CARDIAC ARRYTHMIAS

ORHAN HAKLI, NP
CARDIAC CONDUCTION SYSTEM
SA NODE :
-AT THE UPPER POSTERIOR PART OF THE ATRIUM
-PRIMARY PACEMAKER
-DISCHARGES ELECTICAL IMPULSES 60-100 A
MINUTE

AV NODE :
-RECEIVES IMPULSES FROM SA NODE
-SLOW THE CONDUCTION AND DELAYS THE
INPUT IN ORDER ATRIUMS TO VENTRICULS
COMPLETELY(Atrial kick 5-30% of the CO)
-BLOCK SOME OF THE IMPULSES TO PREVENT
GOING THE HEART TACHY
-SERVES AS A BACK UP PACEMAKER IF SA NODE
FAILS (ELECTRICAL IMPULSES OF 40-60 A MINUTE)

PURKINJE FIBERS:
-RECEIVES IMPULSES FROM BUNDLE
BRANCHES
-DISCHARGES ELECTRICAL IMPULSES 20-40
A MINUTE
CAUSES OF DYSRHYTHMIAS
ENHANCED TRIGIRRED ACTIVITY RE-ENTRY
AUTOMATICITY Abnormal electric Spread of an impulse
Increased activity or impulses when cells are through tissue already
rhythm disturbances at rest stimulated by that same
impulse
ACIDOSIS HYPOXIA HYPERCALIMIA
ALCOLOSIS HYPOMAGNESIA MYOCARDIAL ISCHEMIA
HYPOXIA MYOCARDIAL INJURY ANTIARYTHMATIC MEDS
ISCHEMIA/INFARCT MEDICATIONS THAT
PROLONGS
REPOLARIZATION
(IE.QUINIDINE)
ELECTROLYTE
PROBLEMS (K-CA)
DIG.TOXICITY
ADMINISTRATION OF
ATROPINE/
EPINEPHRINE
 EKG
INTERVALS
-PR :0.12-0.20 sec
-QRS :under 0.10sec
-QT:under 0.38 sec

WAVES HEART RATE

-P wave: atrial depolarization -To determine the ventricular rate, count
-QRS complex :ventricular depolarization the QRS complex on a 6 sec paper and
-Twave :Ventricular repolarization multiply by 10
MAJOR CARDIAC ARRHYTHMIAS
SINUS RYTHMS ATRIAL VETRICULAR ATRIO-
RYTHMS RHYTHMS VENTRICULAR
(AV) RHYTHMS
SINUS BRADY PREMATURE PREMATURE 1ST DEGREE AV
ATRIAL VENTRICULAR BLOCK
CONTRACTION CONTRACTION
(PAC) (PVC)
SINUS ATRIAL VENTRICULAR 2ND DEGREE AV
TACHICARDIA FLUTTER TACHICARDIA BLOCK TYPE I
SINUS ATRIAL VENTRICULAR 2ND DEGREE AV
ARRYTHMIA FIBRILATION FIBRILATION BLOCK TYPE II
SINUS ARREST ASYSTOLE 3RD DEGREE AV
BLOCK
SINUS RHYTMS

CHARACTERISTICS
-less than 60bpm
-regular PP and RR
-PR 0.12-.20
QRS0.10
WHAT TO DO?
-watch the patient for s/s of bradycardia
-If symptomatic; iv access, o2, transcuteneus pacing
MEDICATION
Atropine 0.5mg ivp
SINUS RHYTHMS

 CHARACTERISTICS
 - 101-150bpm
 -regular PP and RR
 -PR 0.12-.20
 QRS0.10 or less
 WHAT TO DO?
 -watch the patient for s/s of Tachycardia
 -correct underlying problems/Never shock ST
 MEDICATION
 Atenelol/Meteprolol (Beta blockers)
SINUS RHYTHMS

 CHARACTERISTICS
 - usually 60-100bpm, but can be slower or faster
 -irregular with respiration, HR increases with inspiration
and decreases with expiration
 -PR 0.12-.20
 QRS0.10 or less
 WHAT TO DO?
 NOTHING !!!
 MEDICATION
 If hemodynamic compromise is present ATROPINE
SINUS RHYTHMS
SINUS ARREST

 CHARACTERISTICS
 - Rate varies because of the pause
 -irregular rhythm
 -PR 0.12-.20
 QRS0.10 or less
 WHAT TO DO?
 If transient and major s/s of decline monitor the pt
 If more than 3 sec. ATROPINE, Bedside Pacer or
Possible Permanent PM insertion
 MEDICATION
 ATROPINE
ATRIAL RHYTHMS
PREMATURE ATRIAL COMPLEX

 CHARACTERISTICS
 - Rate; Depends on the underlying rhythm but usually w/i normal
limits
 -Regular rhythm, except the premature beats
 -PR may be normal or prolonged
 QRS0.10 or less but might be wide
 WHAT TO DO?
 NOTHING!!!
 Reducing stress, stimulants(coffee), treating CHF may help
 MEDICATION
 If needed beta blockers, CA blockers or anxiety meds
ATRIAL RHYTHMS

AFIB

AFLUTTER
VENTRICULAR RHYTMS

PREMATURE VENTRICULAR COMPLEX

 CHARACTERISTICS
 - Rate; Depends on the underlying rhythm
 -Regular rhythm, except the premature beats
 -PR no PR because ectopy comes from ventricles
 QRS more then 0.12, wide and bizarre looking
 WHAT TO DO?
 NOTHING!!!
 Monitor the pt, if frequent check if they have enough cardiac output
VENTRICULAR RHYTHMS

VENTRICULAR TACHICARDIA

VENTRICULAR FIBRILATION

ASYSTOLE
ATRIOVENTRICULAR (AV) BLOCKS
FIRST DEGREE AV BLOCK

 CHARACTERISTICS
 - Rate; Depends on the underlying rhythm, but usually normal
 -Regular rhythm
 -PR prolonged, greater than 0.20 sec
 QRS usually 0.10 sec or less
 WHAT TO DO?
 They are usually asymptomatic, Monitor the pt if MI is causing the
block
 Hold the meds that could cause the block(IE beta blockers, CA
blockers, Dig, quinidine)
ATRIOVENTRICULAR (AV) BLOCKS
SECOND DEGREE AV BLOCK

TYPE -I

TYPE -II
 WHAT TO DO?
 They are usually asymptomatic, Monitor the pt
 Do not give ATROPINE to increase the heart rate
 Type II might be indication for PM
 Hold the meds that could cause the block(IE beta blockers, CA
blockers, Dig, quinidine)
 If associated with MI, watch if the block is getting worse
ATRIOVENTRICULAR (AV) BLOCKS
THIRD DEGREE AV BLOCK

 CHARACTERISTICS
 - Rate; atrial rate is greater then ventricular rate
 -Regular ratrial (P) and regular ventricular but no relationship
between the two
 -P normal size and shape; PR none
 QRS can be narrow or wide
 WHAT TO DO?
 ATROPINE /Transcuteneus Pacing
 Possible permanent Pacemaker
REFERENCES

 Aehlert, B. (2006). ECGs Made Easy. Arizona: Sauthwest EMS

education Inc.
 Heart Blocks. (2012). Retrieved from http://www.nhlbi.nih.gov:
http://www.nhlbi.nih.gov/health/health-topics/topics/hb/types.html
 Huff, j. (2006). ECG Workout: Exercises in Arrhythmia Interpretation. PA:
Lippincott Williams & Wilkins.
 Nicod, P.; Hillis, L.; Winniford, M.D.; Firth, B.G. (February 15, 1986).
Importance of the "atrial kick" in determining the effective mitral valve
orifice area in mitral stenosis. The American Journal of Cardiology ,
Volume 57, issue 6 p. 403-407.
 Sauer, W. (2012). Normal sinus rhythm and sinus arrhythmia. Retrieved
from http://www.uptodate.com:
http://www.uptodate.com/contents/normal-sinus-rhythm-and-sinus-
arrhythmia
