Cardiac arrythmias with all associated notes pptx

With all notes

1. Cardiac arrythmias Brenda Nabawanuka( BSN,MSN,SWS Fellow )

2. Definition A lso known as cardiac dysrhythmias, are abnormal electrical conduction or automatic changes in heart rate and rhythm. They vary in severity, from those that are mild, asymptomatic, and require no treatment to catastrophic ventricular fibrillation, which necessitates immediate resuscitation. It can be the result of a primary cardiac disorder, a response to a systemic condition, the result of electrolyte imbalance, or drug toxicity .

3. ecg

4. EKG

5. Electrocardiogram

6. The Electric Conduction System Of The Heart

7. SINUS TACHYCARDIA Sinus tachycardia is a heart rate greater than 100 beats per minute originating from the sinus node. Rate: 100 to 180 beats per minute P waves precede each QRS complex PR interval is normal QRS complex is normal Conduction is normal Rhythm is regular

8. Causes of sinus tachycardia may include Exercise, Anxiety Fever sinus tachycardia is often asymptomatic. Management, however is directed at the treatment of the primary cause. Carotid sinus pressure (carotid massage) or a beta-blocker may be used to reduce heart rate. drugs anemia, heart failure, hypovolemia, and shock.

9. Sinus bradycardia is a heart rate of less than 60 beats per minute and originates from the sinus node (as the term “sinus” refers to the sinoatrial node. It has the following characteristics Rate is less than 60 beats per minute P Waves precede each QRS complex PR interval is normal QRS complex is normal Conduction is normal Rhythm is regular

10. ECG With Labels

11. Causes of sinus bradycardia Drugs vagal stimulation hypoendocrine states hypothermia, or sinus node involvement in MI. This arrhythmia may be normal in athletes as they have quality stroke volume.

12. Manifestations of sinus bradycardia It is often asymptomatic but manifestations may include: syncope(fainting or passing out) fatigue dizziness. Management includes treating the underlying cause and administering anticholinergic drugs like atropine sulfate as prescribed

13. Atrial flutter is an abnormal rhythm that occurs in the atria of the heart. Atrial flutter has an atrial rhythm that is regular but has an atrial rate of 250 to 400 beats/minute. It has sawtooth appearance. QRS complexes are uniform in shape but often irregular in rate. Normal atrial rhythm Abnormal atrial rate: 250 to 400 beats/minute Sawtooth P wave configuration QRS complexes uniform in shape but irregular in rate

14. Sawtooth Pattern

15. Causes Includes heart failure tricuspid valve or mitral valve diseases pulmonary embolism cor pulmonale inferior wall MI carditis and digoxin toxicity.

16. Management Management if the patient is unstable with ventricular rate of greater than 150 bpm, prepare for immediate cardioversion. If patient is stable, drug therapy may include calcium channel blocker, beta-adrenergic blockers, or antiarhythmics . Anticoagulation may be necessary as there would be pooling of blood in the atria

17. Atrial fibrillation is disorganized and uncoordinated twitching of atrial musculature caused by overly rapid production of atrial impulses. This arrhythmia has the following characteristics: Atrial Rate: 350 to 600 bpm Ventricular Rate: 120 to 200 bpm P wave is not discernible with an irregular baseline PR interval is not measurable QRS complex is normal Rhythm is irregular and usually rapid unless controlled .

18. Atrial Fibrillation ilustration

19. Clinical Manifestations And Mgt Atrial fibrillation may be asymptomatic but clinical manifestation may include palpitations, dyspnea, and pulmonary edema. Nursing goal is towards administration of prescribed treatment to decrease ventricular response, decrease atrial irritability and eliminate the cause.

20. Causes includes atherosclerosis, heart failure, congenital heart disease, chronic obstructive pulmonary disease, hypothyroidism and thyrotoxicosis

21. Premature Junctional Contraction (PJC) occurs when some regions of the heart becomes excitable than normal. It has the following characteristics. PR interval less than 0.12 seconds if P wave precedes QRS complex QRS complex configuration and duration is normal P wave is inverted Atrial and ventricular rhythms irregular .

22. Premature Junctional Contraction (PJC )

23. Causes Of PJC may include myocardial infarction or ischemia digoxin toxicity excessive caffeine or amphetamine use

24. Management correction of underlying cause discontinuation of digoxin if appropriate.

25. Atrioventricular Blocks AV blocks are conduction defects within the AV junction that impairs conduction of atrial impulses to ventricular pathways. The three types are first degree second degree third degree .

26. First degree Heart Block Rate is usually 60 to 100 bpm PR intervals are prolonged for usually 0.20 seconds QRS complex is usually normal Rhythm is regular .

27. Causes First degree AV block is asymptomatic and may be caused by inferior wall MI or ischemia hyperkalemia hypokalemia digoxin toxicity calcium channel blockers, amiodarone and use of antidysrhythmics

28. . Management Includes correction of underlying cause. Administer atropine if PR interval exceeds 0.26 second or symptomatic bradycardia develops

29. Second Degree AV Block Mobitz I (Wenckebach) Atrial rhythm is regular Ventricular rhythm is irregular Atrial rate exceeds ventricular rate PR interval progressively but only slightly, longer with each cycle until QRS complex disappears (dropped beat)

30. 2 nd Heart Degree Block PR Interval shorter after dropped beat. . Treatment includes correction of underlying cause, atropine or temporary pacemaker for symptomatic bradycardia and discontinuation of digoxin if appropriate.

31. Clinical Manifestations include vertigo weakness, irregular pulse. This may be caused by Inferior wall MI cardiac surgery acute rheumatic fever vagal stimulation

32. Second Degree AV Block Mobitz II Atrial rhythm is regular Ventricular rhythm maybe regular or irregular depending on the degree of block P-P interval constant QRS complex periodically absent or disappears

33. Clinical Manifestations Same As Mobitz I. Causes Includes: Severe Coronary Artery Diseases Anterior Wall MI Acute Myocarditis Digoxin Toxicity.

34. Treatment includes: Atropine epinephrine, dopamine for symptomatic bradycardia. Discontinuation of digoxin if appropriate. Installation of pacemaker

35. Third Degree AV Block (Complete Heart Block) Atrial rhythm regular Ventricular rhythm regular and rate slower than atrial rate No relation between P waves and QRS complexes NO constant PR interval QRS interval normal or wide and bizarre

36. Manifestations include hypotension, angina, heart failure

37. Causes This May Be Caused By Congenital Abnormalities, Rheumatic Fever, Hypoxia, MI, Lev’s Disease, Lenegre’s Disease And Digoxin Toxicity

38. Management includes atropine, epinephrine, and dopamine for bradycardia. Installation of pacemaker may also be considered.

39. Premature Ventricular Contractions (PVC) Early or premature ventricular contractions are caused by increased automaticity of ventricular muscle cells. PVCS usually are not considered harmful but are of concern if more than six occur in 1 minute, if they occur in pairs or triplets if they are multifocal or if they occur or near a t wave.

40. Atrial rhythm is regular Ventricular rhythm is irregular QRS complex premature, usually followed by a complete compensatory pause QRS complex is also wide and distorted, usually >0.14 second. Premature QRS complexes occurring singly, in pairs, or in threes

41. Clinical manifestations Includes palpitations Weakness lightheadedness but it is most of the time asymptomatic.

42. Management includes assessment of the cause and treat as indicated. Treatment is indicated if the client has underlying disease because PVCs may precipitate ventricular tachycardia or fibrillation. Assess for life threatening PVCs. Administer antiarrhythmic medication as prescribed.

43. Ventricular Tachycardia Ventricular tachycardia (VT) is three or more consecutive PVCs. it is considered a medical emergency because cardiac output (CO) cannot be maintained because of decreased diastolic filling (preload) Rate is 100 to 250 beats per minute P wave is blurred in the QRS complex but the QRS complex has no associate with P wave. PR Interval is not present QRS complex is wide and bizarre; T wave is in the opposite direction Rhythm is usually regular May start and stop suddenly

44. Clinical manifestations of VT includes lightheadedness weakness dyspnea and unconsciousness.

45. Causes includes MI Aneurysm CAD rheumatic heart diseases mitral valve prolapse Hypokalemia Hyperkalemia pulmonary embolism. Anxiety may also caused VT.

46. Pulseless Ventricular Tachycardia Management for Pulseless VT: Initiate cardiopulmonary resuscitation; follow ACLS protocol for defibrillation, ET intubation and administration of epinephrine or vasopressin Ventricular Tachycardia with Pulse

47. Management With Pulse VT If hemodynamically stable, follow ACLS protocol for administration of amiodarone, if ineffective, initiate synchronized cardioversion .

48. Ventricular Fibrillation Ventricular fibrillation is rapid, ineffective quivering of ventricles that may be rapidly fatal. Rate is rapid and uncoordinated, with ineffective contractions Rhythm is chaotic QRS complexes wide and irregular P wave is not seen PR interval is not seen

49. Causes of ventricular fibrillation is most commonly myocardia ischemia or infarction. It ma result from untreated ventricular tachycardia, electrolyte imbalances, digoxin or quinide toxicity, or hypothermia.

50. clinical manifestations may include loss of consciousness, pulselessness, loss of blood pressure, cessation of respirations, possible seizures and sudden death. Start CPR is pulseless. Follow ACLS protocol for defibrillation, ET intubation and administration of epinephrine or vasopressin

51. Nursing Management Nursing care planning for patients with cardiac arrhythmia due to digitalis toxicity includes prompt assessment of the patient’s condition, prompt treatment of symptoms, and investigation of the cause.

52. Nursing Problem Priorities The following are the nursing priorities for patients with cardiac arrhythmias: Treat life-threatening dysrhythmias. Assess and identify cause or precipitating factors. Providing patient education and health teachings .

53. Nursing Problem Priorities The following are the nursing priorities for patients with cardiac arrhythmias: Treat life-threatening dysrhythmias. Assess and identify cause or precipitating factors. Providing patient education and health teachings.

54. Nursing Assessment Assess For The Following Subjective And Objective Data: Heart Rate. Assessing The Heart Rate Is Essential To Identify The Presence And Type Of Dysrhythmia. Variations From The Normal Range Can Indicate Tachycardia (Fast Heart Rate) Or Bradycardia (Slow Heart Rate), Which Are Common Dysrhythmias. .

55. Rhythm. Determining the regularity or irregularity of the heart rhythm is crucial in identifying dysrhythmias. Blood pressure. Measuring and monitoring blood pressure provides information about the patient’s hemodynamic stability and helps detect any abnormalities associated with dysrhythmias, such as hypertension or hypotension

56. Dysrhythmias can impair cardiac output and lead to variations in blood pressure, indicating compromised cardiovascular function. Assess for factors related to the cause of cardiac arrhythmias: Altered electrical conduction Reduced myocardial contractility Nursing Diagnosis Decreased cardiac output

57. Nursing Goals The client will maintain/achieve adequate cardiac output with blood pressure and pulse within the normal range, appropriate urinary output, palpable pulses of equal quality, and a normal level of mentation. The client will experience a reduced frequency or absence of dysrhythmias. The client will actively engage in activities that decrease the workload on the heart.

58. The client will demonstrate understanding of their prescribed medication, including interactions with other drugs or substances, and recognize the importance of adhering to the prescribed regimen. The client will identify signs of digitalis overdose and developing heart failure, and promptly report them to the physician

59. The client will exhibit no signs of drug toxicity and maintain serum drug levels within an acceptable range specific to the individual. The client, if utilizing a pacemaker, will comprehend their condition, prognosis, and the function of the pacemaker .

60. The client will recognize signs of pacemaker failure. The client will verbalize understanding of their therapeutic regimen. The client will list the desired actions and potential adverse side effects of their medications. The client will correctly perform necessary procedures and provide explanations for their actions.

61. Nursing Interventions And Actions Cardiac arrhythmias are disturbances in the normal heart rhythm. Nursing interventions for managing these conditions involve monitoring and managing symptoms, administering medications and treatments, and providing patient education. The aim is to control the arrhythmia, prevent complications, and improve the patient’s quality of life. Effective nursing care also involves working closely with the healthcare team to develop an individualized care plan and ensure proper communication and coordination of care.

62. Nursing Interventions and Actions cont.. Managing Impaired Cardiac Function Monitoring Diagnostic Procedures and Laboratory Studies Administering Medications and Providing Pharmacological Interventions Preventing Digitalis Toxicity & Poisoning Reducing Anxiety Providing Perioperative Nursing Care Providing Patient Education and Health Teachings

63. Pharmacological Interventions Administer supplemental oxygen as indicated. Increases the amount of oxygen available for myocardial uptake, which decreases irritability caused by hypoxia. 2. Potassium Dysrhythmias are generally treated symptomatically. Correction of hypokalemia may be sufficient to terminate some ventricular dysrhythmias. Potassium imbalance is the number one cause of atrial fibrillation. 3. Antidysrhythmics Antidysrhythmic are medications used to regulate heart rhythm and treat various types of arrhythmias. These include:

64. Class I drugs Class I drugs depress depolarization and alter repolarization, stabilizing the cell. These drugs are divided into groups a, b, and c, based on their unique effects. These drugs increase action potential, duration, and effective refractory period and decrease membrane responsiveness, prolonging both QRS complex and QT interval. Useful for the treatment of atrial and ventricular premature beats, and repetitive arrhythmias (atrial tachycardias and atrial flutter or fibrillation). Myocardial depressant effects may be potentiated when class Ia drugs are used in conjunction with medications possessing similar properties.

65. Class Ia drugs: disopyramide ( Norpace ), procainamide ( Pronestyl , Procan SR) quinidine ( Quinaglute , Cardioquin ) These drugs shorten the duration of the refractory period (QT interval), and their action depends on the tissue affected and the level of extracellular potassium.

66. Class Ib Class Ib : lidocaine (Xylocaine), phenytoin (Dilantin), tocainide ( Tonocard ), mexiletine ( Mexitil ); moricizine ( Ethmozine ) Drugs of choice for ventricular dysrhythmias are also effective for automatic and reentrant arrhythmias and digitalis-induced dysrhythmias. These drugs may aggravate myocardial depression.

67. Class Ic Class Ic: flecainide (Tambocor), propafenone ( Rythmol ), encainide ( Enkaid ) These drugs slow conduction by depressing SA node automaticity and decreasing conduction velocity through the atria, ventricles, and Purkinje fibers. The result is a prolongation of the PR interval and a lengthening of the QRS complex. They suppress and prevent all types of ventricular dysrhythmias. Flecainide increases the risk of drug-induced dysrhythmias post-MI. Propafenone can worsen or cause new dysrhythmias, a tendency called the “proarrhythmic effect.” Encainide is available only for patients who demonstrated good results before the drug was removed from the market.

68. Class II drugs atenolol (Tenormin), propranolol (Inderal), nadolol ( Corgard ), acebutolol ( Sectral ), esmolol ( Brevibloc ), sotalol ( Betapace ); bisoprolol ( Zebeta ) Beta-adrenergic blockers have antiadrenergic properties and decrease automaticity. Therefore, they are useful in the treatment of dysrhythmias caused by SA and AV node dysfunction (SVTs, atrial flutter, or fibrillation). These drugs may exacerbate bradycardia and cause myocardial depression, especially when combined with drugs that have similar properties.

69. Class III drugs: bretylium tosylate ( Bretylol ), amiodarone ( Cordarone ), sotalol ( Betapace ), ibutilide ( Corvert ) These drugs prolong the refractory period and action potential duration, consequently prolonging the QT interval. They are used to terminate ventricular fibrillation and other life-threatening ventricular dysrhythmias or sustained ventricular tachyarrhythmias, especially when lidocaine and procainamide are not effective

70. Class iii ….. Sotalol is a nonselective beta-blocker with characteristics of both class II and class III.

71. Class IV drugs verapamil ( Calan ), nifedipine (Procardia), diltiazem (Cardizem) Calcium antagonists (also called calcium channel blockers) slow conduction time through the AV node (prolonging PR interval) to decrease ventricular response in SVTs, and atrial flutter/fibrillation. Calan and Cardizem may be used for bedside conversion of acute atrial fibrillation.

72. 3.5. Class V drugs: atropine sulfate, isoproterenol ( Isuprel ) Miscellaneous drugs are useful in treating bradycardia by increasing SA and AV conduction and enhancing automaticity. 4. Cardiac glycosides: digoxin (Lanoxin) Cardiac glycosides may be used alone or in combination with other antiarrhythmic drugs to reduce ventricular rate in the presence of uncontrolled or poorly tolerated atrial tachycardias or flutter and fibrillation. First-line treatment for paroxysmal supraventricular tachycardia (PVST).

73. 5. Adenosine ( Adenocard ) Slows conduction and interrupts reentry pathways in the AV node. Note: Contraindicated in patients with second or third-degree heart block or those with sick sinus syndrome who do not have a functioning pacemaker. 4. Preventing Digitalis Toxicity & Poisoning Preventing digitalis toxicity and poisoning is essential in patients with cardiac arrhythmias who are taking digoxin to control their heart rate. Digitalis toxicity can cause serious side effects such as nausea, vomiting, and arrhythmias, which can worsen the patient’s condition. Regular monitoring of the patient’s digoxin levels and symptoms of toxicity is necessary to prevent adverse reactions and ensure safe and effective treatment. 1. Discuss the necessity of periodic laboratory evaluation:

74. Providing Perioperative Nursing Care Assist with insertion and maintenance of pacemaker function. 2. Prepare for invasive diagnostic procedures and surgery as indicated. 3. Prepare for implantation of a cardioverter or defibrillator (ICD) when indicated. This device may be surgically implanted in those patients with recurrent, life-threatening ventricular dysrhythmias unresponsive to tailored drug therapy.

75. Providing Patient Education and Health Teachings Assess the patient and significant other‘s (SO) level of knowledge and ability and desire to learn. 2. Be alert to signs of avoidance: changing the subject away from information being presented or extremes of behavior (withdrawal or euphoria). 4. Provide information in written form for the patient/SO to take home. 5. Reinforce explanations of risk factors, dietary and activity restrictions, medications, and symptoms requiring immediate medical attention.

76. Encourage identification and reduction of individual risk factors: smoking and alcohol consumption, and obesity. Review normal cardiac function and electrical conduction. Explain and reinforce specific dysrhythmia problems and therapeutic measures to the patient and SO. Identify adverse effects and complications of specific dysrhythmias: fatigue, dependent edema, progressive changes in mentation, and vertigo. .

77. Encourage the development of a regular exercise routine, avoiding overexertion. Identify signs and symptoms requiring immediate cessation of activities: dizziness, lightheadedness, dyspnea, and chest pain. Review individual dietary needs and restrictions: potassium, and caffeine.