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Cardiac Dysrhythmias
Sinus Dysrhythmias
Bradycardia
- A Sinus Rhythm
That Is <60 BPM
Tachycardia
- A Sinus Rhythm
That Is > 100 BPM
Respiratory Arrhythmia
• During Inspiration & Expiration,
The R-R Interval Expands &
Contracts
• R-R Interval Widens During
Expiration
• R-R Interval Shortens During
Inspiration
Sinus Arrest
Sinus Arrest
Occurs Because
The Sinoatrial Node Ceases To
Fire
Sinus Arrest
Escape Or Rescue Beats
Secondary
Pacemakers Rescue
The Heart & Create Escape Or
Rescue Beats
Rescue
Beats May Have Their
Origin High Up In The Atria Or
Down Low Close To The AV
Node Or Even In The Ventricles.
If The Ectopic Pacemaker Is
Close To The SA Node, It Will Be
An Atrial Escape Beat. It Will
Have These Features :
The
Escape Beat Is Delayed
P Wave Is Irregularly Shaped
A Normal QRS Complex
Atrial Escape Or Rescue Beat
If
The Rescue Beat Is Close To
The AV Node, Then It Will
Likely Be A Junctional Escape
Beat
Characteristics Of A Junctional
Escape Beat :
A Rescue
Beat Is Delayed
No P Wave
The QRS Is Normal
Rate Will Be Slower
Junctional Rescue Or Escape Beat
If
The Rescue Beat Is Located In
The Ventricles, Then It Is A
Ventricular Pacemaker That Is
Activated To Rescue The Heart
Characteristics Of A Ventricular
Rescue Beat Are :
No
P Wave
A Rescue Beat Is A Delayed Beat
Wide Bizarre QRS Complex
Rate Will Be Very Slow
Ectopic
Pacemakers Have Their
Own Firing Rates
A Maxim : The Lower Your Go Into
The Heart To Find A Pacemaker, The
Slower The Rate
Ectopic Pacemaker Rates
Atrial
Pacemakers ~ 60-80 BPM
Junctional Pacemakers ~ 40-60 BPM
Ventricular Pacemakers ~ 30-45 BPM
What Can Cause The SA Node
To Go Into Sinus Arrest ?
Cardiovascular
Disease
Increased Vagal Tone
Infection
Drugs - Digitalis, Quinidine
Wandering Pacemaker
A Wandering Pacemaker Is A
Condition In Which You Have
Two Or More Pacemakers
Competing For Control Over
The Heart’s Rhythm
Characteristics Of A Wandering
Pacemaker :
P Waves
Have Different Shapes
PR Intervals Are Grossly Within
Normal Limits But Are Slightly
Variant From Each Other
QRS Complexes Are Normal
Wandering Pacemaker
Wandering Atrial Pacemaker
Sick Sinus Syndrome
Patient
Hx. Of Supraventricular
Tachdysrhythmias Like Atrial
Fibrillation Or Atrial Flutter
Significant Ischemic Heart Disease
Sick Sinus Syndrome
Characterized By :
Irregular
Heart Rate Deteriorating
Into Extreme Bradycardia
Episodes Of Syncope
Leads To Pacemaker Implant
Sick Sinus Syndrome
Ectopic Supraventricular
Dysrhythmias
Unsustained SVTD’s:
PAC’s
PJB’s
Or APB’s
Premature Atrial Contractions
(PAC’s Or APB’s)
Characteristics Of PAC’s :
It
Is A Premature Beat
P Wave Is Irregularly Shaped
Normal QRS
Causes Of PAC’s :
Stress
Caffeine
Tobacco
Use
Digitalis
Toxicity
Old MI’s
Low Blood Potassium Levels
Low Blood Magnesium Levels
Premature Atrial Contraction
Premature Atrial Contraction
PAC’s Can Deteriorate Into :
Atrial
Flutter
Atrial Fibrillation
Supraventricular Tachycardia
Premature Junctional
Beats (PJB’s)
PJB’s Occur from An Ectopic
Focus Close To The AV Node
Characteristics
Of PJB’s :
The Beat Is Premature
There is No P Wave
QRS Complex Is Normal
Premature Junctional Beat
Sustained Supraventricular
Dysrhythmias
Sustained SVTD’s Are :
PSVT
or PAT
Atrial Flutter
Atrial Fibrillation
PSVT Or PAT’s
Common
Dysrhythmia
Instigated Often By A Premature
Atrial Beat Or A Premature
Junctional Beat
Causes Are :
Ischemic
Heart Disease
Re-Entry Phenomenon
Stress
Drugs
Characteristics Of PSVT Are :
P Waves Are Absent
- P Waves Are
Hidden If They Are Present
Repeating Pattern Of QRS-T
Very High Heart Rates Of 150 250 BPM
Paroxysmal Atrial Tachycardia
Carotid Massage Can Bring A
Person Out Of PSVT
PSVT Can Be Stopped With
Cardioversion, Valsalva &
Coughing
Exercise
Can I Exercise A Patient With
PSVT Or SVT ?
 No !! This Patient Has An
Uncontrolled Atrial Dysrhythmia
Atrial Flutter
Atrial Flutter Is Also Known As
The Sawtooth Pattern
Characteristics Of Atrial Flutter :
High
Rate Of P Wave Appearance
Of 250-350
QRS Complex Is Followed By A
Regular Pattern Of P Waves - 2:1,
3:1 or 4:1 Block
QRS
Complexes Are Normal
& Regular
No Visible T Waves
No Visible S-T Segment
No Visible PR Interval
Causes Of Atrial Flutter :
Ischemic
Heart Disease
PAC’s
Re-Entry
Phenomenon
Pulmonary
Emboli
Stress
MI’s
Cor
Pulmonale
Valvular Heart Disease
Atrial Flutter
Exercise
Can I Exercise A Patient With
Atrial Flutter ?
 No !! This Patient Has An
Uncontrolled Atrial Dysrhythmia
Atrial Fibrillation
Some Causes Are :
MI’s
Pulmonary
Embolism
Hypertension
CAD
Heart Valve Disease
Characteristics Are :
High
Rates Of Atrial Discharge Of
Between 350-500 BPM
Flat Or Undulating Baseline
Absent P Waves
Irregularly Timed Normal QRS
Complexes
Atrial Fibrillation
Atrial Fibrillation
Exercise
Can I Exercise A Patient In Atrial
Fibrillation ?
 NO !! - The Patient Has An
Uncontrolled Atrial Dysrhythmia
Symptoms
What Will The Patient Feel With A
Supraventricular Tachydysrhythmia ?
Lightheadedness
Dizziness Or Syncope
Shortness Of Breath
Palpitations
Angina
Can A Patient Chronically Live
With These Dysrhythmias ?
Yes,
But There Are Some
Inherent Dangers !
Inherent Dangers
 Supraventricular Tachydysrhythmias
Can Cause The Formation Of Blood
Clots In The Atria.
 Patients
Can Auto-Embolize
Organ Systems If The Heart
Spontaneously Converts Out Of
The Dysrhythmia
 Patients
Must First Be AntiCoagulated & Then Converted
Out Of The Dysrhythmia