ATRIAL TACHYCARDIA ATRIAL FLUTTER ATRIAL FIBRILLATION JUNCTIONAL RHYTHMS

BY: JACQUELYN FAITH P. DAPUL, RN MSN CABANATUAN BATCH III ADVANCED ADULT NURSING IV

Atrial tachycardia is a form of SVT or supraventricular tachycardia resulting from a disturbance to the standard rhythm of the heart within the atria itself.

ATRIAL TACHYCARDIA, WHAT IS IT?

The majority of cases occur in normal, healthy hearts where such an anomaly is completely harmless. However, Atrial tachycardia can also be the result of an abnormal heart structure or could be a symptom of recent surgery within the heart itself.

In extreme cases such a disturbance could also be a symptom of congenital heart disease.

A heart beat that is regular but at a rate that is higher than the average Shortness of breath Dizziness Lasts for several minutes or hours

THE SYMPTOMS

Can be experienced from birth or can be a result of a weakening of the heart due to surgery or a previous cardiac arrest. Can also be initiated by the consumption of alcohol or drugs or could be the result of defects in the thyroid or adrenal gland.

THE CAUSE

The primary focus is to reduce the heart rate itself. This can take the form of blocking agents such as beta-blockers which work directly on the AV nodal or calcium channel blockers. If such medication is ineffective, Cardioversion may be considered.

INITIAL TREATMENT

ATRIAL FLUTTER

Atrial flutter (AFL) is a common abnormal heart rhythm. In AFL, the upper chambers (atria) of the heart beat too fast, which results in atrial muscle contractions that are faster than and out of sync with the lower chambers (ventricles).

With AFL, the electrical signal travels along a pathway within the right atrium. It moves in an organized circular motion, or "circuit," causing the atria to beat faster than the ventricles of your heart.

AFL is a heart rhythm disorder that is similar to the more common Atrial Fibrillation (AFib). In AFib, the heart beats fast and in no regular pattern or rhythm. With AFL, the heart beats fast, but in a regular pattern.

The fast, but regular pattern of AFL is what makes it special. AFL makes a very distinct "sawtooth" pattern on an electrocardiogram (ECG), a test used to diagnose abnormal heart rhythms.

Heart failure Previous heart attack Valve abnormalities or congenital defects High blood pressure Recent surgery Thyroid dysfunction Alcoholism (especially binge drinking) Chronic lung disease Acute (serious) illness Diabetes

RISK FACTORS

Heart palpitations (feeling like your heart is racing, pounding, or fluttering) Fast, steady pulse Shortness of breath Trouble with everyday exercises or activities Pain, pressure, tightness, or discomfort in your chest Dizziness, lightheadedness, or fainting

THE SYMPTOMS

AFL itself is not life threatening. If left untreated, the side effects of AFL can be potentially life threatening.
AFL makes it harder for the heart to pump blood effectively. With the blood moving more slowly, it is more likely to form clots. If the clot is pumped out of the heart, it could travel to the brain and lead to a stroke or heart attack.

COMPLICATIONS

ATRIAL FIBRILLATION

Atrial fibrillation occurs when the upper chambers of the heart, or atria, fibrillate. This means that they beat very rapidly and irregularly.
Blood is not pumped efficiently to the rest of the body which may cause you to feel weak or tired, or to experience uncomfortable heart sensations like a racing or irregular heartbeat.

WHAT IS A-FIB?

ECG of Atrial Fibrillation (top) and Normal Sinus Rhythm (bottom). The purple arrow indicates a P wave, which is lost in Atrial Fibrillation.

Heart palpitations, which may include irregular, thumping, or pounding heartbeats A feeling the heart is racing Chest discomfort or pain Fainting or light-headedness Fatigue, shortness of breath, or weakness

SIGNS AND SYMPTOMS

AF Category First detected Paroxysmal Persistent Permanent

Defining Characteristics only one diagnosed episode recurrent episodes that self-terminate in less than 7 days. recurrent episodes that last more than 7 days an ongoing long-term episode

CLASSIFICATION SYSTEM

All atrial fibrillation patients are initially in the category called first detected AF. These patients may or may not have had previous undetected episodes. If a first detected episode self-terminates in less than 7 days and then another episode begins later on, the case has moved into the category of paroxysmal AF.

Although patients in this category have episodes lasting up to 7 days, in most cases of paroxysmal AF the episodes will self-terminate in less than 24 hours. If instead the episode lasts for more than 7 days, it is unlikely to self-terminate, and it is called persistent AF.

In this case, the episode may be still terminated by cardioversion. If cardioversion is unsuccessful or it is not attempted, and the episode is ongoing for a long time (e.g., a year or more), the patient's AF is called permanent.

JUNCTIONAL RHYTHMS

Describes an abnormal heart rhythm resulting from impulses coming from a locus of tissue in the area of the atrioventricular node, the "junction" between atria and ventricles.

occurs when the SA node fails and the AV node takes over as the primary pacemaker.

Rate: 40-60 Rhythm: Regular

JUNCTIONAL RHYTHM

P Waves: Absent or inverted PR Intervals: Not measurable, unless P wave is inverted and present R-R Intervals: Equal QRS Complexes: Normal and after each inverted P wave, if present

Rate: 60-100 Rhythm: Regular

ACCELERATED JUNCTIONAL RHYTHM

P Waves: Absent or inverted PR Intervals: Not measurable, unless P wave is inverted and present R-R Intervals: Equal QRS Complexes: Normal and after each inverted P wave, if present

Rate: > 100 Rhythm: Regular

JUNCTIONAL TACHYCARDIA

P Waves: Absent or inverted PR Intervals: Not measurable, unless P wave is inverted and present R-R Intervals: Equal QRS Complexes: Normal and after each inverted P wave, if present

When a junctional rhythm (rate 40-60 beats per minute) occurs, it is actually a backup pacemaker and is a design feature of the heart. Without a backup, when the SA node fails, the heart may stop.

Depending on the heart rate, patients with junctional rhythms may complain of slow rates, lightheadedness or dizziness if the rate is slow or rapid rates if the rate is fast. Treatment is directed at first determining the underlying cause and then taking appropriate action.

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