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Arrythmias 2-3

1. Sinus rhythm is a normal heart rhythm where the heart rate is between 60-100 bpm and the rhythm is regular. Disorders include sinus bradycardia (heart rate <60 bpm), sinus tachycardia (heart rate >100 bpm), and premature atrial contractions which present as irregular heart rhythms. 2. Sinus bradycardia is caused by low metabolic needs, vagal stimulation, and some medications. It is treated through medication, cardioversion, adenosine administration, or vagal maneuvers to increase the heart rate. 3. Sinus tachycardia is caused by physiological stress, medications, autonomic dysfunction, infections, thyroid

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0% found this document useful (0 votes)
172 views4 pages

Arrythmias 2-3

1. Sinus rhythm is a normal heart rhythm where the heart rate is between 60-100 bpm and the rhythm is regular. Disorders include sinus bradycardia (heart rate <60 bpm), sinus tachycardia (heart rate >100 bpm), and premature atrial contractions which present as irregular heart rhythms. 2. Sinus bradycardia is caused by low metabolic needs, vagal stimulation, and some medications. It is treated through medication, cardioversion, adenosine administration, or vagal maneuvers to increase the heart rate. 3. Sinus tachycardia is caused by physiological stress, medications, autonomic dysfunction, infections, thyroid

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cayla mae carlos
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Sinus Rhythms straining and these can reduce vasoconstriction another treatment is

cardiac output because of increase through the use of pacemaker.


intrathoracic pressure and therefore,
Sinus Tachycardia
decreases the venous return and
cardiac output which may cause
elevation and dehistoric BP and pulse
rate also increase that cause reflex
bradycardia
- medications – calcium channel
blockers, amiodarone, beta-blockers
● Check the heart rate prior to
administering the medication, if the ● The SA node is charging at a
● A normal sinus rhythm where in the heart patient has < 60 bpm, do not give these rate of > 100 bpm, the result of
rate is ranging from 60 - 100, the rhtym is medication because it has an effect that inhibition of vagal reflex or stimulation
regular and there is no changes in PQRST. can reduce the heart rate of the patient of sympathetic vagus system. If there
- carotid sinus massage - patient with is an increase in heart rate and reduce
Disorders of Atria
arterial wall myocardial infarction in diastolic filling time, it may reduce
- Sinus bradycardia cardiac output the symptoms are
- Sinus tachycardia ▪ 0.5 mg of AtSO4 every 3 – 5 minutes syncopy and low bp and if the rapid
- Premature atrial contraction (PAC) for a maximum total dose of 3 mg rate persist, the heart cannot
▪ Theophylline 100 – 200 mg SIVP who compensate for the decrease
- Supraventricular Tachycardia (SVT)
had a cardiac transplantation and acute inferior ventricular feeling and acute pulmonary
- Atrial flutter
MI or spinal cord injury edema may develop.
- Atrial fibrillation (AF)
Causes

- Physiologic and psychological stress –


Sinus Bradycardia acute blood loss or hypovolemia,
hypoglycemia (related to sympathetic
The conduction pathway has similar rate and
nervous system response that cause
normal sinus rythm and with normal PQRST
palpitations) , hyperthyroidism, fever,
but the SA node is charging at the rate of < 60
anxiety and engaged in exercise,
bpm.
patient who have experience severe
Causes: pain, hypoxia, heart failure and
myocardial ischemia
- low metabolic needs (athletes, - Effects of medications – epinephrine,
sleeping, hypothyroidism) norepinephrine, atropine, theophylline,
- vagal stimulation – vomiting, suctioning, nifedipine, hydralazine
● these medication may cause increase
severe pain), patient with hypothermia - Autonomic dysfunction – postural
heart rate and peripheral
and Valsalva maneuver which means orthostatic tachycardia syndrome
(POTS) which results from sinus - Early, extra heartbeats that originate in
tachycardia without hypotension within the atria, due to abnormal electrical,
5-10 minutes of standing or with head - impulse without waiting for the SA node
upright. The treatment increase fluid - Rate is 60 – 100 bpm and rhythm
Sinus Arrhythmia
intake and use of graded compression irregular
stocking to prevent pooling of blood in - P wave is abnormal, an early and
the lower extremities. different P wave may be seen or may
be hidden in the preceeding of T wave.
Management - PR interval delayed or normal — may
- Synchronized cardioversion be longer or shorter but has normal
hemodynamic instability QRS complex
- Result from emotional stress, use of
- Adenosine administration decrease the caffeine, nicotine or alcohol, low
conduction through AV node, a potassium level that may also cause
vasodilator and it is contraindicated with changes in ECG; hypermetabolic state
patient with asthma because it may like pregnancy or older person or
cause bronchoconstriction due to patient with lung diseases
ECG tracing shows that there is changes in
histamine release of the muscle - Infection, hyperthyroidism, COPD, heart
rhythm of ECG depending on respiration, the
- Vagal maneuvers disease (CAD) and valvular disease
heart rate is variable and the rhythm is irregular
- increase parasympathetic stimulation
but it has a normal PQRS and the interval is
causing slow conduction through AV Premature Atrial Contraction (PAC)
within normal.
node and blocking the re-entry of
impulse. Example of these are - One upright uniform p-wave for every
squatting, hold breath, massage, cold QRS
application to the phase and straining. - Rhythm is irregular
- Beta-blockers and calcium channel - Rate increases as the patient breathes
blockers – rarely used considering in
narrow QRS tachycardia - Rate decreases as the patient breathes
- antiarrthytmic agent like metoprolol, out
atenolol decrease heart rate and - Rate is usually 60-100 (may be slower) - The heart rate is normal but rhythm is
myocardial consumption therefore, it - Variation of normal, not life threatening irregular, except that there is a changes
may decrease heart rate, lower bp and there is no treatment and it is in P wave, it is in premature or
lower cardiac output and decrease common in children and young adult. abnormal or even hidden and PR
automaticity of heart rate.
interval is within the normal.
- Procainamide, amiodarone – options Premature Atrial Complex (PAC)
- Most of these patients who have
for wide QRS tachycardia
- Also known as premature atrial enlarge heart may have premature
- Catheter ablation may be used in cases
contraction (PAC) or atrial extra systole atrial contraction although it not
of persistent inappropriate sinus
or atrial ectopic beat necessary for any treatment but if there
tachycardia unresponsive to other
are frequent or more than 6 per minutes
treatments.
then, it is a sign of atrial fibrillation.
- Treatment would be withdrawal from - ▪ SVT is commonly seen in - QRS complex normal or abnormal
sources of stimulation for example, patient who have wolff- parkinson-white contour
caffeine, sympamimetic drugs beta- (WPW syndrome), a syndrome where - ▪ The significance of the SVT
blockers may be used to decrease in, it bypass the gating mechanism there is a prolong episode and the heart
premature atrial contraction. which means it avoid the node on its rate is more than 180 or 250 which may
- Not significant for healthy person but protection and pass rate may be precipate a decrease of cardiac output
those with heart diseases who have directed transmitted to the ventricle. with hypotension and myocardial
frequent premature atrial contraction or - Tachycardia is usually a short duration ischemia.
complex indicates enchanched resulting to palpitation. SVT, there is a - Signs and symptoms of SVT, shortness
automaticity of the atria or the entry fast rate, an increase in heart rate that of breath, restlessness, chest pain,
mechanism may cause in reduce cardiac output rapid breathing, loss of consciousness,
resulting insignificant signs and diziness, pallor and hypotension.
Supraventricular Tachycardia (SVT) or symptoms and these can allow
Paroxysmal Atrial Tachycardia (PAT) suddenly and result without treatment Treatment
such as stress, exercise and emotion
- SVT in which the atria originating - Vagal stimulation = Carotid massage
can precipitate SVT; even stimulant like
anywhere above --- of bundle of his or and Valsalva maneuver - it may
caffeine, alcohol, nicotine and some
anywhere above the ventricle. If the P increase intrathoracic pressure which
diseases.
wave can't be identified then the rhythm may affect the parareceptors within the
- Associated with overexertion, emotional
may be called as SVT aorta
stress, RHD, digitalis toxicity, CAD, or
- Rapid but regular heart rhythm that
cor pulmonale - Drug therapy =
comes from the atria. Prevent the
- Cor pulmonale is an enlargement and Adenosine (Adenocard) – commonly use
gating mechanism.
failure of the right ventricle of the heart to convert SVT to a normal sinus, this allow
- When impulse is conducted to an area
as a response to increase vascular slow conduction of the AV node to allow
of an AV node that causes the impulse
resistance or high pressure in the better visualization of the flutter wave. It try
to be rerouted back into the same area
lungs to prevent the calcium retttracts and
over and over again at a very fast rate.
Each time the impulse is conducted activate acetyl-sensitive channel which is a
through this area it is also conducted PNS and decrease or inhibit the SNS.
down into the ventricle causes as fast (page 702) (If the patient is conscious
ventricular rate of 150 - 250 bpm. before taking adenosine, instruct the
- HR regular rhythm, rate 150 – 250 bpm patient to avoid caffeine because it may
- Abnormal P wave present but may be antagonized the effect of adenosine)Given
hidden on ST segment or T wave - HR – 150 – 250 bpm intravenously by rapid administration and
- Normally the ventricle is protected - Abnormal P wave present but may be immediately followed by 20 ml of saline
against excessive heart rate arising hidden before T wave or ST segment flush and elevation of the arm with IV line
from supraventricular areas by a gating and has abnormal contour to promote rapid circulation of the
mechanism of the AV node which - Abnormal P wave present but may be medication. The effect is too short
prevent high rates except only hidden before T wave or ST segment so, if the patient is not responsive then,
proportion of the fast impulse to pass. and has abnormal contour electrical cardioversion is a treatment of
choice
- This is usually because of the - warfarin, coumadin - use to prevent
Diltiazem conduction defect in the atrium that stroke of patient with atrial flutter of
Beta-adrenergic blocker that can be used means that the atrial rate is faster than greater than 48 hours duration
Digitalis & Amiodarone the AV node that can conduct which - anti-arrhythmic agents - to convert atrial
Digitalis and Amiodarone can increase means that not all atrial impulses are flutter to sinus rhythm such as
contractility and may also enhance cardiac conducted into the ventricle. amiodarone or procainamide.
output therefore, it may help in the - The premature electrical impulse arises - diltiazem, digoxin, β-adrenergic
perfusion of the kidney in the atria so, the electrical activity blockers - to control ventricular rate by
- Radiofrequency Ablation therapy moves in a localize --- or a circular decreasing the SNS especially, atenolol
- DC cardioversion–for unstable fashion; if all atrial impulses were and metaprolol.
patients conducted to the ventricle then the - The use of the adenosine may also be
ventricular rate would be ranging from rendered because it can block
Atrial Flutter 250 to 350 bpm then ventricular sympathetic and slow down the
fibrillations may occur so, it is a life - conduction in the AV node and allow
threatening dysrythmia or arrythmia. better visualization of the flutter waves.
- If identified by recurring or regular - RFA – curative therapy for atrial flutter,
sawtoothed shape flutter wave, it is it delivers energy in the tiny areas of the
more organized and regular than heart muscles which can either
fibrillation, the impulse slow down at the disconnect pattern of the abnormal
AV node, not all atrial beats are rhythm, block the abnormal path and
transmitted to the ventricle thats why it promote normal conduction of impulse
is demonstrate into a "sawtooth" or disconnect the electrical pathway
appearance. between atria and ventricle.
- The characteristic of the ECG of atrial - Electrical cardioversion – can convert
flutter with atrial rate of 250 - 350 bpm the atrial flutter to sinus rhythm in an
and the PR interval is variable. P wave emergency situation which is very
is sawtoothed apperance. QRS successful
- More than one P-wave for every QRS
complex is normal unless --- or pre-
complex
excitation is present.
- Sawtooth appearance
- Atrial rhythm is regular. Ventricular Signs and symptoms
rhythm will be regular if the AV node
conducts consistently. If the pattern Fatigue, palpitations, chest pain, light-
varies, the ventricular rate will be headedness, syncope, SOB, low BP since
irregular the atrial do not pump efficiently then the
- The common causes of atrial flutter are blood supply to the body is reduced, patient
patient with CAD, hypertension, mitral with atrial flutter are atleast to develop
valve disorders, pulmonary embolus, stroke because of the risk of thrombus
cor pulmonale, hyperthyroidism formation in the atria.

Treatment

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