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Cardiac Dysrhythmias: Causes, Symptoms & Treatment

Explore the complexities of cardiac dysrhythmias in the cardiovascular system, including sinus bradycardia, sinus tachycardia, and atrial dysrhythmias. Learn about their etiology, symptoms, and treatment options. Stay informed for better patient care.

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Cardiac Dysrhythmias: Causes, Symptoms & Treatment

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  1. Nursing 202 Module B Cardiovascular System Alterations

  2. CARDIAC DYRHYTHMIAS

  3. REVIEW OF CONDUCTION

  4. ELECTRICAL CONDUCTION • SINOATRIAL NODE (SA) • INTRAATRIAL FIBER (BACHMAN’S BUNDLE) • INTRANODAL TRACTS • ATRIOVENTRICULAR (AV) NODE • BUNDLE OF HIS (COMMON BUNDLE) • BUNDLE BRANCHES • PURKINJE FIBERS

  5. TERMINOLOGY • WAVE- POSITIVE OR NEGATIVE DEFLECTION GENERALLY BEGINS AND ENDS AT THE BASELINE, REPRESENTING DEPOLARIZATION OR REPOLARIZATION • SEGMENT- LENGTH OF BASELINE BETWEEN 2 WAVES NAMED BY THE WAVE BEFORE AND AFTER • INTERVAL-LENGTH OF A WAVE OR THE LENGTH OF A WAVE WITH THE SEGMENT THAT FOLLOWS • COMPLEX-GROUP OF WAVES THAT FOLLOW ONE AFTER ANOTHER

  6. PR INTERVAL • REPRESENTS TIME FROM THE BEGINNING OF ATRIAL DEPOLARIZATION TO THE BEGINNING OF VENTRICULAR DEPOLARIZATION, MEASURED FROM THE BEGINNING OF THE P WAVE TO THE BEGINNING OF THE QRS COMPLEX (O.12-O.20)

  7. QRS INTERVAL • REPRESENTS THE LENGTH OF TIME FOR DEPOLARIZATION OF THE VENTRICULAR MUSCLE AND IS MEASURED FROM THE BEGINNING OF THE QRS COMPLEX TO THE END OF THE S WAVE, SHOULD MEASURE BETWEEN 0.06-0.10 SECONDS IN DURATION

  8. ST INTERVAL • REPRESENTS THE TOTAL LENGTH OF TIME FOR VENTRICULAR MUSCLE TO BE DEPOLARIZED AND REPOLARIZED, MEASURED FROM THE BEGINNING OF THE QRS COMPLEX TO THE END OF THE T WAVE, NORMAL RANGE IS 0.32-0.42

  9. INHERENT RATES • SA 60-100 • AV JUNCTION 40-60 • VENTRICULAR 20-40

  10. SINUS DYSRHYTHMIA • OCCURS IF THE P - P INTERVAL VARY BY MORE THAN 0.16 . LESS THAN O.16 IS CONSIDERED NORMAL BECAUSE OF THE FLUCTUATION OF THE SYMPATHETIC/ PARASYMPATHETIC STIMULATION • ASSOCIATED WITH RESPIRATION IN CHILDREN AND ELDERLY

  11. SINUS BRADYCARDIA • HR < 60/MIN ARISING FROM THE SA NODE. • IMPULSES FOLLOW THE NORMAL PATHWAY THROUGH THE CONDUCTION SYSTEM • P AND QRS COMPLEXES NORMAL DURATION AND PATTERN

  12. ETIOLOGY • INCREASED VAGAL STIMULATION • MAY BE A NORMAL VARAITION IN ALTHLETES AND HEALTHY YOUG ADULTS • MEDICAL CONDITIONS: • ANOREXIA NERVOSA • ATHEROSCLEROTIC HEART DISEASE • HYPOENDOCRINE STATES • HYPOTHERMIA • INCREASED INTRACRANIAL PRESSURE • MYOCARDIAL INFARCTION • MEDICATIONS: • ANTIHYPERTENSIVES • BETA BLOCKERS • CALCIUM CHANNEL BLOCKERS • CNS DEPRESSANTS • DIGOXIN

  13. SYMPTOMS • SYMPTOMS RELATED TO DECREASE IN CARDIAC OUTPUT • CHEST PRESSURE AND PAIN • DYSPNEA • HYPOTENSION • DIZZINESS • SEIZURES • SYNCOPE

  14. TREATMENT • MANAGEMENT -ONLY IF SYMPTOMATIC- • AIMED AT INCREASING THE HEART RATE • MEDICATIONS • ATROPINE • ISOPROTERENOL • PACEMAKER • SUPRESSION OF THE PARASYMPATHETIC NERVOUS SYSTEM • STIMULATION OF THE SYMPATHETIC NERVOUS SYSTEM

  15. SINUS TACHYCARDIA • HR OF 100-160/ MIN • NORMAL RESPONSE TO SYMPATHETIC NERVOUS SYSTEM STIMULATION • ANY CONDITION THAT PRODUCES AN INCREASE IN METABOLIC RATE

  16. ETIOLOGY • DIET – CAFFEINE • LIFE-STYLE – SMOKING / NICOTINE • MEDICAL CONDITIONS – ANEMIA, HEMORRHAGE, FEVER, HYPOTENSION, PAIN, SHOCK • MEDICATIONS – CENTRAL NERVOUS SYSTEM STIMULANTS • MYOCARDIAL DAMAGE

  17. SYMPTOMS • PRIMARY SYMPTOMS RELATED TO DECREASED CARDIAC OUTPUT • CHEST PRESSURE AND PAIN • DYSPNEA • A CHARACTERISTIC “FLUTTERING” IN THE CHEST • DIZZINESS • SYNCOPE

  18. TREATMENT • ELIMINATE THE CAUSE OF THE TACHYCARDIA • MEDICATIONS: • CALCIUM CHANNEL BLOCKERS • DIGOXIN • BETA BLOCKERS • ANTIANXIETY AGENTS • ADENOSINE • CAROTID MASSAGE

  19. ATRIAL DYSRHYTHMIAS • IMPULSE ARISES OUTSIDE THE SINO ATRIAL NODE • P WAVES DIFFER IN CONFIGURATION • TYPES • WANDERING ATRIAL PACEMAKER • PREMATURE ATRIAL CONTRACTIONS • PAROXYSMAL ATRIAL TACHYCARDIA • ATRIAL FLUTTER • ATRIAL FIBRILLATION

  20. ETIOLOGY • CARDIAC DISEASE • ISCHEMIA • CORONARY ARTERY DISEASE • CONGESTIVE HEART FAILURE • MYOCARDIAL INFARCTION • INCREASED VAGAL STIMULATION • MEDICATIONS

  21. PREMATURE ATRIAL CONTRACTIONS • MOST COMMON ECTOPIC BEAT • OCCURS WHEN IMPULSE IS GENERATED BY AN IRRITABLE AREA OF TISSUE IN THE ATRIA • ABNORMALLY SHAPED P WAVE • QRS COMPLEX NOT AFFECTED

  22. ETIOLOGY • CARDIAC DISEASE • CHRONIC OBSTRUCTIVE PULMONARY DISEASE • MEDICATIONS: CENTRAL NERVOUS SYSTEM STIMULANTS • DIET: CAFFEINE • ELECTROLYTE DISTURBANCES • ANXIETY • LIFE STYLE: EXERCISE, ALCOHOL, NICOTINE

  23. SYMPTOMS • FEELINGS OF PALPITATIONS OR “SKIPPED BEAT”

  24. TREATMENT • TREATMENT DIRECTED TOWARD CAUSE • TREATMENT NOT NECESSARY IF LESS THAN 6 PER MINUTE • DECREASE CAFFEINE CONSUMPTION • DECREASE STRESS • MEDICATIONS: • ANTIANXIETY AGENTS • BETA BLOCKERS • CALCIUM CHANNEL BLOCKERS

  25. PAROXYSMAL ATRIAL TACHYCARDIA • Caused by an irritable area of tissue in the atria that dominates the sinoatrial node and takes over as the pacemaker • Usually preceded by premature atrial contractions • Begin and end abruptly • The raid rate prevents adequate ventricular filling

  26. ETIOLOGY • SAME AS SEEN WITH PREMATURE ATRIAL CONTRACTIONS • NOT USUALLY ASSOCIATED WITH ORGANIC HEART DISEASE

  27. SYMPTOMS • CHEST PAIN • DYSPNEA • HYPOTENSION • PALPITATIONS • WEAK RAPID PULSE • DIZZINESS • SYNCOPE

  28. TREATMENT • CAROTID SINUS PRESSURE • VAGAL NERVE STIMULATION • MEDICATIONS: • DILTIAZEM • VERAPAMIL • DIGOXIN • PROPRANOLOL • PROCAINAMIDE • QUINIDINE • VASOPRESSOR

  29. ATRIAL FLUTTER • ATRIAL ECTOPIC PACER FIRES AT A RATE OF 250-400/ MIN • OCCURS IN A VARIETY OF HEART DISEASES- RHEUMATIC, CORONARY, HYPERTENSIVE, ALSO CARDIOMYOPATHY, HYPOXIA, HEART FAILURE, • MAY BE ASYMPTOMATIC OR HAVE PALPITATIONS • MANAGEMENT- DIGITALIS, BETA BLOCKERS, CALCIUM CHANNEL BLOCKERS, MAY USE CARDIOVERSION

  30. ATRIAL FIBRILLATION • SEVERAL ECTOPIC FOCI CAUSING THE ATRIA TO QUIVER RATHER THAN CONTRACT. • RATE >400 • VENTRICULAR RATE DEPENDS ON THE NUMBER OF IMPULSES CONDUCTED THRU THE AV NODE • MANAGEMENT- DIG., BETA BLOCKERS, CALCIUM CHANNEL BLOCKERS, COUNTERSHOCK

  31. AV HEART BLOCKS • ABNORMAL DELAY IN CONDUCTION OF IMPULSE FROM THE ATRIUM TO THE VENTRICLES • USUALLY ASYMPTOMATIC

  32. FIRST DEGREE • DELAY OCCURS AT THE AV NODE PRODUCING A PROLONGED PR INTERVAL > .20.

  33. ETIOLOGY • COMMON OCCURANCE IN NORMAL HEARTS • CARDIAC DISEASE INCLUDING: • ARTERIOSCLEROTIC HEART DISEASE, MYOCARDITIS, ORGANIC HEART DISEASE, MYOCARDIAL INFARCTION • MEDICATIONS: • BETA BLOCKERS • CALCIUM CHANNEL BLOCKERS • DIGITALIS TOXICITY

  34. TREATMENT • USUALLY NOT NECESSARY UNLESS THE BLOCK THAT IS CAUSED BY MEDICATION THAT CAN BE MODIFIED OR WITHHELD

  35. SECOND DEGREE HEART BLOCK • TYPE I- MOBITZ I OR WENCKEBACH- PROGRESSIVE LENGTHENING OF THE PR INTERVAL UNTIL A QRS COMPLEX IS DROPPED OR NOT CONDUCTED • USUALLY ASYMPTOMATIC • TX- MAYBE NONE, ATROPINE, TEMP. PACER

  36. SECOND DEGREE- TYPE II • EVERY SECOND THIRD OR FOURTH SINUS IMPULSE IS BLOCKED MAY HAVE 2,3,4 Ps TO EACH QRS • MORE SERIOUS- AGGRESSIVE MANAGEMENT TO PREVENT PROGRESSION TO COMPLETE HEART BLOCK • TREATMENT: • PACER • ATROPINE • DOPAMINE FOR SEVERE HYPOTENSION

  37. THIRD DEGREE HEART BLOCK • TOTAL DISASSOCIATION OF ATRIA TO VENTRICLES. VENTRICLES ARE STIMULATED BY A SECONDARY OR ESCAPE BEAT. THE VENTRICULAR RATE WILL BE 40-60 DEPENDING UPON THE LOCATION OF THE VENTRICULAR PACEMAKER • BOTH THE SINUS P WAVE AND THE ESCAPE RHYTHM WILL BE OBVIOUS ON THE ELECTROCARDIOGRAM • ETIOLOGY – • CARDIAC DISEASE • MEDICATIONS – BETA BLOCKERS, CALCIUM CHANNEL BLOCKERS, DIGITALIS TOXICITY • MANIFESTATIONS- FATIGUE, HYPOTENSION, SYNCOPE, HEART FAILURE • TX.- ATROPINE, ISOPROTERENOL, DOPAMINE, PACER

  38. JUNCTIONAL RHYTHMS • RATE 40- 60 • THE DOMINANT PACER OF THE HEART FAILS , RETROGRADE OR BACKWARD STIMULATION OF THE ATRIA- PRODUCING A CHARACTERISTIC P WAVE - MAY BE A NEGATIVE DEFLECTION BEFORE OR AFTER THE QRS COMPLEX OR NO P WAVE AT ALL

  39. ETIOLOGY • CORONARY ARTERY DISEASE • CONGESTIVE HEARAT FAILURE • MYOCARDIAL INFARCTION • CAFFEINE • ANXIETY • ALCOHOL, TOBACCO

  40. SYMPTOMS • FEELINGS OF • PALPITATIONS • FLUTTERING • “SKIPPED BEATS”

  41. MANAGEMENT • TX UNDERLYING CAUSE • MODIFY DIET / LIFESTYLE • REDUCE STRESS • MEDICATIONS : • QUINIDINE

  42. PREMATURE JUNCTIONAL CONTRACTIONS • AN IRRITABLE JUNCTIONAL FOCUS DISCHARGES AN IMPULSE BEFORE THE SINOATRIAL NODE FIRES • ABNORMAL P WAVES CAN PRECEDE, FOLLOW, OR OCCUR SIMULTANEOUSLY WITH THE QRS COMPLEX • VENTRICULAR CONTRACTION IS USUALLY NORMAL • MAY BE FOLLOWED BY AN INCOMPLETE OR COMPENSATORY PAUSE • MAY OCCUR LATE IN THE CYCLE AND IS REFERRED TO AS JUNCTIONAL ESCAPE BEATS • ETIOLOGY, SYMPTOMS, AND TREATMENT IS THE SAME AS LISTED UNDER JUNCTIONAL RHYTHMS

  43. PAROXYSMAL JUNCTIONAL TACHCARDIA • A CLUSTER OF THREE OR MORE PREMATURE JUNCTIONAL CONTRACTIONS FIRING AT A RATE OF MORE THAN 150 BEATS/ MINUTE • ETIOLOGY IS THE SAME AS LISTED UNDER JUNCTIONAL RHYTHMS

  44. SYMPTOMS • MAY BE ASYMPTOMATIC IS RATE IS LESS THAN 150 BEATS/ MINUTE • AT RATES GREATER THAN 150 BEATS/ MINUTE: • CHEST PAIN, PRESSURE, PALPITATIONS, DIZZINESS, SYNCOPE

  45. TREATMENT • MEDICATIONS: • CALCIUM CHANNEL BLOCKER • CENTRAL NERVOUS SYSTEM • DEPRESSANTS • DIGOXIN • VAGAL STIMULATION • CARDIOVERSION

  46. JUNCTIONAL ESCAPE BEATS • BEATS THAT OCCUR WHEN THE AV JUNCTION TAKES OVER THE PACEMAKER ACTIVITY • OCCUR LATE IN THE CYCLE

  47. ETIOLOGY • RHEUMATIC HEART DISEASE • MYOCARDIAL INFARCTION • SINUS ARRHYTHMIAS: • BRADYCARDIA • BLOCK • ARREST • MEDICATIONS • BETA BLOCKERS • CALCIUM CHANNEL BLOCKERS • CENTRAL NERVOUS SYSTEM DEPRESSANTS • DIGOXIN • NARCOTICS • SEDATIVES

  48. SYMPTOMS • MOST ARE ASYMPTOMATIC • FEELINGS OF • PALITATIONS • FLUTTERING • “SKIPPED BEATS”

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