Cardiac Arrhythmia

Cardiac Arrhythmia details

1. PRESENTED BY
Prof.VIJAYREDDY.V
PhD SCHOLAR, M.Sc(N), PGDHA,PGCDE,.
FACULTY
ESIC CON KALABURGI.

2. Heartrhythmproblems(heartarrhythmias)occurwhenthe
electricalimpulsesthatcoordinatesyourheartbeatsdon'twork
properly,causingyourhearttobeattoofast,tooslowor
irregularly.
Heartarrhythmias(uh-RITH-me-uhs)mayfeellikeaflutteringor
racingheartandmaybeharmless.However,someheart
arrhythmiasmaycausebothersome—sometimesevenlife-
threatening—signsandsymptoms.
Heartarrhythmiatreatmentcanoftencontroloreliminatefast,slow
orirregularheartbeats.Inaddition,becausetroublesomeheart
arrhythmiasareoftenmadeworse—orareevencaused—bya
weakordamagedheart,youmaybeabletoreduceyour
arrhythmiariskbyadoptingaheart-healthylifestyle.

3. heartismadeupoffourchambers—twoupperchambers(atria)andtwo
lowerchambers(ventricles).Yourheartrhythmisnormallycontrolled
byanaturalpacemaker(sinusnode)locatedintherightatrium.The
sinusnodeproduceselectricalimpulsesthatnormallystarteach
heartbeat.Theseimpulsescausetheatriamusclestocontractandpump
bloodintotheventricles.
Theelectricalimpulsesthenarriveataclusterofcellscalledthe
atrioventricular(AV)node.TheAVnodeslowsdowntheelectrical
signalbeforesendingittotheventricles.Thisslightdelayallowsthe
ventriclestofillwithblood.Whenelectricalimpulsesreachthe
musclesoftheventricles,theycontract,causingthemtopumpblood
eithertothelungsortotherestofthebody.
Inahealthyheart,thisprocessusuallygoessmoothly,resultingina
normalrestingheartrateof60to100beatsaminute.

4. What is an arrhythmia?
An arrhythmia (also called dysrhythmia) is an irregular
or abnormalheartbeat.

6. Tachycardia (tak-ih-KAHR-dee-uh).This refers to a
fast heartbeat —a resting heart rate greater than 100
beats a minute.
Bradycardia(brad-e-KAHR-dee-uh).This refers to a
slow heartbeat —a resting heart rate less than 60 beats
a minute.

7. Atrialfibrillation (AF)–thisis themost common type,
wherethe heart beatsirregularly and faster than normal
Supraventriculartachycardia–episodes of abnormally
fast heart rate at rest
bradycardia–the heart beats more slowly than normal
Heart block–the heart beats more slowly than normal
and can cause people to collapse
ventricular fibrillation –a rare, rapid and disorganised
rhythm of heartbeats that rapidly leads to loss of
consciousness and sudden death if not treated
immediately

8. Atrialfibrillation.Atrialfibrillationisarapidheartratecausedbychaotic
electricalimpulsesintheatria.Thesesignalsresultinrapid,uncoordinated,
weakcontractionsoftheatria.
ThechaoticelectricalsignalsbombardtheAVnode,usuallyresultinginan
irregular,rapidrhythmoftheventricles.Atrialfibrillationmaybetemporary,
butsomeepisodeswon'tendunlesstreated.
Atrialfibrillationisassociatedwithseriouscomplicationssuchasstroke.
Atrialflutter.Atrialflutterissimilartoatrialfibrillation.Theheartbeatsin
atrialflutteraremore-organizedandmore-rhythmicelectricalimpulsesthanin
atrialfibrillation.Atrialfluttermayalsoleadtoseriouscomplicationssuchas
stroke.
Supraventriculartachycardia.Supraventriculartachycardiaisabroadterm
thatincludesmanyformsofarrhythmiaoriginatingabovetheventricles
(supraventricular)intheatriaorAVnode.Thesetypesofarrhythmiaseemto
causesuddenepisodesofpalpitationsthatbeginandendabruptly.
Wolff-Parkinson-Whitesyndrome.InWolff-Parkinson-Whitesyndrome,a
typeofsupraventriculartachycardia,thereisanextraelectricalpathway
betweentheatriaandtheventricles,whichispresentatbirth.

9. Tachycardiasintheventricles
Tachycardiasoccurringintheventriclesinclude:
Ventriculartachycardia.Ventriculartachycardiaisarapid,regularheartratethat
originateswithabnormalelectricalsignalsintheventricles.Therapidheartratedoesn't
allowtheventriclestofillandcontractefficientlytopumpenoughbloodtothebody.
Ventriculartachycardiamaynotcauseseriousproblemsifyouhaveanotherwisehealthy
heart,butitcanbeamedicalemergencythatrequirespromptmedicaltreatmentifyou
haveheartdiseaseoraweakheart.
Ventricularfibrillation.Ventricularfibrillationoccurswhenrapid,chaoticelectrical
impulsescausetheventriclestoquiverineffectivelyinsteadofpumpingnecessaryblood
tothebody.Thisseriousproblemisfataliftheheartisn'trestoredtoanormalrhythm
withinminutes.
Mostpeoplewhoexperienceventricularfibrillationhaveanunderlyingheartdiseaseor
haveexperiencedserioustrauma.
LongQTsyndrome.LongQTsyndromeisaheartdisorderthatcarriesanincreased
riskoffast,chaoticheartbeats.Therapidheartbeats,causedbychangesintheelectrical
systemofyourheart,mayleadtofainting,andcanbelife-threatening.Insomecases,
yourheart'srhythmmaybesoerraticthatitcancausesuddendeath.

10. severalbradycardias,including:
Sicksinussyndrome.Ifyoursinusnode,whichis
responsibleforsettingthepaceofyourheart,isn'tsending
impulsesproperly,yourheartratemayalternatebetween
tooslow(bradycardia)andtoofast(tachycardia).Sicksinus
syndromecanalsobecausedbyscarringnearthesinus
nodethat'sslowing,disruptingorblockingthetravelof
impulses.Sicksinussyndromeismostcommonamong
olderadults.
Conductionblock.Ablockofyourheart'selectrical
pathwayscanoccurinorneartheAVnode,whichlieson
thepathwaybetweenyouratriaandyourventricles.Ablock
canalsooccuralongotherpathwaystoeachventricle.

11. A heart attack that's occurring right now
Scarring of heart tissue from a prior heart attack
Changes to your heart's structure, such as from
cardiomyopathy
Blocked arteries in your heart (coronary artery disease)
High blood pressure
Overactive thyroid gland (hyperthyroidism)
Underactive thyroid gland (hypothyroidism)
Diabetes
Sleep apnea
Infection with COVID-19

12. Smoking
Drinking too much alcohol or caffeine
Drug abuse
Stress or anxiety
Certain medications and supplements, including over-
the-counter cold and allergy drugs and nutritional
supplements
Genetics

13. Coronaryarterydisease,otherheartproblemsandpreviousheart
surgery.Narrowedheartarteries,aheartattack,abnormalheartvalves,priorheart
surgery,heartfailure,cardiomyopathyandotherheartdamageareriskfactorsforalmost
anykindofarrhythmia.
Highbloodpressure.Thisincreasesyourriskofdevelopingcoronaryarterydisease.It
mayalsocausethewallsofyourleftventricletobecomestiffandthick,whichcan
changehowelectricalimpulsestravelthroughyourheart.
Congenitalheartdisease.Beingbornwithaheartabnormalitymayaffectyourheart's
rhythm.
Thyroidproblems.Havinganoveractiveorunderactivethyroidglandcanraiseyour
riskofarrhythmias.
Diabetes.Yourriskofdevelopingcoronaryarterydiseaseandhighbloodpressure
greatlyincreaseswithuncontrolleddiabetes.
Obstructivesleepapnea.Thisdisorder,inwhichyourbreathingisinterruptedduring
sleep,canincreaseyourriskofbradycardia,atrialfibrillationandotherarrhythmias.
Electrolyteimbalance.Substancesinyourbloodcalledelectrolytes—suchas
potassium,sodium,calciumandmagnesium—helptriggerandconducttheelectrical
impulsesinyourheart.

14. Drugsandsupplements.Certainover-the-counter
coughandcoldmedicinesandcertainprescription
drugsmaycontributetoarrhythmiadevelopment.
Drinkingtoomuchalcohol.Drinkingtoomuch
alcoholcanaffecttheelectricalimpulsesinyourheart
andcanincreasethechanceofdevelopingatrial
fibrillation.
Caffeine,nicotineorillegaldruguse.Caffeine,
nicotineandotherstimulantscancauseyourheartto
beatfasterandmaycontributetothedevelopmentof
more-seriousarrhythmias.

15. Noticeable arrhythmia symptoms may include:
A fluttering in your chest
A racing heartbeat (tachycardia)
A slow heartbeat (bradycardia)
Chest pain
Shortness of breath
Other symptoms may include:
Anxiety
Fatigue
Lightheadednessor dizziness
Sweating
Fainting (syncope) or near fainting

16. Physical examination and complete history collection
Cardiac Catheterization
Cardiac CT Scan
Cardiac MRI
Chest X-Ray
Coronary Angiography
Echocardiography
Electrocardiogram (EKG), (ECG)
Stress Testing.

17. Electrocardiogram (ECG).During anECG, sensors (electrodes) that can
detect the electrical activity of your heart are attached to your chest and
sometimes to your limbs. AnECGmeasures the timing and duration of each
electrical phase in your heartbeat.
Holtermonitor.This portableECGdevice can be worn for a day or more to
record your heart's activity as you go about your routine.
Event recorder.For sporadic arrhythmias, you keep this portableECGdevice
available, attaching it to your body and pressing a button when you have
symptoms. This lets your doctor check your heart rhythm at the time of your
symptoms.
Echocardiogram.In this noninvasivetest, a hand-held device (transducer)
placed on your chest uses sound waves to produce images of your heart's size,
structure and motion.
Implantable loop recorder.If your symptoms are very infrequent, an event
recorder may be implanted under your skin in the chest area to continually
record your heart's electrical activity and detect abnormal heart rhythms.

18. Heartfailure.InaheartwithamediumorlargeVSD,
theheartneedstoworkhardertopumpenoughblood
tothebody.Becauseofthis,heartfailurecandevelopif
mediumtolargeVSDsaren'ttreated.
STROKE

19. Get early prenatal care, even before you're pregnant.Talk to your
doctor before you get pregnant about your health and discuss any
lifestyle changes that your doctor may recommend for a healthy
pregnancy. Also, be sure you talk to your doctor about any medications
you're taking.
Eat a balanced diet.Include a vitamin supplement that contains folic
acid. Also, limit caffeine.
Exercise regularly.Work with your doctor to develop an exercise plan
that's right for you.
Avoid risks.These include harmful substances such as alcohol,
tobacco and illegal drugs.
Avoid infections.Be sure you're up to date on all of your vaccinations
before becoming pregnant. Certain types of infections can be harmful
to a developing fetus.
Keep diabetes under control.If you have diabetes, work with your
doctor to be sure it's well-controlled before getting pregnant.

20. Prevention
To prevent heart arrhythmia, it's important to live a heart-healthy
lifestyle to reduce your risk of heart disease. A heart-healthy
lifestyle may include:
Eating a heart-healthy diet
Staying physically active and keeping a healthy weight
Avoiding smoking
Limiting or avoiding caffeine and alcohol
Reducing stress, as intense stress and anger can cause heart
rhythm problems
Using over-the-counter medications with caution, as some cold
and cough medications contain stimulants that may trigger a
rapid heartbeat

25. Calciumchannelblockers
Calciumchannelblockers,alsoknownas"calciumantagonists,"work
byinterruptingthemovementofcalciumintoheartandbloodvessel
tissue.Besidesbeingusedtotreathighbloodpressure,they'realsoused
totreatangina(chestpain)and/orsomearrhythmias(abnormalheart
rhythms).
Beta-blockers
Beta-blockersdecreasetheheartrateandcardiacoutput,whichlowers
bloodpressurebyblockingtheeffectsofadrenalin.They'realsoused
withtherapyforcardiacarrhythmiasandintreatinganginapectoris.
Anticoagulants
Anticoagulants(bloodthinners)workbymakingitharderforthe
bloodtoclot,orcoagulate.Theyaren'tdesignedtodissolveexisting
bloodclots.Theypreventnewclotsfromformingorexistingclots
fromgettinglarger.

26. Pacemaker–a small device containing its own battery
that is implanted in your chest under local anaesthetic;
it produces electrical signals to do the work of the
natural pacemaker in your heart to help it beat at a
normal rate
Cardioversion:a treatment that uses electricity to
shock the heart back into a normal rhythm while you
are anaesthetised or sedated
catheterablation –a keyhole treatment under local
or general anaesthetic that carefully destroys the
diseased tissue in your heart that causes the arrhythmia

27. Medication or Drug
ClassDosageDescriptionRationaleEpinephrine1 mg IV or
intraosseous(IO) 1:10,000 solution; repeat every 3–5
minCatecholamineCardiacstimulant.
AmiodaroneVFand pulselessVT: 300 mg IV or IO after
dose of epinephrine if no initial response to defibrillation;
repeat 150 mg IV in 3–5 min; Wide complex QRS: 150 mg
IV with
calcium chloride 1 gm IVAntidysrhythmicagentForVF
and pulselessVT; prolongs action potential and
repolarization
Lidocaine1–1.5 mg/kg of body weight IVAntidysrhythmic
agentManagesPVCs or VT with a pulse; inhibits
conduction of nerve impulse

28. 1.Decreased Cardiac Output
2.Activity Intolerance
3.Excess Fluid Volume
4.Risk for Impaired Gas Exchange
5.Risk for Impaired Skin Integrity
6.Deficient Knowledge
7.Acute Pain
8.Ineffective Tissue Perfusion

29. Cardiac dysrhythmiasassociated with altered myocardial automaticity, conductivity or contractility can
effect cardiac output. Reduced cardiac output increases the risk of ineffective tissue perfusion.
Assess for signs of ineffective tissue perfusion by system:
Renal
◦oliguriaor anuria
Gastrointestinal
◦nausea
◦hypoactive or absent bowel sounds
Peripheral
◦edema
◦altered skin color, temperature, sensation or integrity
◦weak or absent pulse
Cerebral
◦dizziness
◦altered mental status (anxiety, confusion, syncope)
◦altered pupillaryresponse
◦speech abnormalities
Cardiopulmonary
◦hypotension
◦abnormal respiratory rate
◦capillary refill >3 seconds
◦chest pain
◦dyspnea, crackles & wheezes
◦jugular vein distention

30. Nursing Intervention for Ineffective Tissue
Perfusion
Assess for and report signs/symptoms of cardiac
dysrhythmias(e.g. irregular apical pulse, adult
pulse rate below 60 or above 100 beats/minute,
apical-radial pulse deficit, syncope, palpitations).
Reduce cardiac workload
◦Position patient to minimizes discomfort and facilitate
respiration.
◦Minimize anxiety with calm reassurance and education.
◦Communicate rationale for monitoring and treatments.
◦Discuss the benefits calm with the patient and family.

31. Initiate EKG monitor and pulse oximetryper policy.
IV access, O
2, medication and 12 lead-EKG as ordered, monitor vital
signs.
◦Positive inotropicagents (e.g. dobutamine, dopamine) to increase myocardial
contractility
◦Vasodilators (e.g. nitroglycerin) to decrease cardiac workload
◦ACE inhibitors (e.g. captopril, ramipril) to decrease cardiac workload
◦Diuretics for elevated capillary wedge pressure
◦Morphine sulfateto reduce pain, preload and anxiety.
Anticipate the need to initiate cardiopulmonary resuscitation.
Assess for contributing factors: pain, fluid and electrolyte imbalance,
drug toxicity (especially digoxin), medication non-adherence.
Provide psychosocial support for patient and family members.
◦If the dysrhythmiais a life-threatening type, encourage the family unit to calmly
formulate a plan of action.
◦Reassure the patient will receive the best care in keeping with his written directives or
medical power of attorney.
◦Communicate the availability and value of social services as needed.

32. Patient teaching:
◦Importance of reporting chest pain, dyspnea, loss of
consciousness, confusion, etc.
◦Educate and prepare patient for planned treatments such
as:
Echo-cardiogram
Cardioversion
Pacemaker insertion
Catheter ablation
Central Venous Catheter insertion
Wellness teaching includes: smoking cessation,
stress reduction, weight reduction, heart healthy
diet, drug regimen, relaxation as well as home
blood pressure, pulse and weight monitoring.

33. 1. https://www.mayoclinic.org/diseases-conditions/adult-
congenital-heart-disease/symptoms-causes/syc-20355456
2.https://medlineplus.gov/congenitalheartdefects.html
3.https://www.healthline.com/health/congenital-heart-
disease#prevention
4. https://www.webmd.com/heart-disease/guide/congenital-
heart-disease#1
5.https://www.cdc.gov/ncbddd/heartdefects/facts.html
6. https://www.nhlbi.nih.gov/health-topics/congenital-heart-
defects
7. https://www.heart.org/en/health-topics/congenital-heart-
defects

34. Thank you