CARDIAC ARRHYTHMIA

CARDIAC ARRHYTHMIA

CARDIAC ARRHYTHMIA 

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 Normal Sinus rhythm

  • Cardiac Rhythm originate from SA node
  • Arterial and ventricular rhythm are regular
  • HR is b/w 60 -100b/min
  • PR interval and QRS complex are normal
  • This is normal ECG and no intervention is needed

Sinus bradycardia

  • Rate is less than 60b/min
  • Rhythm is normal
  • Conduction is normal





Causes
  • Sports man
  • Vagus stimulation (parasympathetic)
  • Raised ICP
  • Hypothermia
  • Mix edema (hypothyroidism)
  • Obstructive jaundice
  • Due to some medicine (digitalis)
Management
  • Closely observe the patient for hypotension, pale and cold, clammy skin, confusion, mental cloudiness, and premature ventricular contraction
  • Administer atropine sulfate 0.6 to 1.2mg iv bolus or isoproterenol IV infusion

Sinus tachycardia

  • Impulse originate from SA node
  • HR is more than 100b/min
  • Normal P, QRS wave
Cause
  • Increased BMR
  • Fever
  • Infection
  • Hyperthyroidism
  • Hypoxia
  • Pain and mental stress
  • CHF
  • Shock
  • and due to some medication like bronchodilator, atropine, adrenalin
management

treat underline cause of tachycardia. If drug over dosage adjust the dosage

sinus arrhythmia

  • RR interval vary
  • But PQRST waves are normal
  • Rhythm is irregular
  • HR is increases during inspiration and decrease during expiration
Management

sinus arrhythmias is a normal  and occur in adolescent and young adult no treatment is required. But close observe the patient for chest pain and atrial dysrhythmias

premature atrial contraction
  • RR interval vary with a compensatory pose
  • After PAC rate varies, rhythm irregular
  • RR interval of premature beats is shorter than normal

Cause

  • Damage to the atrial wall
  • Hypoxia
  • CHF
  • Digitalis over dose
  • Hypokalemia

Management

  • Monitor the patient continuously and inform the doctor if more than 8 PAC appear/Minuit and administer medication
  • If digitalis over dose is suspected with hold the drug
  • Monitor potassium level and if low correct the level
  • Quinidin and varapamil are the drug of choice
Paroximal atrial tachycardia
  • HR is 150 to 250b/min
  • P waves are difficult to identify
  • QRS complex are normal
  • Rhythm is regular

Cause

  • Damage to the SA node
  • Irritability of atrial muscle
  • Stimulation of sympathetic nerve
  • Hypoxia
  • CHF
  • Digitalis over dose
  • Physical and mental stress

Management

  • If it is due to digitalis over dose stop the medicine
  • This arrhythmia can abolish by valsavamanual or carotid sinus pressure
  • Drug therapy include varapamil, propanol
  • Correct the potassium level by infusion of Kcl
  • It can be corrected by cardioversion if necessary
Atrial flutter
  • P wave form a saw toothed pattern
  • There are more than one P wave b/w to consecutive QRS complex
  • Atrial rate is b/w 250 to 350b/min but ventricle rate is less than atrial rate
  • PR interval can not measure

Cause

  • Damage to the SA node or atria
  • Increased sympathetic stimulation
  • Hypoxia
  • CHF

management

  • Monitor patient continual for weak or absent pulse, hypotension and pale ,cold and calmmy skin
  • Medication digoxin or proparnol
  • In resistance case provide elective cardio version

Atrial fibrillation

  • No regular P waves
  • P waves are appear as a wave base line
  • Atria contract 350-600 b/min
  • Rhythm irregular
  • PR interval con not be measures

Cause

  • CAD
  • RHD (rheumatic heart diseases)
  • Cardiomyopathy
  • ASD
  • Hypertension
  • Chronic pulmonary condiction

Management

  • Administer digoxin and varapamil
  • Administer O2
  • Prepare the patient for cardio version
  • If the cause is CAD administer anticoagulant

Premature ventricular contraction (pvc)

  • PVC are occurring as a result from increased irritability of the ventricle
  • There is no P wave
  • QRS complex is wide with T wave inversion
  • Rate is variable
  • Rhythm is irregular
  • PVC frequently occur in repetitive rhythm such as
    • Bigemine :- PVC every second heart beats
    • Trigemine :- PVC every third heart beat
    • Quartygemine :- PVC every 4th  heart beat
  • QRS complex may multi focal or unifocal
  • Unifocal means uniform upward or down ward depletion, arising from same ectopic focus
  • Multifocal means different shape with impulse generating from different side
  • R on T phenomena :- PVC fall on preceding T wave which is consider as vulnerable period may cause VF

 Cause

  • Hypokalemia
  • Hypoxia
  • Acute CAD
  • Acute myocarditis
  • Cardiomyopathy
  • Hypertension
  • Excessive use of tobacco or tea
  • Digitalis over dose

Management

  • Notify the physician if PVC are noted
  • Identify the cause and treat based on the cause
  • Administer the O2
  • Evaluate electrolyte particularly K+
  • Administer Lidocane

Ventricular tachycardia ( VT )





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  • No P waves
  • QRS complex are wide
  • Rate is variable 100 -250b/min
  • Rhythm regular or slightly irregular

Cause

  • Myocardial damage
  • MI
  • Myocarditis
  • Cardiomyopathy
  • HT
  • Digitalis overdose
  • Mitral valve prolapsed

Management

  • A stable client with sustained VT
    • Administer O2
    • Intravenous lidocane 50 to 100mg iv bolus, followed by IV infusion at a rate of 2- 3 mg/minute is the treatment of choice
  • Unstable client with VT
    • Administer O2
    • Administer antidysrhythmic xylocane
    • Attempt cough CPR by asking the client to cough 1 to 3 sec
    • If not effective prepare the patient for cardio version
  • Pulse less or unconscious patient
    • Defibrillate and CPR

 

Ventricular fibrillation ( VF )
  • It is a lethal cardiac dysrhythmias
  • characterized by a wavy base line
  • No QRS complex
  • Rate is not countable
  • There is no pulse or apical impulse
  • Regular QRS complex are absent
  • There is no P wave ,QRS complex, ST segment, and T wave. Instead ,cardiac activity represent by only irregular variable waves

Cause

  • Same like VT

Management

  • Defibrillate immediate up to 3 times consequently at 200j 300j, and 360j
  • Imitate CPR and administrate O2
  • Administer epinephrine or adrenalin and xylocard
AV BLOCK (atrioventricular block )
  • PR interval is greater than 0.20 sec

Cause

  • Over dose of digitalis
  • damage of AV node due to MI
  • degeneration of conduction system
  • myocarditis
  • acute rheumatic fever
  • medication like beta blocker

management

  • monitor the patient care fully
  • withhold the medication if it is due to medication over dose
  • if asymptomatic no treatment is require
2nd degree AV block

Types

  • mobitz type 1:-
    • PR interval is progressively prolonged until finally a QRS complex is draw
    • Rate is variable
    • Atrial rate is faster than ventricular rate
    • Rhythm irregular
    • Cause same as AV block
  • Mobitz type 2
    • QRS complex is present after a period only(after every 2nd , 3rd , 4th P wave)
    • Rate variable
    • P waves are present more than QRS complex
    • Bradycardia may be serious effect on circulation by reducing the cardiac output
    • It produce the a condition known as stoke’s adams syndrome (it is a sudden recurrent episode of loss of consciousness  due to heart block

Management

  • If the cause is drug over dose stop the medicine
  • Administer atropine or isopronol
  • Use pace maker
3rd  degree block
  • P wave has no relationship with QRS complex
  • Atrial rate is normal, but ventricle rate is b/w 35- 60b/min
  • Rhythm is irregular since atria and ventricle produce it own impulse each other
  • There is no relationship b/w QRS and P wave which lead to extreme bradycardia, stoke’s adams syndrome, cardiac failure, and shock

Management

  • Administer atropine or isopronol
  • Use pace maker

 

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