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DYSRHYTHMIAS

an irregular or abnormal heart rate

occurs when the average adult heart rate fallsbelow or rises above the normal range of 60

to 100 beats per minute

Disorders of the formation and/or conduction

of electrical impulses in the heart

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Normal Cardiac Rhythm

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What are the symptoms?

Palpitations, which can be

skipping, fluttering or pounding

in the chest

Fatigue

Chest pressure or pain

Shortness of breath

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Fainting, also known assyncope, or near-syncope

Lightheadedness ordizziness

Cardiac Output

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Sinus Node Dysrhythmias

Sinus Bradycardia

Sinus Tachycardia Sinus Arrhythmia

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Junctional Dysrhythmias

Premature Junctional

Complex

Junctional Rhythm

Atrioventricular NodalReentry Tachycardia

Supraventricular tachycardia

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Ventricular Dysrhythmias

Premature Ventricular

Complex

Ventricular Tachycardia

Ventricular Fibrillation

Idioventricular Rhythm

Ventricular Asystole

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How are arrythmias

diagnosed?

Electrocardiogram

Holter monitor

Treadmill testingElectrophysiologic testing

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ECG Interpretation

P wave represents atrialdepolarization

QRS complex represents ventricular

depolarization T wave represents ventricular

repolarization

U wave may representrepolarization ofPurkinje fibers.May also be seen in hypokalemia,

hypertension, or heart disease

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PR interval normal range is 0.12-0.20seconds

ST segment is identified as isoelectric,or above or below isoelectric line

QT interval normal range is 0.32-0.40seconds

TP interval is isoelectric period

PP

interval signifies atrial rhythm andrate

RR interval signifies ventricular rateand rhythm

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Waves, Complexes, and

Intervals

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Nursing Interventions

Monitoring and

managing thedysrhythmia

Minimizing anxietyTeaching self-care

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Specific Nursing Managements

Provide continuous ECG monitoring.

Maintain heart rate alarms at appropriate

limits.

Administer anti-arrhythmic medications asordered.

Administer defibrillation or CPR as

appropriate for life threateningarrhythmias.

Monitor electrolyte levels and replace as

necessary.

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Maintain at least one patent IV site.

Monitor serum levels of antiarrhythmic medications.

Provide information to the patient

regarding disease process, proceduresand medications.

Teach patient regarding symptoms of

arrhythmias. Teach patient how to take own pulse

Teach patient to avoid proarrhythmic

substances.

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Anti-dysrhythmic Therapy

Class I: Sodium Channel Blockers IA: delay repolarization

IB: accelerate repolarization

Lidocaine (IV)

Enhances repolarization (no QT prolongation)

No anticholinergic effectsOnly works for ventricular dysrhythmias

Adverse effects

CNS toxicity: seizures, resp arrest

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Class II: Beta blockers

Propanolol

Acebutolol

Esmolol

SotalolAdverse effects

Heart failure, AV block, sinus arrest

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Class III: Potassium Channel

Blockers

Amiodarone (PO, IV)

First line for V-fib maintenance

Works against both atrial and

ventricular

Adverse: HR, lung damage, visual

impairment

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Class IV: Calcium Channel

Blockers

Only non-dihidopyridines

Verapamil & diltiazem

Slow SA node automaticity

Delay AV conduction

Reduction of myocardial contractility

HR, AV block, Heart failure,

hypotension, constipation

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Other Antidysrhythmics

Adenosine

Short half life, termination of paroxysmal SVT

Digoxin

Decreases conduction through AV node,

increases Vagal tone, decreases SAautomaticity

Ibutilide

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Pacemaker Therapy

Provides electrical stimuli to

heart muscle

Used for slower-than-normalimpulse formation, to control

some tachycardias, or for

advanced heart failure May be permanent or temporary

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Cardioversion and

DefibrillationDelivery of electrical current

to depolarize a critical mass ofmyocardial cells

When cells repolarize the SA

node, is usually able torecapture its role as

pacemaker of heart

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Cardioversion and

Defibrillation (contd) Cardioversion involves use of timed

electrical current to terminate atachydysrhythmia

Defibrillation is used in emergency

situations as treatment for

ventricular fibrillation and pulseless

VT

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