Arrythmia
Prepared by: Jojo A. Sarmiento RN,
SCFHS-RN, NHRA-RN, USRN
What is arrythmia?
Sinus Bradycardia (SB)
CAUSES :
Drugs such as digitalis, beta-blockers,
calcium channel blockers, and many
antiarrhythmics can slow the sinus rate.
Treatment:
no treatment necessary unless results in
symptoms (chest pain, dizziness,
hypotension, shortness of breath (SOB).
If Symptomatic: Follow the sequence
1.
2.
3.
4.
Sinus Arrhythmia
a. Pwaves:consistent in shape,
occur irregularly.
b. Rhythm:irregular,
c. Rate: usually within normal
range but can be
bradycardic.
d. PR interval: usually normal.
e. QRS complex: normal. Origin: rapid firing of ectopic atrial focus
or reentry
Treatment: Significance: not harmful. Rate: atrial: 150 – 250 bpm
a. Treatment: none necessary. Significance: Can be caused by MI, CHF,
hypoxia, or electrolyte imbalances.
Sinus Arrest (failure of sinus node to [Link]: eliminate underlying cause
fire)
if possible.
[Link] sequence:
1.
2.
3.
sinus arrest occurs when sinus node
4.
automaticity is depressed and impulses
are not formed when expected.
Atrial Flutter
a. Rhythm: irregular due to
absence of sinus node
discharge.
b. Rate:–within normal range
but may be in bradycardic. Atrial rate = 220-300/min
c. Significance: sinus arrest ( P as flutter waves )
occurs when sinus node Causes
automaticity is depressed include MI, rheumatic heart disease,
b. CAUSES : vagal stimulation, thyrotoxicosis, CHF, and ischemia.
hypersensitive carotid sinus
syndrome, MI interrupting blood Treatment: Intervention sequence:
supply to the sinus node 1. Slow ventricular rate
c. Treatment: treat the cause, if with calcium channel
known. blockers, beta-
d. Intervention sequence: same blockers, or
treatment of sinus bradycardia. digitalis.
2. Drugs like
amiodarone,
lidocaine or
Premature Atrial Complexes (PACs): procainamide can
convert flutter to
sinus rhythm.
3. Unstable:
Synchronized
cardioversion 50-100
Cause: Caffeine, nicotine, and alcohol can J biphasic
cause PACs
Treatment: most patients who are
asymptomatic don’t need treatment.
Atrial Tachycardia and Paroxysmal
Atrial Tachycardia (PAT):
Ventricular Rhythms: Ventricular
Supraventricular Tachycardia (SVT): rhythms originate in ventricular
myocardium or Purkinje system and are
considered to be more dangerous than
supraventricular rhythms because of their
greater potential to limit cardiac output.
a. Rhythm: regular.
Premature Ventricular Complexes
b. Rate: 150 – 300bpm
(PVCs) and Ventricular Escape
b. P waves: usually not visible or
a. Origin: focus in ventricular
buried.
myocardium.
b. Rhythm: irregular due to
Treatment: Intervention sequence:
1. early beats or due to pause
2. allowing escape beat.
3.
4.
c. Rate: may occur at any heart
rate and with any basic
rhythm.
d. Treatment: usually not
necessary, unless the
patient has symptoms or a
dangerous form of PVCs.
1.
2. * Monomorphic, meaning that all QRS
3. complexes look alike,
* Polymorphic, QRS complexes change
shape and do not look alike. A special
type of polymorphic VT, called Torsade
de Points (“twisting of the points”)
Treatment
● Intervention sequence for
pulseless VT:
1.
2.
3.
4.
● Antiarrhythmic drug: amiodarone
300 mg IV push or lidocaine 1 - 1.5
mg/kg IV push
Ventricular Tachycardia Intervention sequence for stable
● VT is a ventricular rhythm VT (with pulse
● Rate: faster than 100 beats/minute. 1.
● Origin: rapid, disorganized
2. electrical activity within the
ventricles.
3. ● Rhythm: chaotic, irregular.
● Rate: unable to measure due to
4. rapid, uncoordinated activity.
● P waves: none.
● Intervention sequence for ● PR interval: none.
unstable VT (with pulse): ● QRS complex: none
1.
2.
Asystole:
Asystole is total loss of ventricular
electrical activity resulting in no
ventricular contraction and no cardiac
output. Asystole is always fatal unless it
can be corrected immediately.
a. Rhythm: none.
Ventricular Fibrillation: b. Rate: none.
● VF is chaotic electrical activity in c. P waves:none
the ventricles that results in d. PR interval: none.
quivering of the ventricles and total
loss of cardiac output. VF is always
fatal unless treated immediately.
Significance: always fatal unless Second Degree AV Block – Type I
immediately corrected (Wenckebach):
Treatment:
____________________________________
------Flatline Protocol----
1.
2. ● P waves present
3. ● QRS complexes present
● P wave morphology and axis usual
HEART BLOCKS for the subject
AV block is used when there is delayed or ● QRS complexes morphology and
failed conduction of impulses from the axis usual for the subject
atria to the ventricles. ● Progressive prolongation of the P-R
interval with each succeeding beat
First Degree AV Block: until one P wave occurs without a
QRS ( dropped beat)
Treatment: if symptomatic bradycardia
occurs, treatment will be similar to sinus
bradycardia
Rhythm: usually regular
• PR interval > 0.20 sec
• P waves: normal,
precede every QRS.
Causes: beta blockers, calcium channel
blockers, and digitalis.
Treatment: discontinue causative drugs.
If symptomatic bradycardia: treatment will
be similar to sinus bradycardia.
Second Degree AV Block – Type II
(Mobitz)
a. Rhythm: irregular due to
blocked beats.
b. P waves: normal and
precede each QRS. Some P
waves are not followed by
QRS complexes.(drop beat)
PR interval: constant before conducted
beats. The PR interval preceding the
pause is the same as that following the
pause.
Treatment: if symptomatic bradycardia
occurs, treatment will be similar to sinus
bradycardia.
Treatment: same treatment of second
degree heart block type II.
Treatment: if symptomatic bradycardia.
Intervention sequence:
[Link] 1 mg but do not rely on
atropine
[Link] pacing.
[Link] infusion at 5-10
mcg/kg/minute.
[Link] infusion at 2-10
mcg/minute.
[Link] or permanent transvenous
pacemaker can be inserted.
Third Degree AV Block
All atrial impulses are blocked in the AV
node or bundle branch system; resulting
in dissociation between the sinus or atrial
● Temporary pacemakers:
rhythm and the junctional or ventricular
escape rhythm controlling the ventricles. ● A temporary pacemaker is often
a. P waves: normal but inserted in an emergency. The
dissociated from QRS patient may show signs of
complexes. decreased cardiac output, such as
● PR interval: no relationship hypotension or syncope.
between P waves and QRS ● types of temporary pacemakers
complexes, so no consistent PR are available, including
intervals transvenous, pericardial, and
transcutaneous.
* Permanent pacemaker is used to treat
chronic heart conditions such as AV block.
It is surgically implanted, usually under
local anesthesia.