ARRYTHMIAS

Electrical Conduction System EKG Waveforms :

One complete cardiac cycle =

P, Q, R, S, (QRS complex), and T wave
 ▪ P wave : Atrial depolarization (contraction)
 ▪ QRS Complex : Ventricular depolarization, atrial
repolarization
 ▪ T wave : Ventricular repolarization (resting
phase)
Heart rhythm :

 Rhythm
A sequential beating of the heart as a result of
the generation of electrical impulses .
Classified as:
▪ Regular pattern: Interval between the R
waves is regular
▪ Irregular pattern: Interval between the R
waves is not regular
is a slow, regular heartbeat. It happens when your heart's pacemaker, the sinus node, generates
heartbeats less than 60 times in a minute
This refers to a fast heartbeat — a resting heart rate greater than 100 beats a minute
sinus arrhythmia is an irregular heartbeat that's either too fast or too slow.
A sinus pause or arrest is defined as the transient absence of sinus P waves on the
electrocardiogram (ECG) that may last from two seconds to several minutes
the electrical impulse is delayed or blocked on the way to the atria, thus delaying the atrial beat.
A wandering atrial pacemaker is an arrhythmia that occurs when the control of your heart's electrical impulses
wanders from your SA node to your AV node.
Multifocal atrial tachycardia (MAT) is a cardiac arrhythmia caused by multiple sites of competing atrial activity.
It is characterized by an irregular atrial rate greater than 100 beats per minute (bpm).
Premature atrial contractions (PACs) are premature heartbeats that are similar to PVCs, but occur in the
upper chambers of the heart, an area known as the atria.
Atrial tachycardia (AT) is a type of abnormal heart rhythm, or arrhythmia. It occurs when the electrical signal
that controls the heartbeat starts from an unusual location in the upper chambers (atria) and rapidly repeats,
causing the atria to beat too quickly
Supraventricular tachycardia (SVT) is an abnormally fast heart rhythm arising from improper electrical activity
in the upper part of the heart.
 ATRIAL FLUTTER

is a type of heart rhythm disorder in which the heart's upper chambers (atria) beat too quickly. In atrial flutter,
your heart's upper chambers (atria) beat too quickly.
 ATRIAL FIBRILLATION

Atrial fibrillation is an irregular and often rapid heart rate that occurs when the two upper chambers of your
heart experience chaotic electrical signals.
A junctional rhythm occurs when the electrical activation of the heart originates near or within the
atrioventricular node, rather than from the sinoatrial node. Because the normal ventricular conduction system
(His-Purkinje) is used, the QRS complex is frequently narrow.
An idioventricular rhythm is a cardiac rhythm characterized by a rate of <50 beats per minute (bpm),
absence of P waves and widening of the QRS complex.
Premature ventricular contractions (PVCs) are extra heartbeats that begin in one of your heart's two lower
pumping chambers (ventricles).
In monomorphic ventricular tachycardia, the shape of each heart beat on the ECG looks the same because
the impulse is either being generated from increased automaticity of a single point in either the left or the right
ventricle, or due to a reentry circuit within the ventricle.
Polymorphic (or polymorphous) ventricular tachycardia (VT) is defined as a ventricular rhythm at a rate
greater than 100 beats per minute (bpm) with a continuously varying QRS complex morphology in any recorded
electrocardiographic (ECG) lead.
Torsades de pointes is a specific form of polymorphic ventricular tachycardia in patients with a long QT interval.
It is characterized by rapid, irregular QRS complexes, which appear to be twisting around the electrocardiogram
(ECG) baseline.
Ventricular fibrillation is a heart rhythm problem that occurs when the heart beats with rapid, erratic electrical
impulses. This causes pumping chambers in your heart (the ventricles) to quiver uselessly, instead of pumping
blood.
Pulseless electrical activity (PEA) refers to cardiac arrest in which the electrocardiogram shows a heart rhythm
that should produce a pulse, but does not.
A first-degree atrioventricular node block occurs when conduction through the AV node is slowed, thereby delaying the time
it takes for the action potential to travel from the sinoatrial node through the AV node, and to the ventricles.
Second-degree atrioventricular (AV) block, or second-degree heart block, is a disorder characterized by
disturbance, delay, or interruption of atrial impulse conduction to the ventricles through the atrioventricular node
(AVN) and bundle of His.
Type 2 Second-degree AV block, also known as Mobitz II, is almost always a disease of the distal conduction
system (His-Purkinje System). Mobitz II heart block is characterized on a surface ECG by intermittently
nonconducted P waves not preceded by PR prolongation and not followed by PR shortening.
Third-degree atrioventricular block (AV block) is a medical condition in which the nerve impulse generated in
the sinoatrial node (SA node) in the atrium of the heart can not propagate to the ventricles. Because the
impulse is blocked, an accessory pacemaker in the lower chambers will typically activate the ventricles.
SYMPTOMS
Noticeable arrhythmia symptoms may include:
•A fluttering in your chest
•A racing heartbeat (tachycardia)
•A slow heartbeat (bradycardia)
•Chest pain
•Shortness of breath

Other symptoms may include:

•Anxiety
•Fatigue
•Lightheadedness or dizziness
•Sweating
•Fainting (syncope) or near fainting
CAUSES

•A heart attack that's occurring right now

•Scarring of heart tissue from a prior heart attack
•Changes to your heart's structure, such as from
cardiomyopathy
•Blocked arteries in your heart (coronary artery
disease)
•High blood pressure
•Overactive thyroid gland (hyperthyroidism)
•Underactive thyroid gland (hypothyroidism)
•Diabetes
•Sleep apnea
Other things that can cause an arrhythmia
include:
•Smoking
•Drinking too much alcohol or caffeine
•Drug abuse
•Stress or anxiety
•Certain medications and supplements,
including over-the-counter cold and allergy
drugs and nutritional supplements
Other factors that may put you at higher risk of developing an arrhythmia
include:

•Drugs and supplements. Certain over-the-counter cough and cold

medicines and certain prescription drugs may contribute to arrhythmia
development.

•Drinking too much alcohol. Drinking too much alcohol can affect the
electrical impulses in your heart and can increase the chance of developing
atrial fibrillation.

•Caffeine, nicotine or illegal drug use. Caffeine, nicotine and other

stimulants can cause your heart to beat faster and may contribute to the
development of more-serious arrhythmias. Illegal drugs, such as
Diagnosis
•Electrocardiogram (ECG). During an ECG, sensors (electrodes) that can detect the electrical
activity of your heart are attached to your chest and sometimes to your limbs. An ECG measures
the timing and duration of each electrical phase in your heartbeat.

•Holter monitor. This portable ECG device can be worn for a day or more to record your heart's
activity as you go about your routine.

•Event recorder. For sporadic arrhythmias, you keep this portable ECG device available,
attaching it to your body and pressing a button when you have symptoms. This lets your doctor
check your heart rhythm at the time of your symptoms.

•Echocardiogram. In this noninvasive test, a hand-held device (transducer) placed on your

chest uses sound waves to produce images of your heart's size, structure and motion.
•Implantable loop recorder. If your symptoms are very infrequent, an event recorder may be
implanted under your skin in the chest area to continually record your heart's electrical activity
and detect abnormal heart rhythms.
If your doctor doesn't find an arrhythmia during those tests, he or she may
try to trigger your arrhythmia with other tests, which may include:

•Stress test. Some arrhythmias are triggered or worsened by exercise. During a stress test, you'll
be asked to exercise on a treadmill or stationary bicycle while your heart activity is monitored. If
doctors are evaluating you to determine if coronary artery disease may be causing the arrhythmia,
and you have difficulty exercising, then your doctor may use a drug to stimulate your heart in a way
that's similar to exercise.

•Electrophysiological testing and mapping. In this test, doctors thread thin, flexible tubes
(catheters) tipped with electrodes through your blood vessels to a variety of spots within your heart.
Once in place, the electrodes can map the spread of electrical impulses through your heart.
Treatment

Treating fast heartbeats

For fast heartbeats (tachycardias), treatments may include one or more of the
following:
•Vagal maneuvers. You may be able to stop an arrhythmia that begins above the
lower half of your heart (supraventricular tachycardia) by using particular
maneuvers that include holding your breath and straining, dunking your face in
ice water, or coughing.

•Medications. For many types of tachycardia, you may be prescribed medication

to control your heart rate or restore a normal heart rhythm. It's very important to
take any anti-arrhythmic medication exactly as directed by your doctor in order to
minimize complications.
PREVENTIONS:

•Eating a heart-healthy diet

•Staying physically active and keeping a healthy weight
•Avoiding smoking
•Limiting or avoiding caffeine and alcohol
•Reducing stress, as intense stress and anger can cause heart
rhythm problems
•Using over-the-counter medications with caution, as some
cold and cough medications contain stimulants that may
trigger a rapid heartbeat
•Cardioversion. If you have a certain type of arrhythmia, such as atrial
fibrillation, your doctor may use cardioversion, which can be conducted as a
procedure or by using medications.
•In the procedure, a shock is delivered to your heart through paddles or patches
on your chest. The current affects the electrical impulses in your heart and can
restore a normal rhythm.

•Catheter ablation. In this procedure, your doctor threads one or more

catheters through your blood vessels to your heart. Electrodes at the catheter
tips can use heat, extreme cold or radiofrequency energy to damage (ablate) a
small spot of heart tissue and create an electrical block along the pathway that's
causing your arrhythmia.
Implantable devices
Treatment for heart arrhythmias also may involve use of an
implantable device:

•Pacemaker. A pacemaker is an implantable device that helps

control abnormal heart rhythms. A small device is placed under the
skin near the collarbone in a minor surgical procedure. An insulated
wire extends from the device to the heart, where it's permanently
anchored.
If a pacemaker detects a heart rate that's abnormal, it emits
electrical impulses that stimulate your heart to beat at a normal rate.
Implantable cardioverter-defibrillator (ICD). Your doctor may recommend this
device if you're at high risk of developing a dangerously fast or irregular heartbeat
in the lower half of your heart (ventricular tachycardia or ventricular fibrillation). If
you have had sudden cardiac arrest or have certain heart conditions that
increase your risk of sudden cardiac arrest, your doctor may also recommend an
ICD.
An ICD is a battery-powered unit that's implanted under the skin near the
collarbone — similar to a pacemaker. One or more electrode-tipped wires from
the ICD run through veins to the heart. The ICD continuously monitors your heart
rhythm.
If it detects an abnormal heart rhythm, it sends out low- or high-energy shocks to
reset the heart to a normal rhythm. An ICD doesn't prevent an abnormal heart
rhythm from occurring, but it treats it if it occurs.
Surgery or other procedures

In some cases, surgery may be the recommended treatment for heart arrhythmias:

•Maze procedure. In the maze procedure, a surgeon makes a series of surgical

incisions in the heart tissue in the upper half of your heart (atria) to create a pattern
or maze of scar tissue. Because scar tissue doesn't conduct electricity, it interferes
with stray electrical impulses that cause some types of arrhythmia.
•The procedure is effective, but because it requires surgery, it's usually reserved
for people who don't respond to other treatments or for those who are having heart
surgery for other reasons.
•Coronary bypass surgery. If you have severe coronary artery disease in addition
to arrhythmias, your doctor may perform coronary bypass surgery. This procedure
may improve the blood flow to your heart.
Nursing Interventions: Arrhythmias
1.Document any arrhythmias in a monitored patient.
2.Notify the doctor if a change in pulse pattern or rate occurs in an unmonitored patient.
3.As ordered, obtain an ECG tracing in an unmonitored patient to confirm and identify the type of
arrhythmia present.
4.Be prepared to initiate cardiopulmonary resuscitation, if indicated, when a life threatening
arrhythmia occurs.
5.Administer medication as ordered, monitor for adverse effect, and perform nursing interventions
related to monitoring vital signs, hemodynamic monitoring, and appropriate laboratory work.
6.Provide adequate oxygen and reduce heart workload while carefully maintaining metabolic,
neurologic, respiratory, and hemodynamic status.
7.Evaluate the monitored patient’s ECG regularly for arrhythmia.
8.Monitor for predisposing factors, such as fluid and electrolyte imbalance, and signs of drug
toxicity, especially with digoxin.
9.Teach the patient how to take his pulse and recognize an irregular rhythm and instruct him to
report alterations from his baseline to the doctor.
10.Emphasize the importance of keeping laboratory and physician’s appointments.
THANKYOU!