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BSN3D
DYSRRYTHMIAS
1. Sinus node
arrhythmias
a. Sinus
Bradycardia
b. Sinus
Tachycardia
DESCRIPTION
CAUSES
Lower metabolic
needs (sleep, athletic
training,
hypothermia,
hypothyroidism),
vagal stimulation
(vomiting,
suctioning, severe
pain, extreme
emotions), meds (cachannel blockrs, betablockers), increased
intracranial pressure,
MI
Acute blood loss,
anemia, shock,
hypervolemia,
hypovolemia, CHF,
pain, hypermetabolic
states, fever, exercise,
anxiety
ECG TREATMENT
TREATMENT
NSG
INTERVENT
ION
Calcium channel
blockers and betablockers may be
used to decrease
heart rate quickly
Monitor signs
of circulation,
pulmonary
edema
c. Sinus
Arrhythmia
2. Atrial
Arrhythmias
a. Premature
Atrial
Complex
A single ECG
complex that occurs
when an electrical
impulse starts
in the atrium before
the next normal
impulse of the sinus
node.
Caffeine, alcohol,
nicotine, stretched
atrial myocardium,
anxiety, hypokalemia,
hypermetabolic rates,
atrial ischemia, injury
or infarction
Sinus arrhythmia
does not cause any
significant
hemodynamic
effect and usually is
not treated.
Monitor for
any signs of
complication:
increased
heart rate,
DOB, SOB,
circulatory
parameters
If PACs are
infrequent, no
treatment is
necessary. If they are
frequent (more than
6 per minute), this
may herald a
worsening
disease state or the
onset of more
serious
dysrhythmias, such
as
atrial fibrillation.
Treatment is
directed toward the
cause.
Constantly
monitor ECG
results of the
patient as well
as patients
tolerance for
the
medications.
b. Atrial Flutter
Advanced age,
valvular heart
disease, CAD, HPN,
cardiomyopathy,
hyperthyroidism,
pulmonary disease,
acute moderate to
heavy ingestion of
alcohol (holiday
heart syndrome), or
the aftermath of open
heart surgery.
c. Atrial
Fibrillation
Causes a rapid,
disorganized and
uncoordinated
twitching of atrial
musculature. It may
start and stop
suddenly.
Advanced age,
valvular heart
disease, CAD, HPN,
cardiomyopathy,
hyperthyroidism,
pulmonary disease,
acute moderate to
heavy ingestion of
If patient is unstable,
electrical
cardioversion is
usually indicated. If
the patient is stable,
diltiazem,
verapamil, betablockers, or digitalis
may be administered
IV to slow the
ventricular rate.
Monitor or
assess patient
for chest pain,
SOB, and low
blood pressure
Assess
patients
circulatory
and
respiratory
status.
3. AV Block
a. First-degree
b. 2nd-degree
disease of the
electrical conduction
system of the heart.
It is a conduction
block between the
atria and ventricles.
alcohol (holiday
heart syndrome), or
the aftermath of open
heart surgery.
who are
unresponsive
to medications.
AV nodal disease,
enhanced vagal tone
(for example in
athletes),
myocarditis, acute
myocardial infarction
(especially acute
inferior MI),
electrolyte
disturbances and
medication.
Treatment is
directed toward
increasing the heart
rate to
maintain a normal
cardiac output. If the
patient is stable and
has
no symptoms, no
treatment is
indicated other than
decreasing or
eradicating the cause
Advise and
instruct on
bedrest and to
limit activities
to level of
tolerance.
c. 3rd-degree
4. Junctional
Arrhythmias
occurs when no
atrial impulse is
conducted through
the AV node
into the ventricles.
derlying rhythm
PR interval: PR interval becomes
longer with each succeeding
ECG complex until there is a P wave
not followed by a
QRS. The changes in the PR interval
are repeated between
each dropped QRS, creating a
pattern in the irregular PR
interval measurements.
Ventricular and atrial rate: Depends
on the escape and underlying atrial rhythm
Ventricular and atrial rhythm: The
PP interval is regular and
the RR interval is regular; however,
the PP interval is not
equal to the RR interval.
QRS shape and duration: Depends
on the escape rhythm; in
junctional escape, QRS shape and
duration are usually normal, and in ventricular escape, QRS
shape and duration are
usually abnormal.
P wave: Depends on underlying
rhythm
PR interval: Very irregular
P: QRS ratio: More P waves than
QRS complexes
Based on the cause of the AV block
and the s
a. Premature
Junctional
Complex
An impulse that
Digitalis toxicity,
starts in the AV
CHF, and coronary
nodal area before the artery disease.
next normal sinus
impulse reaches the
AV node.
b. Junctional
Rhythm
c. Atrioventricul
ar Nodal
Reentry
Tachycardia.
Occurs when an
impulse is conducted
to an area in the AV
node that causes the
impulse to be
rerouted back into
the same area over
and over again at a
very fast rate.
Caffeine, nicotine,
hypoxemia, and
stress, CAD,
cardiomyopathy
Treatment for
frequent premature
junctional
complexes is the
same as for frequent
PACs.
Assess patient
for any signs
of distress
Junctional rhythm
may produce signs
and symptoms of reduced cardiac
output. If so, the
treatment is the
same as for sinus
bradycardia.
Emergency pacing
may be needed.
Note for
oxygenation
characteristics
of the patient.
Emphasize on
bedrest.
Promote sleep
and comfort.
Aimed at breaking
the reentry of the
impulse.
Vagal maneuvers,
gag reflex, breath
holding, and
immersing the face
in ice water,
increase
parasympathetic
stimulation, causing
slower conduction through the AV
Assess patient
for symptoms
of
restlessness,
chest pain,
SOB, pallor,
hypotension,
and loss of
consciousness
due to
decreased
cardiac output
5. Ventricular
Arrhythmias
a. Premature
Ventricular
Complex
b. Ventricular
Tachycardia
0.12 seconds
P: QRS ratio: 1:1, 2:1
an impulse that
starts in a ventricle
and is conducted through the
ventricles before the
next normal sinus
impulse.
Cardiac ischemia or
infarction, increased
workload on the
heart,
Digitalis toxicity,
hypoxia, acidosis, or
electrolyte
imbalances,
hypokalemia.
Lidocaine
(Xylocaine) is the
medication most
commonly used for
immediate, shortterm therapy
Emphasize on
bedrest and
limit activities
to level of
tolerance to
decrease
workload of
the heart.
Advise not to
do valsalva
maneuver.
Unstable:
cardioversion
Unconscious, wo
pulse: Defibrillation
Never leave
the patient
unattended.
Perform CPR
if needed.
c. Ventricular
Firbrillation
rapid but
disorganized
ventricular rhythm
that causes
ineffective quivering
of the ventricles.
Same as PVC
electrical shock and
Brugada syndrome