DYSRHYTHMIA NOTES

WHAT IS DYSRHYTHMIA?
- is an abnormal or irregular heartbeat. If you have dysrhythmia, your heart
might beat too fast or too slowly. Or your heart's rhythm might be disrupted,
leading you to feel like your heart skipped a beat.

THE CARDIAC CONDUCTION SYSTEM?

- The heart conduction system is the network of nodes, cells and signals
that controls your heartbeat. Each time your heart beats, electrical signals
travel through your heart. These signals cause different parts of your heart to
expand and contract.

SA NODE
- generates an electrical signal that causes the atria to contract.
- Known as the “primary pacemaker of the heart”
- Located in the right upper corner of the right atrium
- It generates impulses for about 60-100 BPM

AV NODE
- It delays the impulses by 0.04 seconds to keep the ventricles from contracting
quickly.
- Located in the inferior right atrium near the coronary sinus
- It generates impulses for about 40-60 BPM

BUNDLE OF HIS
- is a group of fibers that carry electrical impulses through the center of
the heart. If these signals are blocked, you will have problems with your
heartbeat.
- It resumes the rapid conduction of impulses through the ventricles
- Divides into right and left bundle branches

PURKINJE FIBERS
- Extend from the bundle branches into the endocardium, deep into the
myocardial tissue. These fibers conduct impulses rapidly through the muscle
to assist in its depolarization and contraction.
- It generates impulses at a rate of 20-40 BPM
 THE ECG COMPONENTS

P wave
- The first component of ECG waveform
- It represents atrial depolarization
- It precedes the QRS complex
- Amplitude: 2-3 mm high
- Duration: 0.06-0.12 second
- Configuration: usually rounded and upright
CLINICAL SIGNIFICANCE:
- Peaked or enlarged P waves may represent atrial hypertrophy or heart
enlargement associated with COPD, pulmonary emboli, valvular disease or
heart failure.

PR interval
- Tracks the atrial impulse from the atria through the AV node, bundle of his,
and right and left bundle branches.
- Changes in the PR interval indicate an alteration in the impulse delay as seen
in AV block.
- It is located from the beginning of the P wave to the beginning of the QRS
complex
- Duration: 0.12 - 0.20 second
CLINICAL SIGNIFICANCE:
- Prolonged PR intervals may represent delayed conduction through the atria or
AV junction due to heart block or ischemia.

QRS COMPLEX
- It represents ventricular depolarization.
- Immediately after the ventricles depolarize, they contract. This contraction
ejects blood from the ventricles and pumps it through the arteries, creating a
pulse.
- It follows the PR interval
- AMPLITUDE: 5 to 30 mm high
- DURATION: 0.06 to 0.10 second.
- Duration is measured from the beginning of the Q wave to the end of the S
wave
- CONFIGURATION : consists of the Q wave (the first negative deflection after
the P wave), the R wave (the first positive deflection after the P wave), and
the S wave (the first negative deflection after the R wave).
- The ventricles contracts rapidly minimizing contact time between the stylus
and ecg paper
ST segment
- Represents the end of ventricular depolarization and the beginning of
ventricular repolarization
- LOCATION: extends from the S wave to the beginning of the T wave

CLINICAL SIGNIFICANCE: a change in the ST segment may indicate myocardial

damage.
ST segment depression - indicates myocardial ischemia
ST segment elevation - indicates myocardial injury

T wave
- represents ventricular repolarization
- LOCATION: follows the S wave
- CONFIGURATION: typically round and smooth

ECG INTERPRETATION:

NORMAL SINUS RHYTHM (NSR)

- Is defined as the rhythm of a healthy heart. It means the electrical pulse
from your sinus node is being properly transmitted throughout the heart
muscle. In adults, normal sinus rhythm usually accompanies a heart rate of 60
to 100 bpm.

SINUS TACHYCARDIA
- characterized by a sinus rate of more than 100 BPM.
- Atrial and Ventricular rhythms are regular, both rates are equal generally 100-
160 BPM.
- This can be seen in cases like hypovolemia, hemorrhage or pain.

SINUS BRADYCARDIA
- characterized by a sinus rate below 60 BPM but with regular rhythm
- CLINICAL SIGNIFICANCE: this may be caused by hyperkalemia, IICP,
hypothyroidism, hypothermia, sleep and glaucoma.

PREMATURE ATRIAL CONTRACTION:

- are extra heartbeats that start in the upper chambers of your heart. When
the premature, or early, signal tells the heart to contract, there may not be
much blood in the heart at that moment.
- PAC’s are common among patients with Lung Disorders (i.e. COPD)
 - PAC’s happen when atria are activated by an ectopic site in an atrium, instead
of the SA node.

ATRIAL FLUTTER
- Is characterized by an atrial rate of 250-350 BPM, originating in a single atrial
focus. (has multiple p waves with regular space QRS)
- Resembles saw tooth appearance called “flutter waves” or “f waves”
- CLINICAL SIGNIFICANCE: Commonly found in patients with severe mitral
valve diseases, hyperthyroidism, pericardial and myocardial disease.
- IRRITABLE FOCUS - happens when the cells outside the sinus node start
generating electrical impulse automatically on their own.

ATRIAL FIBRILLATION
- The most common type of cardiac arrhythmia
- Electrical impulses are initiated randomly from many other sites called
“ectopic sites” These unsynchronized, chaotic impulses cause the atria to
quiver rather than to contract.

PREMATURE VENTRICULAR CONTRACTION

- Often caused by electrical irritability in the ventricular conduction system.
- Electrical signals originates from the ventricular myocytes rather than from SA
node producing broader QRS complex
- This is caused by Increased Automaticity secondary to stressors like;
Electrolyte Imbalances, drugs like cocaine/methamphetamines, heart attack
or anything that causes increased sympathetic activity.

VENTRICULAR TACHYCARDIA
- Commonly called “V-tach”
- 3 or more consecutive PVC in a row and the ventricular rate exceeds 100
BPM.
- This arrhythmia may precede ventricular fibrillation and sudden cardiac death.

VENTRICULAR FIBRILLATION
- Commonly called “V-Fib”
- Is a chaotic pattern of electrical activity in the ventricles in which electrical
impulses arise from many different foci.