Professional Documents
Culture Documents
Cardiac Dysrhythmias
ECG Basics
How to Analyze a Rhythm
Normal Sinus Rhythm
Dysrhythmias
Treatment
and
Nursing
Management
NORMAL IMPULSE
CONDUCTION
Sinoatrial node
AV node
Bundle of His
Bundle Branches
Purkinje fibers
intrinsic rate of
40 - 60 beats/minute.
ECG COMPLEX
The PQRST
P WAVE
Atrial
Depolarization
QRS
Ventricular
Depolarization
T WAVE
Ventricular
Repolarization
RHYTHM ANALYSIS
Step
Step
Step
Step
Step
1:
2:
3:
4:
5:
Interpretation?
(3 - 5 small boxes)
Interpretation?
3
sec
Option 1
Count the # of R waves in a 6 second rhythm
strip, then multiply by 10.
Interpretation?
R
wave
Option 2
Find a R wave that lands on a bold line.
Memorize the sequence:
300 - 150 - 100 - 75 - 60 - 50
(1 - 3 small boxes)
Interpretation?
P waves
PR interval
Rate
Regularity
QRS duration
Normal
0.12 s
90 to 94 bpm
Regular
0.06 to 0.08
sec
DYSRHYTHMIA
RECOGNITION AND
MANAGEMENT
P waves
PR interval
Rate
Regularity
QRS duration
Normal
0.16 s
50 to 52 bpm
Regular
0.04 to 0.06
sec
Rules of Interpretation
Sinus Bradycardia
Rate
Less than 60
Rhythm
Regular
Pacemaker
Site
SA node
P Waves
PRI
Normal
QRS
Normal
SINUS BRADYCARDIA
Occurs as a response to a reduced demand for blood flow
Automaticity in the SA Node diminishes
NURSING INTERVENTION:
1. Maintain patent airway, assist breathing if necessary
2. Provide Oxygen
3. Attached cardiac monitoring
4. Monitor blood pressure and pulse oximetry
5. Assess patient of hypoperfusion
6. Asymptomatic Patient: Continue monitoring
7. Evaluate patients tolerance to rhythm and with activity
8. Review PMHx especially drugs
SINUS BRADYCARDIA
NURSING INTERVENTION:
4. Identify and treat underlying cause
5. Prepare ordered meds: ATROPHINE 0.5 mg
6. If patient not responding to Atropine
Prepare the patient for TRANSCUTANEOUS
PACING
b. Epinephrine or Dopamine 2-10 mcg/kg
a.
Bradycardia Algorithm.
P waves
PR interval
Rate
Regularity
QRS duration
Normal
0.12 s
120 to 136 bpm
Regular
0.04 to 0.06
sec
Interpretation: Sinus Tachycardia
Rules of Interpretation
Sinus Tachycardia
Rate
Rhythm
Regular
Pacemaker
Site
SA node
P Waves
PRI
Normal
QRS
Normal
SINUS TACHYCARDIA
Due to SYMPATHETIC STIMULATION
NURSING INTERVENTION:
1. Maintain patent airway, assist breathing in necessary
2. Provide Oxygen
3. Attached cardiac monitoring
4. Monitor blood pressure and pulse oximetry
5. Assess patient of hypoperfusion
6. Check LOC
7. Provide calm environment
8. Assess patient for s/sx of angina
9. If leads to cardiac ischemia, TX includes Ca channel/Beta
Blocker
FIBRILLATION
ATRIAL
FLUTTER
SUPRAVENTRICULAR
TACHYCARDIA
ATRIAL FIBRILLATION
Rules of Interpretation
Atrial Fibrillation
Rate
Rhythm
Pacemaker
Site
P Waves
PRI
QRS
Irregularly
irregular
Atrial (outside SA
Node)
None discernible
None
Normal
ATRIAL FIBRILLATION
CAUSES:
1. DRUGS
2. RHD, Valvular Heart Disease, Hyperthyroidism,
ATRIAL FLUTTER
Rules of Interpretation
Atrial Flutter
Rate
Rhythm
Usually regular
Pacemaker
Site
Atrial (outside SA
node)
P Waves
Sawtooth waves
are present
PRI
Usually normal
QRS
Usually normal
ATRIAL FLUTTER
CAUSES:
1. DRUG:DIGOXIN
2. Mitral and Tricuspid Valvular Disease
3. Hyperthyroidism
4. COPD
5. Cardiac Surgery
6. MI
ATRIAL FIBRILLATION/ATRIAL
FLUTTER
NURSING INTERVENTION:
1. Maintain patent airway, assist breathing in
2.
3.
4.
5.
necessary
Provide Oxygen
Attached cardiac monitoring
Monitor rhythm, HR blood pressure and pulse
oximetry
Assess patient of hypoperfusion
ATRIAL FIBRILLATION/ATRIAL
FLUTTER
NURSING INTERVENTION:
STABLE PATIENTS: Control, Convert, Administer
Assess for symptoms of decreased CO and HF
Drug of Choice: Beta Blockers/Ca Channel Blockers
If pt with reduced left ventricular function: DIGOXIN
Monitor serum drug levels and observe for toxicity
Obtain baseline serum coagulation studies
UNSTABLE PATIENTS:
Prepare patient for SYNCHRONIZED CARIOVERSION
SUPRAVENTRICULAR
TACHYCARDA
Rules of Interpretation
Paroxysmal
Supraventricular
Tachycardia
Rate
Rhythm
Pacemaker
Site
P Waves
150250
Regular
Atrial (outside SA
Node)
Often buried in
preceding T wave
PRI
Usually normal
QRS
Usually normal
SUPRAVENTRICULAR TACHYCARDIA
CAUSES:
1. Occurs in a pt with normal heart:
2. MI
3. Cardiomyopathy
4. Hyperthyroidism
5. Systemic Hypertension
6. Digoxin Toxicity
SUPRAVENTRICULAR TACHYCARDIA
NURSING INTERVENTION
1. Maintain patent airway, assist breathing
2.
3.
4.
5.
6.
in necessary
Provide Oxygen
Attached cardiac monitoring
Monitor rhythm, HR blood pressure and
pulse oximetry
Assess patient of hypoperfusion
Treat the underlying cause
SUPRAVENTRICULAR TACHYCARDIA
NURSING INTERVENTION
STABLE PATIENTS:
1. Perform VALSALVA MANEUVER:
2. If Valsava Maneuver not effective,
PHARMACOLOGIC THERAPY advised:
ADENOSINE
Ca Channel Blocker/Beta Blocker
Digoxin
Amiodarone
SUPRAVENTRICULAR TACHYCARDIA
NURSING INTERVENTION
UNSTABLE PATIENTS:
1. SYNCHRONIZED CARDIOVERSION is
highly advised
STABLE
IV ACCESS if not established
Obtain 12-Lead ECG
NARROW IRREGULAR QRS
ATRIAL FIBRILLATION
BETA BLOCKER/CACHANNEL
BLOCKER
Verapamil:
Diltiazem:
Atenolol:
STABLE
IV ACCESS if not established
Obtain 12-Lead ECG
NARROW REGULAR QRS
SVT
VAGAL MANEUVERS
Carotid Sinus Massage
Valsalva Maneuver
No Effect
ADENOSINE 6 mg
No Effect
ADENOSINE 12 mg
No Effect
ADENOSINE 12 mg
No Effect
BETA BLOCKER
Ca CHANNEL BLOCKER
No Effect
AMIODARONE 150 mg
ATRIAL
FLUTTER
BETA BLOCKER/CACHANNEL
BLOCKER
Verapamil:
Diltiazem:
Atenolol:
CARDIAC ARREST
(Pulseless Arrest)
I.
Ventricular Tachyarrhythmias :
a. Ventricular fibrillation
b. Sustained Ventricular Tachycardia
II. Asystole
III. Pulseless Electrical Activity (PEA)
R
FIBRILLATION
VENTRICULA
R
TACHYCARDI
A
VENTRICULAR FIBRILLATION
Rules of Interpretation
Rate
Ventricular
No organized
Fibrillation
Rhythm
rhythm
No organized
rhythm
Pacemaker
Site
Numerous
ventricular foci
P Waves
Usually absent
PRI
None
QRS
None
VENTRICULAR TACHYCARDIA
Rules of Interpretation
Rate
Ventricular
Tachycardia100250
Rhythm
Pacemaker
Site
P Waves
PRI
QRS
Usually regular
Ventricle
If present, not
associated with
QRS
None
>0.12 seconds,
bizarre
V FIB/VTACH
CAUSES:
1. CARDIAC CONDITION: CAD, MI
Cardiomyopathy
2. Drug: DIGOXIN
3. Electrolyte Imbalance
V FIB/V TACH
NURSING INTERVENTION
1. DEFIBRILLATE
2. CPR
3. PHARMACOLOGIC TREATMENT:
EPINEPHRINE or VASOPRESSION
AMIODRONE
CARDIAC ARREST
(Pulseless Arrest)
NON SHOCKABLE RHYTHM
I.
ASYSTOLE
II. PEA
Rules of Interpretation
Asystole
Rate
No Electrical
Activity
Rhythm
No Electrical
Activity
Pacemaker
Site
No Electrical
Activity
P Waves
Absent
PRI
Absent
QRS
Absent
PEA
Rules of Interpretation
First-Degree AV
Depends on
Block
Rate
underlying
rhythm
Rhythm
Pacemaker
Site
P Waves
Usually regular
SA node or atrial
Normal
PRI
QRS
Rules of Interpretation
Type I Second-Degree AV
Block
Rate
Rhythm
Pacemaker
Site
P Waves
PRI
QRS
Atrial, normal;
ventricular, normal
to slow
Atrial, regular;
ventricular,
irregular
SA node or arial
Normal, some P
waves not followed
by QRS
Increases until QRS
is dropped, then
repeats
Usually < 0.12
seconds
Rules of Interpretation
Type II Second-Degree AV
Block
Rate
Rhythm
Pacemaker
Site
Atrial, normal;
ventricular, slow
May be regular
or irregular
SA node or atrial
P Waves
Normal, some P
waves not followed
by QRS
PRI
QRS
Rules of Interpretation
Third-Degree AV Block
Rate
Rhythm
Pacemaker
Site
P Waves
PRI
QRS
Atrial, normal;
ventricular, 40
60
Both atrial and
ventricular are
regular
SA node and AV
junction or
ventricle
Normal,with no
correlation to
QRS
No relationship to
QRS
0.12 seconds or
greater
Thank you