TYPES OF DYSRHYTHMIAS

Sinus Node Dysrhytmias

Sinus Bradycardia
Sinus Tachycardia Tuanda, Mary Joy
Catipay, Menutska
Sinus Arrhytmia Tumbiga, Vielka
Atrial Dysrhytmias Villarante, Kevin
Basay, Reynart
Premature Atrial Complex Supangan, Angel
Atrial Flutter Dini-ay, Camelle
Palencia, Keziah
Dawn
Cabasag, Jessica
Banagodos, April
Kate
Martinez, Leann
Kate
Bacon, Angel
Libron, Cassey
Labor, Elaissa Mae
Balagtas Recyven
 Normal Sinus Rhythm

Ventricular and atrial rate:\60 to 100 bpm in the adult

Ventricular and atrial heart rate determination
Ventricular and atrial rhythm: Regular
with a regular rhythm: 1,500 divided by the number of
QRS shape and duration: Usually normal, but may be
small boxes between two P waves (atrial rate) or between
regularly abnormal
two R waves (ventricular rate).
P wave: Normal and consistent shape; always in front of the
QRS Heart rate determination if the rhythm is
PR interval: Consistent interval between 0.12 and 0.20 irregular: Approximate number of RR intervals in 6
seconds seconds multiply by 10, so if there are about 7 RR intervals
P:QRS ratio: 1:1 in 6 seconds (7 × 10 = 70), then there are 70 RR in 60
seconds.
Sinus Node Dysrhythmias
Sinus Bradycardia
Sinus Tachycardia
Sinus Arrhytmia
 Sinus Bradycardia
What is Sinus Bradycardia?
A regular, but slower than normal
rhythm of the heart.
Ventricular and atrial rate: Less than 60 bpm in the adult
Ventricular and atrial rhythm: Regular
QRS shape and duration: Usually normal, but may be regularly
abnormal
P wave: Normal and consistent shape; always in front of the
QRS
PR interval: Consistent interval between 0.12 and 0.20 seconds
P:QRS ratio: 1:1
 Sinus Bradycardia

MEDICAL MANAGEMENT NURSING INTERVENTIONS

• The cause and symptoms determine how to treat the • Assess breathing and place an oxygen if necessary.
condition. The only necessary treatment might be to • Make sure your patient has IV access.
address the root causes. • Assess lung and heart sounds
• If the bradycardia causes signs and symptoms of • Assess/ hold any medications that can slow heart rate.
clinical instability, 0.5 mg of atropine may be quickly • Check patient’s lab levels.
administered intravenously as a bolus, followed by a • Make sure emergency medications and equipment are near.
repeat administration every 3 to 5 minutes up to a
maximum dosage of 3 mg.
• Rarely if bradycardia is unresponsive to atropine
emergency transcutaneous pacing can be instituted or
medications such as dopamine, isoproterenol,
epinephrine.
• A pacemaker may be suggested by your cardiologist
to treat your slow heartbeat.
 Sinus Tachycardia
What is Sinus Tachycardia?
A regular, but faster than normal
rhythm of the heart.
Ventricular and atrial rate: >100bpm in the adult, but usually
<120 bpm.
Ventricular and atrial rhythm: Regular
QRS shape and duration: Usually normal, but may be regularly
abnormal
P wave: Normal and consistent shape; always in front of the
QRS, but may be buried in the preceding T wave.
PR interval: Consistent interval between 0.12 and 0.20 seconds
P:QRS ratio: 1:1
 Sinus Tachycardia

MEDICAL MANAGEMENT NURSING INTERVENTIONS

• Treatment of sinus tachycardia is usually • Assess for causes and report them
determined by the severity of symptoms and • Monitor vitals, heart rhythm (assess for signs of
directed at identifying and abolishing its cause. decreased cardiac output)
• Beta-blockers and calcium channel blockers, • Assess for hypotension, confusion, syncope, increased
although rarely used, may be administered to CRT, shortness of breath, cool extremities
reduce the heart rate quickly. • Teach or encourage patient to avoid smoking,
• Catheter ablation of the SA node may be used in caffeine, and other stimulant
cases of persistent inappropriate sinus tachycardia
unresponsive to other treatments.
• Treatment for POTS may include increased fluid
and sodium intake and use of anti-embolism
stockings to prevent pooling of blood in the lower
extremities
 Sinus Arrhythmia
What is Sinus Arrhythmias?
Occurs when the sinus node creates
an impulse at an irregular rhythm; the
rate usually increases with inspiration
and decreases with expiration.
Ventricular and atrial rate: 60-100 bpm
Ventricular and atrial rhythm: Irregular
QRS shape and duration: Usually normal, but may be regularly
abnormal
P wave: Normal and consistent shape; always in front of the
QRS, but may be buried in the preceding T wave.
PR interval: Consistent interval between 0.12 and 0.20 seconds
P:QRS ratio: 1:1
 Sinus Arrhythmia
MEDICAL MANAGEMENT
• Sinus arrhythmia does not cause any significant
hemodynamic effect and therefore is not typically
treated.
• Should be evaluated for hemodynamic instability.
• Can be treated with intravenous (IV) atropine.
• Temporary or permanent pacemaker.
• Should be treated for an acute myocardial
infarction appropriately.
• Workup should be initiated for an infectious cause
(including chest x-ray, blood cultures, urinary
analysis, viral panel) together with thyroid
function tests.
• The patient's medication list should also be
reviewed for possible causes of sinus arrhythmias.
NURSING INTERVENTIONS
• Careful physical assessment of the patient.
• Assessment of vital signs, with special attention to
heart rate. Especially, prior to administering a
medication which may have an effect on heart rate or
blood pressure.
• Immediately notify the physician, or advanced
practice provider, if the patient experiences shortness
of breath, hypotension, or chest pain.
• Immediately notify the physician, or advanced
practice provider, of other changes in patient
condition.
Atrial Dysrhythmias
Premature Atrial Complex
Atrial Flutter
 Premature Atrial Complex (PAC)
What is PAC?
Is a single ECG complex that
occurs when an electrical
impulse starts in the atrium
before the next normal
impulse of the sinus node.
Ventricular and atrial rate: Depends on underlying rhythm
Ventricular and atrial rhythm: Irregular due to early P waves, creating a PP interval that is
shorter than the others. This is sometimes followed by a longer-than-normal PP interval, but
one that is less than twice the normal PP interval. This type of interval is called a
noncompensatory pause.
QRS shape and duration: The QRS that follows the early P wave is usually normal, but it may
be abnormal (aberrantly conducted PAC). It may even be absent (blocked PAC).
P wave: An early and different P wave may be seen or may be hidden in the T wave; other P
waves in the strip are consistent.
PR interval: Consistent interval between 0.12 and 0.20 seconds
P:QRS ratio: 1:1
 Premature Atrial Complex (PAC)

MEDICAL MANAGEMENT NURSING INTERVENTIONS

• Treatment of PACs depends on the symptomatology, triggers, and associated structural
heart conditions. Typically, only patients with symptomatic PACs require treatment. After
• Monitor for complication
appropriate identification of triggers or underlying structural cardiac conditions, therapy • Continuous Cardiac Monitoring
starts by reassuring patients that PACs are typically benign and can be controlled by • Monitoring for complications
avoiding triggers.
• Lifestyle Changes
• Immediately report to health care provider if it has;
• Avoid smoking Conversion to a different rhythm
• Eat a heart-healthy diet • Administer medication if prescribed medication helps
• Exercise under directions from your doctor.
• If you're overweight, talk to your doctor about weight-loss options. maintain a more normal heart rhythm
• Limit alcohol consumption to 1 drink per day for women and 2 drinks per day for men. • Advise lifestyle modifications
• Manage stress • Encourage to increase sodium intake.
• Make and keep appointments to see your doctor for routine check-ups and follow-up tests.
• Pharmacologic management can be achieved using:
 Antiarrhythmic medications will help control your heart’s rhythm.
 Anticoagulants “blood-thinners” will help treat, prevent and reduce blood clots.
 Beta blockers will help reduce your blood pressure.
 Calcium channel blockers will help relax blood vessels and increase the supply of
blood and oxygen to the heart while also reducing the heart's workload.
 Atrial Flutter
What is Atrial Flutter?
Occurs in the atrium and
creates impulses at rate
between 250 to 400 times per
minute.
Ventricular and atrial rate: Atrial rate: 250-400 bpm; Ventricular rate 75-
150 bpm
Ventricular and atrial rhythm: The atrial rhythm is regular; the ventricular
rhythm is usually regular but may be irregular because of the changes in the
AV conduction
QRS shape and duration: Usually normal, but may be abnormal or may be
absent
P wave: Saw-toothed shape. These waves are referred to as F waves.
PR interval: Multiple F waves may make it difficult to determine PR interval
P:QRS ratio: 2:1, 3:1, or 4:1
 Premature Atrial Complex (PAC)

MEDICAL MANAGEMENT NURSING INTERVENTIONS

• Your primary care doctor can make a preliminary • Obtain 12 lead ECG
diagnosis of AFL with an ECG. You may also be • Measure vitals- if unstable may need cardioversion
referred to a cardiologist for further testing. • Hook patient to cardiac monitor
• Several tests are used to diagnose and confirm • Administer drugs as prescribed
AFL: • Administer anticoagulant
• Electrocardiogram • Check neurovitals
• Holter monitors
• Electrophysiology
MEDICATION:
• Medications can slow or regulate your heart rate.
Examples of these medications include:
• calcium channel blockers
• beta-blockers
• digoxin
• Certain medications may require a brief hospital
stay while your body adjusts, such as anti-
arrhythmic medications.
THANK YOU