a minute.

The electrical impulse quickly travels from the SA node through the atria to the
atrioventricular (AV node); this process known as Conduction. The electrical stimulation
of the muscle cells of the atria causes them to contract.

Cardiac Arrhythmia can be classified by site of origin:

 Sinus rhythms

 Atrial rhythms

 Ventricular rhythms

SINUS RHYTHMS

Is an irregular heart beat that's either too fast or too slow.

Sinus arrhythmia occurs with another condition called Bradycardia, or slow heartbeat, is
diagnosed when your heart natural rhythm is below 60 beats per minute.

Another type of sinus arrhythmia occurs when the heart beats too fast. This is called sinus
Tachycardia. It refers to heart rates above 100 beats per minute.

ATRIAL RHYTHMS
Atrial dysrhythmias originate from foci within the atria and not the SA node. These
include aberrancies such as;

 Premature atrial complexes (PAC’s),

 Atrial fibrillation

 Atrial flutter

Premature Atrial Complex

A premature atrial complex (PAC) is a single ECG complex that occurs when an
electrical impulse starts in the atrium before the next normal of the sinus node. PAC
maybe caused of caffeine, alcohol, nicotine, stretched atrial myocardium, anxiety,
hypokalemia, injury, infarction. The cause of a premature heartbeat is generally unknown.

Medical Management:

If PAC’s are infrequent, no treatment is necessary. If they are frequent, this may herald a
worsening disease states or the onset of more serious dysrhythmias. Medical
management is directed toward treating the underlying cause (e.g., reduction of caffeine
intake, correction of hypokalemia).

Atrial Fibrillation

Atrial fibrillation results from abnormal impulse formation that occurs when structural or
electrophysiological abnormalities alter the atrial tissue causing a rapid, disorganized, and
uncoordinated twitching of the atrial musculature.

Patients with atrial fibrillation are at increased risk of heart failure, myocardial ischemia,
and embolic events such as stroke.

Patients with atrial fibrillation may exhibit a pulse deficit- numeric differences between
apical and radial pulse rates.

Medical treatment:

Treatment of atrial fibrillation depends on the cause, pattern, and duration of the
dysrhythmia, the ventricular response rate, as well as the presence of structural or
valvular heart disease and other cardiac conditions such as coronary artery disease or
heart failure. In some cases, atrial fibrillation spontaneously converts to sinus rhythm
within 24-48 hours and without treatment.

Medical management resolves around preventing embolic events such as stroke with
antithrombotic drugs, controlling the ventricular rate response with antiarrhythmic
agents.
Atrial Flutter

Atrial flutter occurs because of a conduction defect in the atrium and cause a rapid,
regular atrial impulse at a rate of between 250-400 beats per minute. Because the atrial
rate is faster than the AV node.

Because atrial flutter comes from the atria, it is called a supraventricular (above the
ventricle) tachycardia.

Management:

Atrial flutter can cause signs and symptoms, such as chest pain, shortness of breath, and
low blood pressure. Medical management involves the use of vagal maneuvers or a trail
administration of adenosine, which causes sympathetic block and slowing of conduction
through the AV node.

VENTRICULAR RHYTHMS

Ventricular dysrhythmias originate from foci within the ventricles; these may include:

 Premature Ventricular complexes

 VT

 Ventricular fibrillation

 Idioventricular rhythms

Premature Ventricular complexes

A PVC is an impulse that starts in a ventricle and is conducted through the ventricles
before the next normal sinus impulse.

PVC can occur in normal people, especially with intake of caffeine, nicotine, or alcohol.

PVC may caused by cardiac ischemia or infarction, increased workload on the heart,
digitalis toxicity, hypoxia, acidosis or electrolyte imbalances, especially hypokalemia.

Medical Management:

PVC usually are not serious. PVCs that are frequent and persistent may be treated with
amiodarone or satalol, but long term pharmacotheraphy for only PVCs is not usually
indicated.
Ventricular Tachycardia

VT is defined at three or more PVCs in a raw, occuring at a rate exceeding 100 bpm. The
causes are similar to those of PVC.

Medical Management:

Several factors determine the initial treatment, including the following: identifying the as
monomorphic

Ventricular Fibrillation

The most common dysrhythmia in patients with cardiac arrest in ventricular fibrillation,
which is a rapid, disorganized ventricular rhythm that causes ineffective quivering of the
ventricles.

Medical Medication:

Ventricular fibrillation is always characterized by the absence of an audible heartbeat, a

palpable pulse, and respirations. Because there is no coordinated cardiac activity, cardiac
arrest and death

Idioventricular Rhythm

Idioventricular rhythm, also called ventricular escape rhythm, occurs when the impulse
starts in the conduction system below the AV node.When the sinus node failes to create
an impulse or when the impulse is created but cannot be conducted through the AV node
(due to complete AV node).

Medical Management:

Idioventricular rhythm commonly causes the patient to lose consciousness and experience
other sign and symptoms of reduced cardiac output.Intervention include identifying the
underlying causes: administering IV epinephrine, atropine, and vasopressor medications.

ETIOLOGY

 A heart attack that’s occurring right now

 Scaring of heart tissue from a prior heart attack

 Changes to your heart’s structure, such as from cardiomyopathy

 Blocked arteries in your heart (coronary artery disease)

 High blood pressure

 Overactive thyroid gland (hyperthyroidism)

 Underactive thyroid gland(hypothyroidism)

 Smoking

 Drinking too much alcohol or caffeine

 Drug abuse

 Stress

 Certain medication and supplements, including over-the-counter cold and allergy

drugs and nutritional supplements

 Sleep apnea

 Genetics

PATHOPHYSIOLOGY

The normal heart beats in a regular, coordinated way because electrical impulses
generated and spread by myocytes with unique electrical properties trigger a sequence of
organized myocardial contraction. Arrhythmias and conduction disorders are caused by
abnormalities in the generation or conduction of these electrical impulses or both. Any
heart disorders, including congenital abnormalities of structure or function can disturb the
rhythm. Systemic factors that can cause or contribute to a rhythm disturbance include
electrolyte abnormalities, drugs and toxins.

SIGN OF SYMPTOMS

 A fluttering in your chest

 A racing heartbeat (tachycardia)

 A slow heartbeat (bradypnea)

 Chest pain

 Shortness of breath
 Sweating

 Fainting

 Lightheadedness or dizziness

Nursing Intervention

When the patient experiences episodes of dysrhthymia, the Nurse stays with the patient
and provides assurance of safety and security while maintining a calm.

Monitoring of blood pressue, pulse rate and rhythm, rate and depth of respiration, and
breath sounds on an goiong basis to determine the dysrhythmia hemodynamic effect.

If the patient is hospitalized,the nurse may obtain a 12-lead ECG, continuously monitor
the patient.