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Cardiac Dysrhythmias Sinus Dysrhythmias Bradycardia - A Sinus Rhythm That Is < 60 BPM Tachycardia - A Sinus Rhythm That Is > 100 BPM Respiratory Arrhythmia During Inspiration & Expiration, The R-R Interval Expands & Contracts R-R Interval Widens During Expiration

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Presentation Transcript
sinus dysrhythmias
Sinus Dysrhythmias
  • Bradycardia - A Sinus Rhythm That Is <60 BPM
  • Tachycardia - A Sinus Rhythm That Is > 100 BPM
slide5
Respiratory Arrhythmia
    • During Inspiration & Expiration, The R-R Interval Expands & Contracts
slide6
R-R Interval Widens During Expiration
  • R-R Interval Shortens During Inspiration
sinus arrest
Sinus Arrest
  • Sinus Arrest Occurs Because The Sinoatrial Node Ceases To Fire
escape or rescue beats
Escape Or Rescue Beats
  • Secondary Pacemakers Rescue The Heart & Create Escape Or Rescue Beats
slide10
Rescue Beats May Have Their Origin High Up In The Atria Or Down Low Close To The AV Node Or Even In The Ventricles.
slide11
If The Ectopic Pacemaker Is Close To The SA Node, It Will Be An Atrial Escape Beat. It Will Have These Features :
    • The Escape Beat Is Delayed
    • P Wave Is Irregularly Shaped
    • A Normal QRS Complex
slide14
Characteristics Of A Junctional Escape Beat :
    • A Rescue Beat Is Delayed
    • No P Wave
    • The QRS Is Normal
    • Rate Will Be Slower
slide16
If The Rescue Beat Is Located In The Ventricles, Then It Is A Ventricular Pacemaker That Is Activated To Rescue The Heart
slide17
Characteristics Of A Ventricular Rescue Beat Are :
    • No P Wave
    • A Rescue Beat Is A Delayed Beat
    • Wide Bizarre QRS Complex
    • Rate Will Be Very Slow
slide18
Ectopic Pacemakers Have Their Own Firing Rates
  • A Maxim : The Lower Your Go Into The Heart To Find A Pacemaker, The Slower The Rate
ectopic pacemaker rates
Ectopic Pacemaker Rates
  • Atrial Pacemakers ~ 60-80 BPM
  • Junctional Pacemakers ~ 40-60 BPM
  • Ventricular Pacemakers ~ 30-45 BPM
slide20
What Can Cause The SA Node To Go Into Sinus Arrest ?
    • Cardiovascular Disease
    • Increased Vagal Tone
    • Infection
    • Drugs - Digitalis, Quinidine
wandering pacemaker
Wandering Pacemaker
  • A Wandering Pacemaker Is A Condition In Which You Have Two Or More Pacemakers Competing For Control Over The Heart’s Rhythm
slide22
Characteristics Of A Wandering Pacemaker :
    • P Waves Have Different Shapes
    • PR Intervals Are Grossly Within Normal Limits But Are Slightly Variant From Each Other
    • QRS Complexes Are Normal
sick sinus syndrome
Sick Sinus Syndrome
  • Patient Hx. Of Supraventricular Tachdysrhythmias Like Atrial Fibrillation Or Atrial Flutter
  • Significant Ischemic Heart Disease
slide26
Sick Sinus Syndrome Characterized By :
    • Irregular Heart Rate Deteriorating Into Extreme Bradycardia
    • Episodes Of Syncope
    • Leads To Pacemaker Implant
ectopic supraventricular dysrhythmias
Ectopic Supraventricular Dysrhythmias
  • Unsustained SVTD’s:
    • PAC’s Or APB’s
    • PJB’s
premature atrial contractions pac s or apb s
Premature Atrial Contractions (PAC’s Or APB’s)
  • Characteristics Of PAC’s :
    • It Is A Premature Beat
    • P Wave Is Irregularly Shaped
    • Normal QRS
slide30
Causes Of PAC’s :
    • Stress
    • Caffeine
    • Tobacco Use
slide31
Digitalis Toxicity
  • Old MI’s
  • Low Blood Potassium Levels
  • Low Blood Magnesium Levels
slide34
PAC’s Can Deteriorate Into :
    • Atrial Flutter
    • Atrial Fibrillation
    • Supraventricular Tachycardia
premature junctional beats pjb s
Premature Junctional Beats (PJB’s)
  • PJB’s Occur from An Ectopic Focus Close To The AV Node
slide36
Characteristics Of PJB’s :
    • The Beat Is Premature
    • There is No P Wave
    • QRS Complex Is Normal
sustained supraventricular dysrhythmias
Sustained Supraventricular Dysrhythmias
  • Sustained SVTD’s Are :
    • PSVT or PAT
    • Atrial Flutter
    • Atrial Fibrillation
psvt or pat s
PSVT Or PAT’s
  • Common Dysrhythmia
  • Instigated Often By A Premature Atrial Beat Or A Premature Junctional Beat
slide40
Causes Are :
    • Ischemic Heart Disease
    • Re-Entry Phenomenon
    • Stress
    • Drugs
slide41
Characteristics Of PSVT Are :
    • P Waves Are Absent - P Waves Are Hidden If They Are Present
    • Repeating Pattern Of QRS-T
    • Very High Heart Rates Of 150 - 250 BPM
slide43
Carotid Massage Can Bring A Person Out Of PSVT
  • PSVT Can Be Stopped With Cardioversion, Valsalva & Coughing
exercise
Exercise
  • Can I Exercise A Patient With PSVT Or SVT ?
  • No !! This Patient Has An Uncontrolled Atrial Dysrhythmia
atrial flutter
Atrial Flutter
  • Atrial Flutter Is Also Known As The Sawtooth Pattern
slide46
Characteristics Of Atrial Flutter :
    • High Rate Of P Wave Appearance Of 250-350
    • QRS Complex Is Followed By A Regular Pattern Of P Waves - 2:1, 3:1 or 4:1 Block
slide47
QRS Complexes Are Normal & Regular
  • No Visible T Waves
  • No Visible S-T Segment
  • No Visible PR Interval
slide48
Causes Of Atrial Flutter :
    • Ischemic Heart Disease
    • PAC’s
    • Re-Entry Phenomenon
slide49
Pulmonary Emboli
  • Stress
  • MI’s
  • Cor Pulmonale
  • Valvular Heart Disease
exercise51
Exercise
  • Can I Exercise A Patient With Atrial Flutter ?
  • No !! This Patient Has An Uncontrolled Atrial Dysrhythmia
atrial fibrillation
Atrial Fibrillation
  • Some Causes Are :
    • MI’s
    • Pulmonary Embolism
    • Hypertension
    • CAD
    • Heart Valve Disease
slide53
Characteristics Are :
    • High Rates Of Atrial Discharge Of Between 350-500 BPM
    • Flat Or Undulating Baseline
    • Absent P Waves
    • Irregularly Timed Normal QRS Complexes
exercise56
Exercise
  • Can I Exercise A Patient In Atrial Fibrillation ?
  • NO !! - The Patient Has An Uncontrolled Atrial Dysrhythmia
symptoms
Symptoms
  • What Will The Patient Feel With A Supraventricular Tachydysrhythmia ?
    • Lightheadedness
    • Dizziness Or Syncope
    • Shortness Of Breath
    • Palpitations
    • Angina
slide58
Can A Patient Chronically Live With These Dysrhythmias ?
  • Yes, But There Are Some Inherent Dangers !
inherent dangers
Inherent Dangers
  • Supraventricular Tachydysrhythmias Can Cause The Formation Of Blood Clots In The Atria.
slide60
Patients Can Auto-Embolize Organ Systems If The Heart Spontaneously Converts Out Of The Dysrhythmia