Management of Patients with Dysrhythmias and Conduction Problems :Management of Patients with Dysrhythmias and Conduction Problems Chapter 27


Electrocardiogram :Electrocardiogram ECG or EKG – graphic tracing of the electrical activity of the cardiac cells as specific waveforms and complexes 12 lead vs 5 lead Holter monitor Electrodes – materials applied to capture the electrical activity of the heart Leads –record of electrical activity between two electrodes


Can Get Artifact :Can Get Artifact Movement 60-cycle interference ALWAYS ASSESS THE PATIENT-not the monitor!


ECG Paper and Measurement :ECG Paper and Measurement Small= 0.04 seconds Large= 0.2 seconds 5 large boxes = 1 second 30 large boxes = 6 seconds


ECG Waveforms / Intervals :ECG Waveforms / Intervals


ECG Waveforms :ECG Waveforms P wave represents atrial depolarization (contraction) and the spread of electrical impulse from SA node throughout the atria round, upright deflection in Lead II Normally precedes every QRS


ECG Intervals :ECG Intervals QRS Interval (Complex) represents ventricular depolarization (contraction) Reflects the time it takes for the impulse to spread throughout both ventricles


ECG Waveforms :ECG Waveforms T wave represents ventricular repolarization (relaxation) Normally upright, after the QRS complex


ECG Segment :ECG Segment ST Segment Connects the QRS complex to the T wave Usually isoelectric or flat Represents the early part of repolarization of the ventricles Look for depression or elevation ST elevation: myocardial injury ST depression: myocardial ischemia


Rate :Rate Regular or Irregular rhythm = rule of 10 Atrial = P-P Ventricular = R-R


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Sinus Bradycardia :Sinus Bradycardia Causes: vagal, drugs, ischemia, athletes Treat: according to symptoms – transcutaneous pacing/ drugs (Atropine), pacemaker


Permanent Pacemaker :Permanent Pacemaker Implanted totally within the body Power source implanted SQ Can stimulate atrium, ventricles, or both


Complications :Complications Failure to sense - fails to recognize atrial or ventricular activity, and fires inappropriately Pacer lead damage, battery failure, dislodgement of the electrode Failure to capture- electrical charge is insufficient to produce atrial or ventricular contraction Pacer lead damage, battery failure, dislodgement of the electrode


Complications :Complications Infection Hematoma Pneumothorax Perforation of septum


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Sinus Tachycardia :Sinus Tachycardia Causes: stimulants, exercise, fever, anxiety volume overload, hypoxia, drugs Treat the cause Assess for symptoms of low cardiac output


Atrial Fibrillation :Atrial Fibrillation Most common dysrhythmia in the US and prevalence increases with age Disorganized atrial activity due to multiple irritable areas Loss of effective atrial contraction “atrial kick” Cause: age, underlying heart disease, electrolyte imbalances, stress, cardiac surgery Significance: Decreased cardiac output and HIGH RISK FOR EMBOLI Treat: Calcium channel blockers, beta blockers, digoxin, Coumadin, Amiodarone, cardioversion, ablation


Atrial Flutter :Atrial Flutter Single ectopic foci in the atrium Atrial rate fast and regular (3:1 or 4:1) Classic “sawtooth pattern” Significance: Loss of “atrial kick” (atrial contraction), loss of cardiac output and can cause heart failure Treatment: Calcium channel blockers, beta blockers, cardioversion, antidysrhythmias, ablation


Ventricular Tachycardia :Ventricular Tachycardia Different forms exist (monomorphic and polymorphic) Patient may or may not have a pulse May be sustained or nonsustained


Ventricular Tachycardia :Ventricular Tachycardia Causes: MI, CAD, electrolyte imbalances, digoxin toxcitity Significance: sustained VT can cause severe decreased CO, hypotension, cardiac arrest Treat: pulse-treat cause; drugs, cardioversion, if not pulse-CPR and defib


Ventricular Fibrillation :Ventricular Fibrillation Chaotic rhythm that is characterized by a quivering of the ventricles that results in total loss of cardiac output If not treated rapidly, the patient will die Can occur without a known cause Treat: DEFIBRILLATION, CPR


Implantable Cardioverter-Defibrillator (ICD) :Implantable Cardioverter-Defibrillator (ICD) Inserted in patients with spontaneous VT or VT and patients at risk for life threatening dysrhythmias Lead place via subclavian vein to the myocardium A battery powered pulse generator is implanted subcutaneously Identifies VT or VF and after 25 seconds, delivers a shock the patients heart


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