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Understanding Cardiac Arrhythmias

1. The document describes various types of cardiac arrhythmias including sinus rhythms, atrial rhythms, junctional rhythms, and ventricular rhythms. 2. Each rhythm is defined by characteristics such as heart rate, regularity, P wave presence and morphology, PR interval, and QRS width. 3. Treatment options are provided for many of the arrhythmias, including medications, cardioversion, defibrillation, and other procedures depending on the rhythm and hemodynamic stability of the patient.

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Mouriyan Aman
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308 views26 pages

Understanding Cardiac Arrhythmias

1. The document describes various types of cardiac arrhythmias including sinus rhythms, atrial rhythms, junctional rhythms, and ventricular rhythms. 2. Each rhythm is defined by characteristics such as heart rate, regularity, P wave presence and morphology, PR interval, and QRS width. 3. Treatment options are provided for many of the arrhythmias, including medications, cardioversion, defibrillation, and other procedures depending on the rhythm and hemodynamic stability of the patient.

Uploaded by

Mouriyan Aman
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
  • Cardiac Arrhythmias: Title page introducing the focus on cardiac arrhythmias.
  • Sinus Rhythms - Normal: Examines normal sinus rhythm with ECG features like heart rate and PR interval.
  • Sinus Rhythms - Bradycardia: Covers sinus bradycardia with specific ECG waveform interpretations.
  • Sinus Rhythms - Tachycardia: Details sinus tachycardia with characteristic ECG patterns and rates.
  • Sinus Arrhythmia: Focuses on sinus arrhythmia, illustrating irregularities in the ECG scoring.
  • Premature Atrial Contraction (PAC): Explores PAC with ECG characteristics, rhythm type, and wave morphology.
  • Atrial Rhythms: Overview of atrial rhythms with treatment notes for rate management.
  • Atrial Fibrillation: Details atrial fibrillation with varying wave patterns and irregularity.
  • Atrial Flutter: Examines atrial flutter with distinctive 'sawtooth' ECG appearance.
  • Management - Atrial Conditions: Lists management strategies and medications for atrial rhythm disturbances.
  • Junctional Rhythms: Analyzes junctional rhythms, including premature and escape rhythms on ECG.
  • Supraventricular Tachycardia (SVT): Defines SVT with ECG markers and treatment reflexes to manage high heart rates.
  • SVT Treatments: Outlines treatment approaches, including maneuvers and medications for SVT.
  • Premature Ventricular Contractions (PVC): Delineates PVC characteristics with wave absence and irregular beats on ECG.
  • Ventricular Rhythms: Covers ventricular flutter with distinct rhythms and regular heartbeat intervals.
  • Torsade de Pointes: Discusses torsade de pointes, with criteria defining QT interval prolongation and rhythm.
  • Ventricular Fibrillation: Outlines ventricular fibrillation with chaotic waves and absences of normal ECG features.
  • Management - Ventricular Conditions: Lists management protocols and necessary medications for ventricular disturbances.
  • Cardioversion vs Defibrillation: Compares cardioversion with defibrillation techniques for arrhythmia treatment.
  • Illustration - Cardioversion & Defibrillation: Contains illustrative comparisons of cardioversion and defibrillation processes.
  • Detailed Illustration: Illustrates step-by-step procedures for both cardioversion and defibrillation with visual guides.

Cardiac Arrhythmias

Sinus Rhythms
Normal Sinus Rhythm

Heart PR Interval QRS


Rhythm P Wave
(sec.) (Sec.)
Rate

60 - Before each QRS,


Regular .12 - .20 <.12
100 Identical
Sinus Rhythms
Sinus Bradycardia

Heart PR Interval QRS


Rhythm P Wave
(sec.) (Sec.)
Rate

Before each QRS,


<60 Regular .12 - .20 <.12
Identical
Sinus Rhythms
Sinus Tachycardia

Heart PR Interval QRS


Rhythm P Wave
(sec.) (Sec.)
Rate

Before each QRS,


>100 Regular .12 - .20 <.12
Identical
Sinus Rhythms
Sinus Arrhythmia

Heart PR Interval QRS


Rhythm P Wave
(sec.) (Sec.)
Rate

Before each QRS,


Var. Irregular .12 - .20 <.12
Identical
• If low rate – Atropine
• If high rate and low CO – Cardiac glycosides
Atrial Rhythms
Premature Atrial Contraction (PAC)

Heart PR Interval QRS


Rhythm P Wave
(sec.) (Sec.)
Rate
Premature &
NA Irregular abnormal or .12 - .20 <.12
hidden
Atrial Rhythms
Atrial Fibrillation

Heart PR Interval QRS


Rhythm P Wave
(sec.) (Sec.)
Rate

Var. Irregular Wavy irregular NA <.12


Atrial Rhythms
Atrial Flutter

PR Interval QRS
Heart Rate Rhythm P Wave
(sec.) (Sec.)
Atrial=250
Not
– 400
Irregular Sawtooth Measur- <.12
Ventricular
able
Var.
Management
Amiodarone and Flecainide.
Digoxin
Beta-blockers
Calcium channel blockers
Anticoagulants
Junctional Rhythms
Premature Junctional Contraction PJC

Heart PR Interval QRS


Rhythm P Wave
(sec.) (Sec.)
Rate
Premature,
Usually Short Normal
Irregular abnormal, may be
<.12 <.12
inverted or
normal
hidden
Junctional Rhythms
Junctional Tachycardia

Heart PR Interval QRS


Rhythm P Wave
(sec.) (Sec.)
Rate

May be inverted or Short Normal


>100 Regular
hidden <.12 <.12
Junctional Rhythms
Junctional Escape

Heart PR Interval QRS


Rhythm P Wave
(sec.) (Sec.)
Rate

40 – Absent, inverted Short Normal


Regular
60 or after QRS <.12 <.12
Rx:
1. Vagal manoeuvre - such as gagging, holding your breath
and bearing down (Valsalva manoeuvre), coughing
2. Mammalian diving reflex
3. Carotid sinus massage/ Czermak Hering test – u/l for 15-

20 sec
4. Oculo cardiac reflex/ Aschner reflex
5. Adenosine 6mg as a rapid push :- Inj.Atropine and
Salbutamol nebulization kept ready
Ventricular Rhythms
Premature Ventricular Contraction (PVC)

PR
Heart QRS
Rhythm P Wave Interval
(Sec.)
Rate (sec.)

No P waves
Wide
Var. Irregular associated with NA
>.12
premature
beat
Classification
Unifocal — Arising from a single ectopic focus
Multifocal — Arising from two or more ectopic foci
Bigeminy — every other beat is a PVC.
Trigeminy — every third beat is a PVC.
Quadrigeminy — every fourth beat is a PVC.
Couplet — two consecutive PVCs.
Triplet — three consecutive PVCs.
Rx: Anti-arrhythmic medication: Lidocaine
Nx: Avoid common PVC triggers :caffeine or tobacco
Monitor therapeutic range of digoxin & S.K+
Ventricular Rhythms
Ventricular Flutter

Heart PR Interval QRS


Rhythm P Wave
(sec.) (Sec.)
Rate

150 – Wide
Regular No P waves NA
300 >.12
Ventricular Rhythms
Ventricular Flutter
“Extreme V-
Tach”
Call code
Begin
CPR
Ventricular Rhythms
Ventricular Tachycardia

Heart PR Interval QRS


Rhythm P Wave
(sec.) (Sec.)
Rate
No P waves
100 –
Regular corresponding to QRS, NA >.12
250
a few may be seen
Ventricular Rhythms
Ventricular Fibrillation

Heart PR Interval QRS


Rhythm P Wave
(sec.) (Sec.)
Rate

0 Chaotic None NA None


Management
VT with pulse and normal cardiac output - can be managed
with lidocaine and amiodarone
VT with pulse and decreased cardiac output -can be
managed with cardioversion
Pulseless VT -Should be managed with defibrillation
Cardioversion vs
Defibrillation
Regular vs Irregular with Narrow complex vs Wide complex

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