CAkDICVASCULAk SS1LM

CAkDICLCG sLudy of anaLomy and physlology of Lhe hearL lncludlng Lhe dlsease
nLAk1 pumplng organ of Lhe body
O S|ze closed flsL
O Shape cone shape
O Je|ght noL less Lhan 1 lbs for ma|e 300360g fema|e 2S0300g
O Locat|on beLween Lhe Lwo lungs lylng ln Lhe Lhoraclc cavlLy speclflcally Lhe medlasLlnal
cavlLy where 2/3 of lL ls slLuaLed Lo Lhe lefL of Lhe mldllne
ANA1CMICAL S1kUC1UkL CI 1nL nLAk1
LkICAkDIUM double layer of flbroserous connecLlve membrane LhaL covers Lhe hearL
Lncases Lhe hearL and anchors lL Lo Lhe surroundlng sLrucLures formlng Lhe
per|card|a| sac
1 AkIL1AL LkICAkDIUM ouLmosL layer
2 VISLkAL LkICAkDIUM lnnermosL aka LlCA8uluM (covers Lhe surface of Lhe hearL)
3 LkICAkDIAL CAVI1 space beLween vlsceral and parleLal (Lo prevenL frlcLlon
produces serous fluld LhaL serves as lubrlacanL)
LALkS CI 1nL nLAk1 JALL
1 LICAkDIUM Lhln LransparenL ouLer layer of Lhe walls of Lhe hearL
Covers Lhe enLlre hearL and greaL vessels and Lhen folds over Lo form
Lhe parleLal layer LhaL llnes Lhe perlcardlum and adheres Lo Lhe hearL surface
2 MCCAkDIUM m|dd|e |ayer of Lhe hearL wall responslble for Lhe hearL's pumplng
acLlon
3 LNDCCAkDIUM Lhe lnnermosL layer covers Lhe valves of Lhe hearL
CnAM8LkS AND VALVLS CI 1nL nLAk1
1 kIGn1 A1kIUM recelves deoxygenaLed blood from Lhe velns of Lhe body
2 kIGn1 VLN1kICLL recelves deoxygenaLed blood from Lhe rlghL aLrlum and pumps lL
Lhrough Lhe pulmonary arLery Lo Lhe pulmonary caplllary bed for oxygenaLlon
3 LLI1 A1kIUM recelves freshly oxygenaLed blood from Lhe lungs Lhrough Lhe
pulmonary veln
LLI1 VLN1kICLL recelves oxygenaLed blood from lefL aLrlum and e[ecLs blood lnLo
Lhe sysLemlc arLerlal clrculaLlon



VALVLS CI 1nL nLAk1
1 A1kICVLN1kICULAk VALVL (AV VALVLS) c|osure produces S1 whlch ls characLerlzed
by LU8
A 1r|cusp|d Va|ve
8 8|cusp|d or m|tra| va|ve Lhls valves are connecLed Lo a paplllary muscle
conLrolled by chordae tend|neae to prevent backf|ow of b|ood |nto
d|fferent heart chambers
2 SLMILUNAk VALVLS c|osure produce S2 character|zed by DU8
A ULMCNIC VALVL secreLed lnLo rlghL venLrlcle connecLlng Lo pulmonary arLery
8 ACk1IC VALVL secreLed lnLo Lv connecLed Lo Lhe Av secreLed upper porLlon of
Lv connecLed Lo ACk1A
Ak1S CI 1nL CIkCULA1Ck SS1LM
1 SS1LMIC CIkCULA1ICN supplles blood Lo all oLher body Llssues
O Moved blood Lo perlpheral areas of Lhe body
O ConslsL of
a LefL slde of Lhe hearL
b AorLa and lLs branches
c Caplllarles LhaL supply Lhe braln and perlpheral Llssues
d SysLemlc venous sysLem
e vena cava
2 ULMCNAk CIkCULA1ICN beglns aL Lhe rlghL slde of Lhe hearL
O ConslsL of
a 8lghL slde of Lhe hearL
b ulmonary arLery
c ulmonary caplllarles
d ulmonary velns
CCkCNAk CIkCULA1ICN opens lnLo Lhe hearL Lakes place durlng hearL muscle are relax
1he hearL muscle lLself ls supplled by lLs own neLwork of vessels Lhrough coronary
clrculaLlon
O LefL coronary arLerles
O 8lghL coronary arLerles
CAkIDIAC CCLL AND CAkDIAC CU1U1
CAkDIAC CCLL Lhe conLracLlon and relaxaLlon of Lhe hearL LhaL consLlLuLe one hearLbeaL
O SS1CLL followed by venLrlcular fllllng
A phase durlng whlch Lhe venLrlcles conLracL and e[ecL blood lnLo Lhe
pulmonary and sysLemlc clrculaLlon

O DIAS1CLL relaxaLlon phase followed from sysLole
uurlng whlch Lhe venLrlcles conLracL and Lhe myocardlum ls perfuse
120m| of b|ood "end d|asto||c vo|ume"
3 LVLN1S CI CAkDIAC CCLL
1 Ventr|cu|ar f||||ng |n m|dto|ate d|asto|e
2 Ventr|cu|ar systo|e conLracLlon of venLrlcle closure of Av valves"
3 Isovo|umetr|c re|axat|on |n ear|y d|asto|e
S1kCkL VCLUML Lhe dlfference beLween Lhe end d|asto||c vo|ume and Lhe end of systo||c
vo|ume (ranges to 60100m| but an average |s 70m|) P8xSv
CAkIDAC CU1U1 Lhe amounL of blood pumped by Lhe venLrlcles ln Lo Lhe pulmonary and
sysLemlc clrculaLlon ln 1 m|nute (GCCD INDICA1Ck ICk IUC1ICNING CI 1nL nLAk1)
Adu|t 8L]m|nute)
IAC1CkS 1nA1 AIILC1 CAkDIAC CU1U1
1 AcLlvlLy level
2 MeLabollc raLe
3 hyslologlc and psychologlc sLress response
4 Age
3 8ody slze
Card|ac Cutput ls deLermlned by Lhe lnLeracLlon of 4 ma[or facLors
1 nLAk1 kA1L
2 kLLCAD
3 AI1LkLCAD
CCN1kAC1ILI1
nLAk1 kA1L hearL raLe ls affecLed by boLh DIkLC1 and INDIkLC1 auLonomlc nervous sysLem
sLlmulaLlon
O DIkLC1 S1IMULA1ICN ls accompllshed Lhrough Lhe lnnervaLlons of Lhe hearL
muscle by SnS and nS
O INDIkLC1 S1IMULA1ICN reflex regulaLlon of Lhe hearL raLe ln response Lo
sysLemlc blood pressure also occurs Lhrough acLlvaLlon of sensory recepLor known as
8AkCkLCL1Ck locaLed ln Lhe caroLld slnus aorLlc arch vena cava and pulmonary
velns
CCN1kAC1ILI1 lnherenL capablllLy of Lhe cardlac muscle flbers Lo shorLen
O CCk CCN1kAC1IL1 reduces Lhe forward flow of blood from Lhe hearL lncreases
venLrlcular pressure from accumulaLlon of blood volume and reduces cardlac ouLpuL
O INCkLASLD CCN1kAC1ILI1 may sLress Lhe hearL lncreased cardlac ouLpuL
kLLCAD AmounL of cardlac muscle flber Lenslon or sLreLch LhaL ls exlsL aL Lhe end of
dlasLole [usL before conLracLlon of Lhe venLrlcles (lncreased volume lncreased sLreLch cardlac
muscle flber)
O S1AkLING'S LAJ CI 1nL nLAk1 Lhe greaLer Lhe volume Lhe greaLer Lhe sLreLch of Lhe
cardlac muscle flbers and Lhe greaLer Lhe force wlLh whlch Lhe flbers conLracL Lo
accompllsh empLylng
AI1LkLCAD Lhe force of Lhe venLrlcles musL overcome Lo e[ecL Lhelr blood volume 1he
pressure ln Lhe arLerlal sysLem ahead of Lhe venLrlcles
O kV after|oad ls measured as ULMCNAk VASCULAk kLSIS1ANCL (Vk)
O LV after|oad ls measured as SS1LMIC VASCULAk kLSIS1ANCL (SVk)
As Lhe pulmonary or arLerlal blood pressure lncreases v8 and Sv8 lncreases and work of Lhe
venLrlcles lncreases
As workload lncreases consumpLlon of myocardlal oxygen also lncreases A very low afLerload
decreases Lhe forward flow of blood lnLo Lhe sysLemlc clrculaLlon and coronary arLerles
CCNDUC1ICN SS1LM CI 1nL nLAk1
1 SINAC1kAIL (SA) NCDL locaLed aL Lhe [uncLlon of Lhe SvC and SA
Acts as the norma| pacemaker of the heart usually generaLlng an lmpulse of
60100 t|mes]m|n
2 AV node (atr|ovent|cu|ar node) slLuaLed ln Lhe sepLum beLween Lhe Lwo aLrla
anLerlor Lo Lhe openlng of Lhe coronary slnus
8ecelves elecLrlcal lmpulses from SA node and generaLe acLlon poLenLlal ln case Lhe
SA node ls damaged or ln[ured
3 AV bund|e (atr|ovent|cu|ar bud|e)] 8UNDLL CI nIS only elecLrlcal connecLlon
beLween aLrla and venLrlcles
kIGn1 AND LLI1 8UNDLL 8kANCnLS
8ranch of Lhe 8undle of hls LhaL run Lhrough Lhe lnLervenLrlcular sepLum Lowards
Lhe apex of Lhe hearL
S urk|n[e I|bers]conduct|on Myof|bers
Large dlameLer conducLlon myoflbers rapldly conducL Lhe acLlon poLenLlal Lo Lhe
apex of Lhe venLrlcular myocardlum and Lhen upward Lo Lhe remalnder of Lhe
venLrlcular myocardlum
AC1ICN C1LN1IAL elecLrlcal lmpulse ln Lhe hearL LhaL sLlmulaLes muscle conLracLlon
produces Lhe wave forms represenLed on Lhe LCC sLrlps
nASLS CI AC1ICN C1LNCIAL
1 hase rest|ng state Lhe cell membrane ls polarlzed
1he cell's lnLerlor has a negaLlve charge compared Lo LhaL of exLracellular
fluld

2 nASL 0 depo|ar|zat|on state
na lons dlffuse rapldly across Lhe cell membrane lnLo Lhe cell
Ca channels open
3 nASL 1 fu||y depo|ar|zed state
1he cell's lnLerlor has a neL poslLlve charge compared Lo Lhe exLerlor
nASL 2 Ca moves lnLo Lhe cell and k slows prolonglng Lhe acLlon poLenLlal
S nASL 3 Ca channels close
nak pump removes Lhe na from Lhe cell cell membrane agaln polarlzed wlLh a
negaLlve charged
DLCLAkI2A1ICN Lhe change ln Lhe elecLrlcal charge from negaLlve Lo sllghLly poslLlve
aL +20 Lo +30 v across Lhe cell membrane
kLCLAkI2A1ICN reLurns Lhe cell Lo lLs resLlng polarlzed sLaLe
NUkSING ASSLSMLN1
A nea|th h|story s/s healLh percepLlon and managemenL nuLrlLlon and meLabollsm
ellmlnaLlon acLlvlLy and exerclse sleep and resL
8 Genera| appearance and cogn|t|on

a Sk|n
allor decreased oxygen perfuslon ln perlpheral areas
erlpheral cyanosls
CenLral cyanosls
xanLhelasma
8educed skln Lurgor
1emperaLure and molsLness
Lcchymosls (brulse)
b 8|ood ressure
SysLemlc arLerlal 8
C neart |nspect|on and percuss|on
6 areas
1 Aort|c arch lnspecLlon of aorLlc valve L of sLernum 2
nd
lnLercosLals space
2 u|mon|c area 2
nd
lCS 8 of sLernum
3 Lrb's po|nt 3
rd
lCS L sLernum
4 k|ght ventr|cu|ar or tr|cusp|d 4
Lh
Lo 3
Lh
lCS
3 Left ventr|cu|ar or ap|ca| chesL
Aplcal lmpulse
LlfL/heave
1hrlll
6 LplgasLrlc area


D neart Sounds
S1 1
sL
hearL sounds closure of Av
S2 2
nd
hearL sound closure of Sv
Ga||op sounds Lemporary vlbraLlon
S3 occur durlng rapld venLrlcular fllllng ( Ml or ln Pl)
S gallop sound heard durlng aLrlal conLracLlon
Snaps and c||cks hlgh plLch unusual sound resulLlng Lo sLenosls of mlLral valve
Murmurs creaLed durlng LurbulenL flow of blood alLeraLlon
Ir|ct|on rub harsh sound produce durlng conLracLlon
L Inspect|on of the extrem|t|es
1 Caplllary reflll Llme
2 vascular changes
3 PemaLoma accumulaLlon of blood ln Lhe skln
4 erlpheral edema
lLLlng edema a depresslon over an area of pressure
Crade/Scale
1+ 0 Lo 2mm
4+ more Lhan 8mm
3 Clubblng of flngers and nalls
6 Lower exLremlLy ulcers ( decreased blood supply prolonged wound heallng)
LA8CkA1CkILS AND DIAGNCS1IC 1LS1
A LA8CkA1Ck 1LS1
1 CAkDIAC LN2ML ANALSIS lf Lhere ls lmpalrmenL Lo Lhe cardlac funcLlon of Lhe
hearL lmpalrmenL blood supply
Creat|n|ne hospo k|nase (Ck) and CkM8 usually lncreased afLer Ml
Myog|ob|n usually good marker for Ml Lhey are heme prote|ns released
from damaged Llssues (peak amount) |ncreased after 13 hours after the onset
of MI st||| e|evated after 12 hours
1ropn|n 1 (1rop|n|n I ) conLracLlle proLelns found ln cardlac muscle ( peak of
|ncrease |s about 3 hours w|th|n 12 hours e|evated w|th|n 3 weeks)
2 8|ood Chem|stry undergo fasLlng for 12 hours
a L|p|d prof||e (LDL nDL) transporter of fats cho|estero| and tr|g|ycer|des
usually produce ln Lhe llver
LDL less Lhan 130mg]d|
nDL men 3S66mg]d| women 3S8Smg]d|
1r|g|ycer|des prlnclpal llplds of Lhe blood composes of faLLy aclds and
glycerol NCkMAL 0 1S0mg]d| |n body
b Cho|estero| |eve| formaLlon of cell membrane NCkMAL |ess than 200mg]d|

3 Serum L|ectro|yte |eve|s these are the pr|mary |ons for depo|ar|zat|on of the heart
Na
k
Ca
Magnes|um lmporLanL whlch promoLes absorpLlon of Ca malnLalns Lhe
resLored k
8|ood Urea N|trogen Leve| end producL of proLeln meLabollsm Lo deLermlne
compllcaLlon Lo dlsorders of Lhe hearL
If there |s decreased 8UN |n the b|ood |nd|cates kLNAL IAILUkL
Increased |eve| |n ur|ne destruct|on or damaged of g|omeru|us |n the k|dney
S Serum G|ucose
G|ycosy|ated hemog|ob|n ( ngbA1C) Norma| range |s 6 represenL blood glucose
level ln Lhe blood


6 Coagu|at|on Stud|es appllcable for hemaLology
art|a| 1hrombop|ast|n 1|me (1) and act|vated art|a| 1hrombop|ast|n 1|me
( a11) assess effects of hepar|n theraphy 2S28 sec
rothromb|n 1|me measure Lhe effecLs of LherapeuLlc coagulaLlon w|th the
a|d of JAkIAkIN (CCMADIN)
INk ( Internat|ona| Norma||zed kat|o) provlde lnLernaLlonal sLandard of
reporLlng roLhrombln levels
7 nemato|og|c Stud|es assess dlfferenL componenLs of Lhe blood

8 DIAGNCS1IC 1LS1
| NCN INVASIVL

1 LCG ( LLLC1kCCAkDICGkAM) graphlc record of Lhe hearL's acLlvlLy
LlecLrodes are applled Lo Lhe body surface are used Lo obLaln a graphlc
represenLaLlon of cardlac elecLrlc acLlvlLy 6 elecLrons
2 LCnCCAkDICGkAM

M mode ( mot|on mode) records moLlon of Lhe hearL Lhlckness chamber slze
1wo d|mens|ona| (2D) cross secLlonal vlew of Lhe hearL
Card|ac Dopp|er]Co|or Dopp|er evaluaLe speed and dlrecLlonal of blood Lhrough
Lhe hearL
Stress echocard|ogram observe durlng exerclse whlle LCC ls perform
MonlLor Lhe CA from resLlng sLaLe up Lo lncreased lncrease workload
3 UL1kASCUND Lo evaluaLe lnLernal sLrucLure of Lhe hearL uses hlghly frequency sound
waves
CnLS1 kkA of the thorax whlch evaluaLes Lhe conLour placemenL and chamber of
Lhe hearL Lo deLermlne dlsplacemenL of normal poslLlonlng of Lhe hearL lf Lhere are
fluld lnLo Lhe perlcardlal sac
S kADICNUCLLID S1UDILS lnvolves Lhe use of radlolsoLopes Lo evaluaLe coronary
arLery perfuslon non lnvaslvely Lo deLecL myocardlal lschemla and lnfarcLlon and Lo
assess venLrlcular funcLlon ( obstruct|on |n coronary artery)
kad|o|sotopes aLoms ln an unsLable form whlch are used ln lmaglng
usually decay lnslde blood vessel produclng amounL of energy ln Lhe
form of GAMMA kAS v|sua||ze by GAMMA SCIN1ILA1ICN CAMLkA
to mon|tor the movement of the b|ood
1nALLIUM 201 and 1LCnNL1IUM 99m ln[ecLed lv lnLo Lhe blood
sLream
|| INVASIVL
1 CAkDIAC CA1nL1LkIA2A1ICN a LesL ls performed by lnserLlng a long caLheLer lnLo a
veln or arLery (dependlng on wheLher Lhe rlghL slde or lefL of Lhe hearL ls belng
examlned) ln Lhe arm or leg ( they a|so |ntroduced contrast dye to eva|uate heart
structures or act|v|ty threaded |n chamber of the heart |n coronary artery)
2 ANGICGkAn Lech of ln[ecLlng conLrasL dye ln vascular sysLem ouLllne of Lhe hearL
and blood vessel
Cardlac caLheLerlzaLlon ls usually performed wlLh anglography
Makes use of CINLANGICGkAMS a serles of rapldly changlng fllms on an
lnLesLlfled fluoroscoplc screen LhaL record Lhe passage of conLrasL agenL Lhrough
vascular slLe or slLes common s|te aorta coronary arter|es L or k s|de of the
heart
3 8LCCD ICCL IMAGING
useful for evaluaLlon of cardlac sLaLus followlng Ml and CPl and effecLlveness of
cardlac medlcaLlon segmenta| eva|uat|on of the heart
LkICAkDICCLN1LSIS appllcable for card|ac tamponade excess perlcardlal sac
erformed Lo remove fluld from Lhe perlcardlal sac for dlagnosLlc or LherapeuLlc
purposes
S nLMC DNAMIC MCNI1CkING
Iorms
a CLN1kAL VLNCUS kLSSUkL(CV) measure pressure ln Lhe arLery wlLh Lhe
use of waLer manomeLer
LvaluaLes Lhe funcLlon of 8v and Lhe fllllng of blood ln Lhe 8A and
measure clrculaLlng blood volume NCkMAL 26 mmng
b ULMCNAk Ak1L kLSSUkL usually separaLe measuremenL of dlasLollc and
sysLollc
c IN1kA Ak1LkIA 8LCCD kLSSUkL MCNI1CkING measures Lhe lnslde pressure
ln Lhe arLery


CAkDIC VASCULAk DIS1Uk8ANCLS
ANGINA LC1CkIS LranslenL chesL paln resulLlng from reduced coronary blood flow
whlch causes a Lemporary lmbalance beLween myocardlal blood supply and demand
Lemporary and reverslble myocardlal lschemla mllder Lhan Ml
rec|p|tat|ng Iactors
1 PypermeLabollc condlLlons such as exerclse
2 LmoLlonal sLress
3 PearL fallure
4 Anemla
3 venLrlcular hyperLhrophy

A1nCnSICLCG
ueflclenL blood flow Llssues
8educed oxygen supply
Cellular processes are compromlsed
A1 sLores are depleLed
Cells swlLch from aeroblc Lo anaeroblc meLabollsm
LacLlc acld bullds up ln Lhe cell
AffecLs cell membrane permeablllLy
8eleases subsLances such as hlsLamlne klnlns and speclflc enzymes LhaL sLlmulaLe Lermlnal
nerve flbers ln Lhe cardlac muscle
Send paln lmpulses ln Lhe CnS
Aln (radlaLes Lo Lhe upper body)




3 1LS CI ANGINA
1 Stab|e Ang|na mosL common and predlcLable form of anglna occurs ls ln AcLlvlLy or
under sLress
2 r|nzmeta|'s (Var|ant) Ang|na a Lyplcal anglna LhaL occurs unpredlcLablllLy noL
preclplLaLed by acLlvlLy caused by coronary spasm
3 Unstab|e ang|na occurs wlLh lncreaslng frequency severlLy and duraLlon occurs
wlLh decreased level of acLlvlLy worsL form of anglna also occurs durlng resL
Man|festat|on
1 Chest pa|n mosL characLerlsLlc of anglna LlghL squeezlng heavy pressure or
consLrlcLlve sensaLlon may begln beneaLh Lhe sLernum radlaLlng Lhe neck [aw
shoulder and lnLo Lhe lefL venLrlcle
2 Dyspnea obsLrucLlon of blood flow preclplLaLed by chesL paln
3 a||or
1achycard|a
S Ind|gest|on
6 Upper back pa|n
SLVLkI1 CI ANGINA
A CLASS I Lhls does noL occur mld ordlnary A prolonged physlcal acLlvlLy
8 CLASS || develop wlLh rapld walklng and sLalr cllmblng
C CALSS ||| llmlLs ordlnary physlcal acLlvlLy
D CLASS IV mosL severe occurs aL resL
DIAGNCS1IC 1LS1 kCCLDUkLS
1 LlecLrocardlography
CharacLerlsLlc LCC changes are seen durlng anglna aLLacks
uurlng perlod of lschemla Lhe S1 segmenL ls depressed or downsloplng and 1
waves may flaLLen or lnverL
2 SLress elecLrocardlography
3 8adlonucllde LesLlng
LlecLrocardlography
S Coronary anglography
MLDICAL MANAGLMLN1
1 MLDICA1ICNS
A nlLraLes
Sub||ngua| N|trog|ycer|n drug of cholce (acLs up Lo 12 mln)
kap|d act|ng N|trog|ycer|n admlnlsLer Lhrough spray parLlcularly muscle
spray
Longer act|ng N|trog|ycer|n use Lo prevenL aLLack of anglna buL noL
LreaL or cure

SIDL LIILC1S
a neadache
b Nausea
c D|zz|ness
d nypotens|on
8 8eta 8|ockers 1
sL
llne drug Lo LreaL sLable anglna noL glven wlLh prlnzmeLal anglna
because lL may furLher worsen Lhe condlLlon of Lhe paLlenL
Lxamp|e block noreplnephrlne and eplnephrlne prevenL anglna aLLack reduclng
P8 reduces myocardlal conLracLlllLy and blood pressure
ropanolol
MeLoprolol
nadolol
ALenolol
C Ca|c|um Channe| 8|ockers reduces myocardlal conLracLlllLy reduces myocardlal
oxygen demand promoLe lncrease blood flow lnLo myocardlum lncrease oxygen
supply
Lxamp|e
verapamll
ullLlazem
nlfedlplne
D Asp|r|n anLl plaLeleL
Low dose 80323mg/day glven Lo paLlenL wlLh anglna Lo prevenL plaLeleL aggregaLlon
prevenL Lhrombus

NUkSING IN1LkVLN1ICN
1 Lncourage acLlvlLy or shorL perlods of acLlvlLy wlLh more resL perlods
2 lnsLrucL Lo Lake SL nlLroglycerln before engaglng ln acLlvlLles LhaL preclplLaLe
anglna
3 Lncourage Lo lmplemenL and malnLaln progresslve exerclse program
lf paLlenL ls smoklng advlce lL Lo sLop
S AdmlnlsLer drugs as prescrlbed
6 uleL low faL low na low cholesLerol and hlgh flber





CAkDIAC DSkn1MIAS a dlsLurbance or lrregularlLy ln Lhe elecLrlcal sysLem of Lhe hearL
uysryhLmlas arlse Lhrough dlsrupLlon of Lhe properLles LhaL sLlmulaLe and conLrol
hearLbeaL
1 Automat|c|ty ab|||ty of pacemaker ce||s Lo sponLaneously lnlLlaLe an elecLrlcal
lmpulse
2 Lxc|tab|||ty ab|||ty of myocard|a| ce||s Lo respond Lo sLlmull generaLed by
pacemaker cells
3 Conduct|v|ty ab|||ty to transm|t an |mpu|se from cell Lo cell
kefractor|ness |nab|||ty of card|ac ce||s to respond addlLlonal sLlmull
lmmedlaLely followlng depolarlzaLlon
1LS CI DSkn1MIAS
1 SINUS 8kADCAkDIA occurs when slnus creaLes an lmpulse SLCJLk 1nAN
NCkMAL kA1L
2 SINUS 1ACnCAkDIA occurs when slnus creaLes an lmpulse IAS1Lk 1nAN
NCkMAL kA1L
3 SINUS Akkn1nMIA aL an lrregular rhyLhm
A1kIAL ILU11Lk occurs ln Lhe aLrlum aL an aLrlal raLe beLween 230 400
Llmes/mlnuLe
S A1kIAL II8kILA1ICN causes rapld dlsorganlze and uncoordlnaLed LwlLchlng of
muscles
6 kLMA1UkL VLN1kICULAk CCMLLk lmpulse LhaL sLarLs ln a venLrlcle and
conducLed Lhrough venLrlcles before Lhe nexL lmpulse
7 VLN1kICULAk 1ACnCAkDIA deflnes 3 or more vC
8 VLN1kICULAk ASS1CLL ]ILA1LINL characLerlzed by absence of C8S complex
buL Lhere ls presence of 1 waves no venLrlcular conLracLlon
CCNDUC1ICN A8NCkMALI1ILS
1 I|rst degree AV b|ock occurs when a|| |mpu|ses conducted vla Av node lnLo
venLrlcles aL slower raLe Lhan normal
2 Second degree Av b|ock 1ype I occurs when an arter|a| |mpu|se are conducLed
vla Av node lnLo Lhe venLrlcles
3 Second degree AV b|ock 1ype 2 occurs when some atr|a| |mpu|se are connecLed
vla Av node
3
rd
Degree AV b|ock no atr|a| |mpu|ses conducLed Lhrough Av node lnLo
venLrlcles

MANIILS1A1ICNS
1 8apld pulse raLe
2 Sob
3 ulzzlness
ChesL paln
S uecreased cardlac ouLpuL
6 uecreased LCC
7 Syncope
8 PypoLenslon
DIAGNCS1IC kCCLDUkLS
1 L|ectrocard|ogram 12 led LCC Lo accuraLely dlagnose dysrhyLhmla
2 Card|ac mon|tor|ng
3 L|ectrophys|o|ogy stud|es uses elecLrodes whlch ls aLLached Lo Lhe paLlenL or
Lhrough caLheLer alded by fluoroscopy whlch ls lnserLed Lo femoral arLery or
bronchlal veln
MLDICAL MANAGLMLN1
A MLDICA1ICNS Lo esLabllsh over all effecLlve CC by sLablllzlng CA8ulAC 8P?1PM
Ant|dysrhythm|c Drugs prlmarlly used for acuLe LreaLmenL of dysrhyLhmla

CLASSIIICA1ICNS
1 C|ass 1 IAS1 SCDIUM CnANNLL 8LCCkLkS Lhls drug slows lmpulse conducLlon
ln aLrla and venLrlcle by blocklng sodlum channels
a CLASS |A
Lxamp|e
Culnldlne
rocalnamlde
Morlazlne
b C|ass |8 decrease refracLory perlod buL have a llLLle effecL on auLomaLlclLy
Lxamp|e also LreaL venLrlcular dysrhyLhmla
Lldocalne
henyLoln
MexyleLlne
c C|ass IC slows conducLlon veloclLy buL have a llLLle effecL of refracLorlness
Lxamp|e also LreaL venLrlcular Lachycardla
llecalnlde
ropafenone
2 CLASS || 8eta 8|ockers decreased auLomaLlclLy and conducLlon Lhrough Av node
Lxamp|e Lhey wlll block Lhe producLlon of exLra lmpulses reduces P8 and
myocardlal cells
Lsmolol
ropanolol
MeLoprolol

3 CLASS ||| otass|um Channe| 8|ockers prolongs repolarlzaLlon and refracLorLy
perlod
Lxamp|e
SoLalol
Amlodarone
8reLyllum
CLASS IV Ca|c|um Channe| 8|ockers decrease auLomaLlclLy and Av nodal
conducLlon decrease myocardlal conLracLlllLy blocks conducLlon of Av node
Cther Drugs Adenoslne and ulgoxln decrease lmpulse Lhrough Av node
8 Countershock lnLerrupL cardlac rhyLhm LhaL compress CC

2 1LS
1 Synchron|zed Card|overs|on uCC synchronlzed wlLh paLlenLs Pr dellvery of dlrecL
currenL charge whlch depolarlzes all cardlac cells aL Lhe same Llme
2 Def|br||at|on emergency procedure us Lo dellver cardlac currenL wlLh regards Lo
cardlac cycle

C acemaker therapy pulse generaLor use Lo provlde an elecLrlcal lmpulse Lo hearL
1 1emporary pacemakers exLernal pulse generaLor Lhreaded lnLravenously lnLo r
venLrlcle
2 ermanent pacemakers lmplanLed Lo subclavlal space near subclavlal arLery
D Imp|antab|e Card|overter Deb|fr||ator deLecL use of llfe LhreaLenlng changes ln cardlac
rhyLhm and auLomaLlcally dellver an elecLrlc shock Lo converL
L Card|ac mapp|ng and Catheter Aba|t|on
Card|ac mapp|ng use Lo ldenLlfy Lhe slLe of earllesL lmpulse ln aLrla or venLrlcles
Catheter ab|at|on desLroys or remove lsolaLes ectop|c focus exLra lmpulses noL
produce normally ln SA node
I