most common cardiac arrythmias

1. CARDIAC ARRYTHMIAS
ORHAN HAKLI, NP

2. CARDIAC CONDUCTION SYSTEM
SA NODE :
-AT THE UPPER POSTERIOR PART OF THE ATRIUM
-PRIMARY PACEMAKER
-DISCHARGES ELECTICAL IMPULSES 60-100 A
MINUTE
AV NODE :
-RECEIVES IMPULSES FROM SA NODE
-SLOW THE CONDUCTION AND DELAYS THE
INPUT IN ORDER ATRIUMS TO VENTRICULS
COMPLETELY(Atrial kick 5-30% of the CO)
-BLOCK SOME OF THE IMPULSES TO PREVENT
GOING THE HEART TACHY
-SERVES AS A BACK UP PACEMAKER IF SA NODE
FAILS (ELECTRICAL IMPULSES OF 40-60 A MINUTE)
PURKINJE FIBERS:
-RECEIVES IMPULSES FROM BUNDLE
BRANCHES
-DISCHARGES ELECTRICAL IMPULSES 20-40
A MINUTE

3. CAUSES OF DYSRHYTHMIAS
ENHANCED
AUTOMATICITY
Increased activity or
rhythm disturbances
TRIGIRRED ACTIVITY
Abnormal electric
impulses when cells are
at rest
RE-ENTRY
Spread of an impulse
through tissue already
stimulated by that same
impulse
ACIDOSIS HYPOXIA HYPERCALIMIA
ALCOLOSIS HYPOMAGNESIA MYOCARDIAL ISCHEMIA
HYPOXIA MYOCARDIAL INJURY ANTIARYTHMATIC MEDS
ISCHEMIA/INFARCT MEDICATIONS THAT
PROLONGS
REPOLARIZATION
(IE.QUINIDINE)
ELECTROLYTE
PROBLEMS (K-CA)
DIG.TOXICITY
ADMINISTRATION OF
ATROPINE/
EPINEPHRINE

4. EKG
HEART RATE
-To determine the ventricular rate, count
the QRS complex on a 6 sec paper and
multiply by 10
WAVES
-P wave: atrial depolarization
-QRS complex :ventricular depolarization
-Twave :Ventricular repolarization
INTERVALS
-PR :0.12-0.20 sec
-QRS :under 0.10sec
-QT:under 0.38 sec

5. MAJOR CARDIAC ARRHYTHMIAS
SINUS RYTHMS ATRIAL
RYTHMS
VETRICULAR
RHYTHMS
ATRIO-
VENTRICULAR
(AV) RHYTHMS
SINUS BRADY PREMATURE
ATRIAL
CONTRACTION
(PAC)
PREMATURE
VENTRICULAR
CONTRACTION
(PVC)
1ST DEGREE AV
BLOCK
SINUS
TACHICARDIA
ATRIAL
FLUTTER
VENTRICULAR
TACHICARDIA
2ND DEGREE AV
BLOCK TYPE I
SINUS
ARRYTHMIA
ATRIAL
FIBRILATION
VENTRICULAR
FIBRILATION
2ND DEGREE AV
BLOCK TYPE II
SINUS ARREST ASYSTOLE 3RD DEGREE AV
BLOCK

6. SINUS RHYTMS
CHARACTERISTICS
-less than 60bpm
-regular PP and RR
-PR 0.12-.20
QRS0.10
WHAT TO DO?
-watch the patient for s/s of bradycardia
-If symptomatic; iv access, o2, transcuteneus pacing
MEDICATION
Atropine 0.5mg ivp

7. SINUS RHYTHMS
 CHARACTERISTICS
 - 101-150bpm
 -regular PP and RR
 -PR 0.12-.20
 QRS0.10 or less
 WHAT TO DO?
 -watch the patient for s/s of Tachycardia
 -correct underlying problems/Never shock ST
 MEDICATION
 Atenelol/Meteprolol (Beta blockers)

8. SINUS RHYTHMS
 CHARACTERISTICS
 - usually 60-100bpm, but can be slower or faster
 -irregular with respiration, HR increases with inspiration
and decreases with expiration
 -PR 0.12-.20
 QRS0.10 or less
 WHAT TO DO?
 NOTHING !!!
 MEDICATION
 If hemodynamic compromise is present ATROPINE

9. SINUS RHYTHMS
 CHARACTERISTICS
 - Rate varies because of the pause
 -irregular rhythm
 -PR 0.12-.20
 QRS0.10 or less
 WHAT TO DO?
 If transient and major s/s of decline monitor the pt
 If more than 3 sec. ATROPINE, Bedside Pacer or
Possible Permanent PM insertion
 MEDICATION
 ATROPINE
SINUS ARREST

10. ATRIAL RHYTHMS
 CHARACTERISTICS
 - Rate; Depends on the underlying rhythm but usually w/i normal
limits
 -Regular rhythm, except the premature beats
 -PR may be normal or prolonged
 QRS0.10 or less but might be wide
 WHAT TO DO?
 NOTHING!!!
 Reducing stress, stimulants(coffee), treating CHF may help
 MEDICATION
 If needed beta blockers, CA blockers or anxiety meds
PREMATURE ATRIAL COMPLEX

11. ATRIAL RHYTHMS
AFIB
AFLUTTER

12. VENTRICULAR RHYTMS
PREMATURE VENTRICULAR COMPLEX
 CHARACTERISTICS
 - Rate; Depends on the underlying rhythm
 -Regular rhythm, except the premature beats
 -PR no PR because ectopy comes from ventricles
 QRS more then 0.12, wide and bizarre looking
 WHAT TO DO?
 NOTHING!!!
 Monitor the pt, if frequent check if they have enough cardiac output

13. VENTRICULAR RHYTHMS
VENTRICULAR TACHICARDIA
VENTRICULAR FIBRILATION
ASYSTOLE

14. ATRIOVENTRICULAR (AV) BLOCKS
 CHARACTERISTICS
 - Rate; Depends on the underlying rhythm, but usually normal
 -Regular rhythm
 -PR prolonged, greater than 0.20 sec
 QRS usually 0.10 sec or less
 WHAT TO DO?
 They are usually asymptomatic, Monitor the pt if MI is causing the
block
 Hold the meds that could cause the block(IE beta blockers, CA
blockers, Dig, quinidine)
FIRST DEGREE AV BLOCK

15. ATRIOVENTRICULAR (AV) BLOCKS
 WHAT TO DO?
 They are usually asymptomatic, Monitor the pt
 Do not give ATROPINE to increase the heart rate
 Type II might be indication for PM
 Hold the meds that could cause the block(IE beta blockers, CA
blockers, Dig, quinidine)
 If associated with MI, watch if the block is getting worse
SECOND DEGREE AV BLOCK
TYPE -I
TYPE -II

16. ATRIOVENTRICULAR (AV) BLOCKS
 CHARACTERISTICS
 - Rate; atrial rate is greater then ventricular rate
 -Regular ratrial (P) and regular ventricular but no relationship
between the two
 -P normal size and shape; PR none
 QRS can be narrow or wide
 WHAT TO DO?
 ATROPINE /Transcuteneus Pacing
 Possible permanent Pacemaker
THIRD DEGREE AV BLOCK

17. REFERENCES
 Aehlert, B. (2006). ECGs Made Easy. Arizona: Sauthwest EMS
education Inc.
 Heart Blocks. (2012). Retrieved from http://www.nhlbi.nih.gov:
http://www.nhlbi.nih.gov/health/health-topics/topics/hb/types.html
 Huff, j. (2006). ECG Workout: Exercises in Arrhythmia Interpretation. PA:
Lippincott Williams & Wilkins.
 Nicod, P.; Hillis, L.; Winniford, M.D.; Firth, B.G. (February 15, 1986).
Importance of the "atrial kick" in determining the effective mitral valve
orifice area in mitral stenosis. The American Journal of Cardiology ,
Volume 57, issue 6 p. 403-407.
 Sauer, W. (2012). Normal sinus rhythm and sinus arrhythmia. Retrieved
from http://www.uptodate.com:
http://www.uptodate.com/contents/normal-sinus-rhythm-and-sinus-
arrhythmia
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