Cardiac Arrhythmias for paramedical students.

Cardiac Arrhythmia definition, classification, normal sinus rhythm, characteristics , types and management with medical ,surgical & nursing, health education and nursing diagnosis for paramedical students.

1. P RESENTED BY : MS.HELAN MARIA, M.Sc.(N)1 ST YEAR, CON-SRIPMS, CBE. CARDIAC ARRHYTHMIA

2. Introduction: Without a regular rate & rhythm, the heart may not perform efficiently as a pump to circulate oxygenated blood & other life sustaining nutrition to all of the body’s tissues & organs with an irregular or rhythm, the heart is considered to be dysrhythmic( arrhythmic) Dysrhythmia - bad rhythm Arrhythmia – without rhythm

3. Definition: An arrhythmia (also called dysrhythmia) is an abnormal heartbeat. Arrhythmias can start in different parts of your heart and they can be too fast, too slow or just irregular. - WHO It is an disorder of the formation or conduction (or both) of the electrical impulse within the heart. These disorders can cause disturbance of the heart rate, heart rhythm or both. - B runner & Suddarth’s textbook of medical surgical nursing.

4. INCIDENCE The prevalence of arrhythmias is expected to be 1.5% to 5% in the general population, with atrial fibrillation being the most common. Arrhythmias may or may not produce any symptoms and can be paroxysmal, leading to difficulty in estimating true prevalence. The overall presence of arrhythmia is associated with higher morbidity and mortality.

5. ETIOLOGY There are a number of factors that can cause a heart arrhythmia, including:  Heart attack or scarring of the heart tissue from a heart attack;  Coronary heart disease High blood pressure Smoking  Genetics: Changes to the heart’s structure e.g. from cardiomyopathy; Diabetes; Sleep apnea

6.  Alcohol abuse Excessive caffeine consumption Overactive thyroid gland (hyperthyroidism) Underactive thyroid gland (hypothyroidism) Drug abuse Stress

7. NORMAL SINUS RHYTHM A normal sinus rhythm (NSR) is the regular rhythm of a healthy heart. It's caused by electrical impulses from the heart's natural pacemaker, the sinoatrial (SA) node. 

8. CHARACTERISTICS ventricular & atrial rate: - 60- 100bpm ventricular & atrial rhythm : regular QRS shape & duration : normal P – wave: normal & always in front of the QRS PR interval : consistent interval 0.12 -0.20 sec P:QRST ratio: 1:1

9. CLASSIFICATION: Sinus node dysrhythmia. Atrial dysrhythmias. Junctional dysrhythmias. Ventricular dysrhythmias. Conduction abnormalities.

10. SINUS NODE DYSRHYTHMIA Sinus bradycardia. Sinus tachycardia. Sinus arrhythmia.

11. ATRIAL DYSRHYTHMIAS . Premature atrial complex. Atrial fibrillation Atrial flutter

12. JUNCTIONAL DYSRHYTHMIAS. Premature junctional complex Junctional rhythm Non paroxysmal junctional tachycardia Atrioventricular nodal reentry tachycardia

13. VENTRICULAR DYSRHYTHMIAS. Premature ventricular complex. Ventricular fibrillation. Idioventricular rhythm. Ventricular asystole.

14. CONDUCTION ABNORMALITIES. First –degree AV block Delayed conduction from the atrium to the ventricle (defined as a prolonged pr interval of >200 ms ) without interruption in atrial to ventricular conduction.

15. Second-degree AV block   Second-degree atrioventricular (AV) block is a heart condition that occurs when some atrial impulses are blocked from reaching the ventricles. It's a type of "incomplete" heart block. 

16. Symptoms lightheadedness and syncope.  Types   Mobitz type I : The site of the block is usually within the AV node. Mobitz type II : The site of the block is almost always below the AV node .

17. Third-degree atrioventricular (AV) block , also known as complete heart block (CHB), It is a condition that prevents electrical signals from traveling between the heart's atria and ventricles. This results in the atria and ventricles beating independently, which can lead to insufficient blood flow and life-threatening complications. 

18. SINUS BRADYCARDIA Sinus bradycardia is a heart rhythm where the heart beats slower than normal, but in a regular pattern. It's defined as a heart rate of less than 60 beats per minute (bpm) in adults.

19. CHARACTERISTIC Ventricular & atrial rate: < 60bpm Ventricular & atrial rhythm : regular QRS shape & duration : normal P – wave: normal & always in front of the QRS PR interval : consistent interval 0.12 -0.20 sec P:QRST ratio: 1:1

20. MANAGEMENT Atropine- 0.5mg IV bolus. After 3-5 mins, max dosage of 3mg will be administer Dopamine /epinephrine

21. SINUS TACHYCARDIA Sinus tachycardia is a regular heart rhythm where the heart beats faster than normal. It's often a normal response to exercise or stress, but it can also be a sign of an underlying condition.  Symptoms of sinus tachycardia  Palpitations, Fainting , Chest pain, Difficulty breathing, and Dizziness.

22. CHARACTERISTICS ventricular & atrial rate :> 100bpm < 120bpm ventricular & atrial rhythm : regular QRS shape & duration : normal P – wave: normal & always in front of the QRS PR interval : consistent interval 0.12 -0.20 sec P:QRST ratio: 1:1

23. MANAGEMENT Beta-blockers : metoprolol, nadolol , and propranolol, these can help with tachycardia, especially during exercise  Calcium channel blockers : verapamil can help lower your heart rate  Anti-arrhythmic medications :  potassium or sodium channel blockers, adenosine, digoxin, and magnesium sulfate 

24. SINUS ARRHYTHMIA Sinus arrhythmia is a variation in the heart's rhythm that's usually normal and indicates good heart health. It's a type of arrhythmia, which is an abnormal heart rhythm.  When you breathe in, your heart rate increases and the time between heartbeats shortens. When you breathe out, your heart rate decreases and the time between heartbeats lengthens.

25. CHARACTERISTIC Ventricular & atrial rate: 60-100bpm Ventricular & atrial rhythm : irregular QRS shape & duration : normal P – wave: normal & always in front of the QRS PR interval : consistent interval 0.12 -0.20 sec P:QRST ratio: 1:1

26. MANAGEMENT It does not cause any significant hemodynamic effects & therefore is not typically treated.

27. PREMATURE ATRIAL COMPLEX PAC is a single ECG complex that occurs when an electrical impulse starts in the atrium before the next normal impulse of the sinus node.

28. characteristics Ventricular & atrial rate: depends on the underlying rhythm Ventricular & atrial rhythm : irregular due to early p wave QRS shape & duration : due do early p wave is abnormal P – wave: seen or be hidden PR interval : p wave is shorter than normal PR interval 0.12 -0.20 sec P:QRST ratio: 1:1

29. MANAGEMENT Treatment is not necessary but, they focus on underlying causes e.g.: Intake of caffeine, correction of hypokalemia

30. ATRIAL FIBRILLATION Atrial fibrillation( afib or AF) is an irregular heartbeat that occurs when the upper chambers of the heart beat too fast and out of rhythm. It's the most common type of arrhythmia that lasts more than a few seconds.  Risk factors: Post operative cardiac surgery Hypertension Obesity VHD Heart failure

31. CHARACTERISTIC Ventricular & atrial rate: atrial rate 300-600bpm ventricular rate 120-200bpm in untreated AF Ventricular & atrial rhythm : highly irregular QRS shape & duration : usually normal maybe abnormal P – wave: no discernible P wave PR interval : cannot be measured P:QRST ratio: many :1

32. Management Beta blockers : Slow the heart rate Calcium channel blockers : Control the heart rate Digoxin : Controls the heart rate at rest Blood thinners : Prevent blood clots and reduce the risk of stroke Anti- arrhythmics : Restore normal heart rhythm

33. ATRIAL FLUTTER Atrial flutter is a heart rhythm abnormality that causes the upper chambers of the heart to beat too fast.

34. CHARACTERISTICS Ventricular & atrial rate: - atrial rate 250-400bpm ventricular rate 75-150bpm Ventricular & atrial rhythm : atrial rhythm is regular but ventricular maybe irregular QRS shape & duration : usually normal, maybe abnormal or may be absent. P – wave: saw-toothed shape PR interval : multiple f wave cannot be measure P:QRST ratio: 2:1,3:1or4:1

35. Management Adenosine IV followed by 20ml saline flush Elevation of arm with IV line to promote rapid circulation of medication. Antiarrhythmics - amiodarone Beta blockers - adrenaline  Calcium channel blockers Anticoagulants - prevent blood clots, such as heparin, warfarin,

36. PREMATURE JUNCTIONAL COMPLEX A premature junctional complex (PJC) is an extra heartbeat that originates in the atrioventricular (AV) junction of the heart. Causes: Heart failure CAD

37. CHARACTERISTICS P wave : may be inverted, absent, or occur after the QRS complex PR interval : short or absent QRS complex : normal in shape and morphology

38. JUNCTIONAL RHYTHM Junctional or idionodal rhythm occurs when the AV node , instead of the sinus node, become the pacemaker of the heart.

39. CHARACTERISTIC ventricular & atrial rate: 40-60bpm ventricular & atrial rhythm : regular QRS shape & duration : normal/abnormal P – wave: maybe absent after or before QRS complex PR interval : PR interval is < 0.12 sec P:QRST ratio: 1:1 or 0:1

40. MANAGEMENT Pacemaker therapy

41. NON PAROXYSMAL JUNCTIONAL TACHYCARDIA NPJT is a form of SPV originating from AV junction with a gradual onset & termination it is similar to junctional rhythm

42. ATRIOVENTRICULAR NODAL REENTRY TACHYCARDIA It is a type of abnormal, rapid heart rhythm where electrical signals within the atrioventricular (AV) node of the heart loop back on themselves, creating a " reentry circuit " that causes the heart to beat very fast, often with sudden onset and termination

43. CHARACTERISTICS Ventricular & atrial rate: - 60- 100bpm Ventricular & atrial rhythm : regular QRS shape & duration : normal P – wave: normal & always in front of the QRS PR interval : consistent interval 0.12 -0.20 sec P:QRST ratio: 1:1

44. MANAGEMENT Vagal maneuvers: simple actions like coughing, holding your breath, or applying cold water to the face can sometimes stop an AVNRT episode.  Adenosine: this is the first-line medication   Calcium channel blockers: verapamil can be used.  Beta-blockers

45. PREMATURE VENTRICULAR CONTRACTION A ventricular premature complex (VPC), also known as a premature ventricular contraction (PVC), is an extra heartbeat that originates in the heart's lower chambers.  Pvc are common and usually harmless. 

46. CHARACTERS Ventricular & atrial rate: depends on the underlying rhythm Ventricular & atrial rhythm : irregular P – wave: visible P wave PR interval : consistent interval 0.12 sec P:QRST ratio: 0:1 , 1:1

47. MEDICAL MANAGEMENT Beta blocker : to lower blood pressure and reduce pvcs Calcium channel blockers: to lower blood pressure and reduce pvc Antiarrhythmic: to control irregular heart rhythms

48. VENTRICULAR TACHYCARDIA Ventricular tachycardia (VT) is a condition in which the heart's lower chambers beat abnormally fast. It can be life-threatening and may require immediate medical care. 

49. Symptoms   Chest pain Lightheadedness or dizziness Fainting Shortness of breath Palpitations Anxiety Tightness in the neck Tiredness

50. CAUSES   Heart attack Anti-arrhythmic drugs Congenital heart disease Ischemic heart disease Structural heart disease Electrolyte imbalances

51. CHARACTERISTICS ventricular & atrial rate: - 100-200 bpm ventricular & atrial rhythm : regular QRS shape & duration : abnormal P – wave: very defect to detect PR interval : irregular P:QRST ratio : difficult to determine

52. MEDICAL MANAGEMENT Defibrillation to restore normal heart rhythm and Anti-arrhythmic medication injections. 

53. VENTRICULAR FIBRILLATION Ventricular fibrillation (v-fib) is a life-threatening heart rhythm disorder that causes the heart's ventricles to quiver instead of pumping blood. It's the most common cause of sudden cardiac death. 

54. SYMPTOMS   Chest pain, fullness, discomfort, or pressure Dizziness or lightheadedness Nausea Racing or erratic pulse Heart palpitations Shortness of breath

55. CAUSES Heart attack Heart disease Heart surgery Sudden blow to the chest Medicines Potassium levels in the blood

56. MANAGEMENT Treatment cardiopulmonary resuscitation (CPR), Shocks to the heart with an automated external defibrillator (AED), Medications, Implanted devices and surgery. 

57. IDIOVENTRICULAR RHYTHM Idioventricular rhythm is a heart rhythm where the lower chambers of the heart beat more slowly than normal. It's also known as a "slow ventricular tachycardia”

58. CHARACTERISTICS A rate of less than 50 beats per minute No conducted P waves, and A widened QRS complex.

59. MANAGEMENT Atropine may be used to increase heart rate, and verapamil, Antiarrhythmic drugs

60. VENTRICULAR ASYSTOLE Ventricular asystole is a complete absence of the heart's electrical and mechanical activity, also known as flat line .

61. MANAGEMENT High –quality CPR Assess for possible causes Hs Hypoxia Hypovolemia Hydrogen ion (acid- base imbalance) Hypo/hyperglycemia Hypo/hyperkalemia hyperthermia

62. Ts Trauma Toxins Tamponade Tension pneumothorax Thrombus CPR>INTUBATION>IV MEDICATION(emergency med)

63. SYMPTOMS Tightness Chest pain Palpitation Sob Dizziness Fainting

64. DIAGNOSTIC EVALUATION History Collection Physical Examination ECG Echo- cardiogram Blood test -electrolyte -cardiac biomarker Genetic testing(if needed)

65. COMPLICATIONS Stroke Heart failure Sudden cardiac arrest Cardiogenic shock Chronic fatigue MI End- organ damage

66. SURGICAL MANAGEMENT Maze procedure Valve replacement Pacemaker & implantable cardioverter defibrillator(ICD) CABG Heart transplantation

67. NURSING DIAGNOSIS Decreased Cardiac Output Related to Altered heart rate and rhythm As evidenced by Irregular pulse Risk for Decreased Cardiac Tissue Perfusion Related to Inadequate blood flow due to abnormal heart rhythms Ineffective Tissue Perfusion Related to Inadequate cardiac output from arrhythmia as evidenced by weak pulses Activity Intolerance Related to Insufficient oxygenation due to abnormal heart rhythms as evidenced by Fatigue Anxiety Related to Fear of life-threatening arrhythmia episodes as evidenced by Restlessness

68. HEALTH EDUCATION Lifestyle Changes Eat a healthy diet (low salt, low cholesterol, more vegetables ). Exercise regularly (as recommended by your doctor ). Quit smoking and limit alcohol and caffeine. Reduce stress with relaxation techniques like yoga or meditation . Monitor your blood pressure, cholesterol, and blood sugar.

69. Seek Emergency Help Call emergency services immediately if you experience : Severe chest pain or pressure . Sudden shortness of breath . Fainting or losing consciousness . A very fast or very slow heart rate that doesn’t stop.

70. Patient Self-Care & Monitoring Check your pulse regularly and report irregularities to your doctor . Take medications as prescribed and attend all follow-up visits . Wear a medical alert bracelet if you have a serious arrhythmia . Educate family members on CPR in case of emergencies.

71. CONCLUSION In conclusion ,arrhythmias are abnormal heart rhythms that can range from harm- less to life-threating .however, ongoing research is essential to enhance prevention, early intervention & treatment strategies to reduce the risk of complications like stoke and sudden cardiac arrest.