Caring for Clients with DYSRHYTHMIAS

CARDIAC RHYTHM
Pattern or pace of heart beat Normal sinus rhythm (NSR)

CHARACTERISTICS OF NSR
Heart rate is between 60 and 100 bpm The SA node initiates the impulse Impulse travels to the AV node in 0.12 to 0.2 second (the PR interval) Ventricles depolarize in 0.12 second or less Each impulse occurs regularly

DYSRHYTHMIA
Arrhhtmia Conduction disorder that results in abnormally slow or rapid heart rate Does not proceed through the conduction system in a usual manner Most common cause of dysrhythmia is ischemic heart disease

PREDISPOSING FACTORS
Drug therapy Electrolyte disturbances Metabolic acidosis Hypothermia Degenerative age related changes

CARDIAC DYSRHYTHMIAS DYSRHYTHMIAS ORIGINATING IN THE SINOATRIAL NODE

SINUS BRADYCARDIA
Proceeds normally through the conduction pathway but at a slower than usual rate (<60beats/minute) Reflects well toned heart conditioned through regular exercise Pathologic in clients with Heart disorders Increased intracranial pressure Hypothyroidism Digitalis toxicity

 Slow HR is insufficient to maintain CO Atropine sulfate IV is given

SINUS TACHYCARDIA
Proceeds normally through the conduction pathway but at a faster rate (100-150bpm) Physiologic response to strenuous activity Anxiety Fear Pain Fever Hyperthyroidism Hemorrhage Shock hypoxemia

PREMATURE ATRIAL CONTRACTIONS

Early electrical impulse Irregularity in underlying rhythm Initiated somewhere in the atria other than the SA node Consumption of caffeine Use of nicotine or other sympathetic nervous system stimulants Response to heart disease or hypothyroidism

SUPRAVENTRICULAR TACHYCARDIA
Dysrhythmias in which the heart rate is extremely high (>150 beats/minute) Diastole is shortened CO drops Tachycardia, angina Hypotension, syncope Reduced renal output Digitalis, CCB, adrenergic blockers

ATRIAL FLUTTER
Single atrial impulse outside the SA node causes the atria to contract at an exceedingly rapid rate (200 to 400 contractions/minute) AV node conducts only some impulses resulting in slower than atrial rate contractions Saw tooth pattern

ATRIAL FIBRILLATION
Several areas in right atrium initiates impulses resulting in disorganized rapid activity Atria quiver than contract Ibutilide (corvert) {use to convert new onset atrial fibrillation into sinus rhythm} Flecainide (Tambocor) {use to treat and prevent atrial fibrillation}

MANAGEMENT FOR FIBRILLATION

CHEMICAL CARDIOVERSION Use of drugs to eliminate dysrhythmias ELECTIVE CARDIOVERSION MAZE PROCEDURE Creation of new conduction pathway that eliminates rapid firing of ectopic pacemaker sites in the atria

DYSRHYTHMIA ORIGINATING IN THE ATRIOVENTRICULAR NODE

HEART BLOCK
Disorder in the conduction pathway that interfere with the transmission of impulses from SA node through the AV node May be first or second degree Complete heart block = atrial impulse never gets through Ventricular rate is slow (30 to 40 bpm) PACEMAKER insertion is the treatment for heart block

DYSRHYTHMIA ORIGINATING IN THE VENTRICLE

PREMATURE VENTRICULAR CONTRACTIONS

Ventricular contraction that occurs early and independently in the cardiac cycle before SA node initiates electrical impulses Often cause flip-flop sensation in the chest Sometimes describe as fluttering Pallor, nervousness, sweating, faintness Related to anxiety, stress, fatigue, alcohol withdrawal or tobacco use

VENTRICULAR TACHYCARDIA
Caused by single irritable focus in the ventricle that initiates the heartbeat Ventricles beat very fast (150-250bpm) CO is decreased May progress to ventricular fibrillation

VENTRICULAR FIBRILLATION
Rhythm of a dying heart PVCs or VT may precipitate it Indication for CPR and immediate defibrillation

PREDISPOSING FACTORS
Myocardial ischemia Lack of oxygenated blood to heart muscles CHF Inadequate ventilation Shock Anxiety Endocrine disorders Valvular heart diseases

ASSESSMENT
Weak and tired Anginal pain or faintness Palpitations or fluttering Low BP Apical and radial pulse differ Disoriented Confuse ELECTROPHYSIOLOGY STUDIES = origin 12 LEAD ECG = identification of dysrhythmias

DRUG THERAPY
Oral and IV antidysrhythmics Lidocaine hydrochloride (xylocaine) Procainamide hydrochloride (pronestyl) Verapamil hydrochloride (calan) Adenosin (Adenocard) Athropine sulfate Calcium chloride

ELECTIVE ELECTRICAL CARDIOVERSION

Non-emergency procedure to stop rapid atrial but necessarily life threatening dysrhytmia

DEFIBRILLATION
Only treatment for life treatening ventricular dysrhythmia Used during pulseless ventricular fibrillation and asystole

AUTOMATIC IMPLANTED CARDIAC DEFIBRILLATOR

PACEMAKERS
Provides electrical stimulus to the heart muscle to treat an ineffective bradydysrhythmia 2 divisions; temporary permanent

3 types of temporary pacemakers

TRANSTHORACIC PACEMAKER

Inserted during open heart surgery

3 types of temporary pacemakers

TRANSVENOUS PACEMAKERS Temporary pulse generating device Subclavian Jugular vein Cephalic vein

3 types of temporary pacemakers

TRANCUTANEOUS PACEMAKER Emergency measure for maintaining adequate HR Uses disposable, self adhering leads

PACEMAKER FUNCTION
1. DEMAND (SYCHRONOUS) MODE Self activating when pulse falls below certain level 2. FIXED RATE (ASYNCHRONOUS) MODE Produce electrical stimulus at preset rate despite the clients natural rhythm

RADIOFREQUENCY CATHETER ABLATION

END