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Cardiac Dysrhythmias

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

Samuel
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Cardiac Dysrhythmias

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  1. Cardiac Dysrhythmias

  2. Sinus Dysrhythmias • Bradycardia - A Sinus Rhythm That Is <60 BPM • Tachycardia - A Sinus Rhythm That Is > 100 BPM

  3. Respiratory Arrhythmia • During Inspiration & Expiration, The R-R Interval Expands & Contracts

  4. R-R Interval Widens During Expiration • R-R Interval Shortens During Inspiration

  5. Sinus Arrest • Sinus Arrest Occurs Because The Sinoatrial Node Ceases To Fire

  6. Sinus Arrest

  7. Escape Or Rescue Beats • Secondary Pacemakers Rescue The Heart & Create Escape Or Rescue Beats

  8. Rescue Beats May Have Their Origin High Up In The Atria Or Down Low Close To The AV Node Or Even In The Ventricles.

  9. 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

  10. Atrial Escape Or Rescue Beat

  11. If The Rescue Beat Is Close To The AV Node, Then It Will Likely Be A Junctional Escape Beat

  12. Characteristics Of A Junctional Escape Beat : • A Rescue Beat Is Delayed • No P Wave • The QRS Is Normal • Rate Will Be Slower

  13. Junctional Rescue Or Escape Beat

  14. If The Rescue Beat Is Located In The Ventricles, Then It Is A Ventricular Pacemaker That Is Activated To Rescue The Heart

  15. 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

  16. Ectopic Pacemakers Have Their Own Firing Rates • A Maxim : The Lower Your Go Into The Heart To Find A Pacemaker, The Slower The Rate

  17. Ectopic Pacemaker Rates • Atrial Pacemakers ~ 60-80 BPM • Junctional Pacemakers ~ 40-60 BPM • Ventricular Pacemakers ~ 30-45 BPM

  18. What Can Cause The SA Node To Go Into Sinus Arrest ? • Cardiovascular Disease • Increased Vagal Tone • Infection • Drugs - Digitalis, Quinidine

  19. Wandering Pacemaker • A Wandering Pacemaker Is A Condition In Which You Have Two Or More Pacemakers Competing For Control Over The Heart’s Rhythm

  20. 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

  21. Wandering Pacemaker

  22. Wandering Atrial Pacemaker

  23. Sick Sinus Syndrome • Patient Hx. Of Supraventricular Tachdysrhythmias Like Atrial Fibrillation Or Atrial Flutter • Significant Ischemic Heart Disease

  24. Sick Sinus Syndrome Characterized By : • Irregular Heart Rate Deteriorating Into Extreme Bradycardia • Episodes Of Syncope • Leads To Pacemaker Implant

  25. Sick Sinus Syndrome

  26. Ectopic Supraventricular Dysrhythmias • Unsustained SVTD’s: • PAC’s Or APB’s • PJB’s

  27. Premature Atrial Contractions (PAC’s Or APB’s) • Characteristics Of PAC’s : • It Is A Premature Beat • P Wave Is Irregularly Shaped • Normal QRS

  28. Causes Of PAC’s : • Stress • Caffeine • Tobacco Use

  29. Digitalis Toxicity • Old MI’s • Low Blood Potassium Levels • Low Blood Magnesium Levels

  30. Premature Atrial Contraction

  31. Premature Atrial Contraction

  32. PAC’s Can Deteriorate Into : • Atrial Flutter • Atrial Fibrillation • Supraventricular Tachycardia

  33. Premature Junctional Beats (PJB’s) • PJB’s Occur from An Ectopic Focus Close To The AV Node

  34. Characteristics Of PJB’s : • The Beat Is Premature • There is No P Wave • QRS Complex Is Normal

  35. Premature Junctional Beat

  36. Sustained Supraventricular Dysrhythmias • Sustained SVTD’s Are : • PSVT or PAT • Atrial Flutter • Atrial Fibrillation

  37. PSVT Or PAT’s • Common Dysrhythmia • Instigated Often By A Premature Atrial Beat Or A Premature Junctional Beat

  38. Causes Are : • Ischemic Heart Disease • Re-Entry Phenomenon • Stress • Drugs

  39. 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

  40. Paroxysmal Atrial Tachycardia

  41. Carotid Massage Can Bring A Person Out Of PSVT • PSVT Can Be Stopped With Cardioversion, Valsalva & Coughing

  42. Exercise • Can I Exercise A Patient With PSVT Or SVT ? • No !! This Patient Has An Uncontrolled Atrial Dysrhythmia

  43. Atrial Flutter • Atrial Flutter Is Also Known As The Sawtooth Pattern

  44. 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

  45. QRS Complexes Are Normal & Regular • No Visible T Waves • No Visible S-T Segment • No Visible PR Interval

  46. Causes Of Atrial Flutter : • Ischemic Heart Disease • PAC’s • Re-Entry Phenomenon

  47. Pulmonary Emboli • Stress • MI’s • Cor Pulmonale • Valvular Heart Disease

  48. Atrial Flutter

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