1 / 64

Coronary Artery Disease Complications Cardiac Arrhythmias/Dysrhythmias

Coronary Artery Disease Complications Cardiac Arrhythmias/Dysrhythmias. Conduction System Four Properties of Cardiac Tissue Automaticity – ability to initiate an impulse Contractility – ability to respond mechanically to an impulse

euclid
Download Presentation

Coronary Artery Disease Complications Cardiac Arrhythmias/Dysrhythmias

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Coronary Artery DiseaseComplicationsCardiac Arrhythmias/Dysrhythmias • Conduction System • Four Properties of Cardiac Tissue • Automaticity – ability to initiate an impulse • Contractility – ability to respond mechanically to an impulse • Conductivity – ability to transmit an impulse along a membrane in an orderly manner • Excitability – ability to be electrically stimulated

  2. Cardiac Conduction System Specialized neuromuscular tissue • PR Interval: • SA Node – upper R atrium through Bachman’s Bundle • AV Node – internodal pathway • Bundle of His • QRS Complex: • Right and Left Bundle Branches • Purkinje Fibers

  3. Cardiac Conduction

  4. Cardiac MonitoringPQRS Complex

  5. Cardiac Action Potential

  6. Calculating Heart Rate • EKG paper is a grid where time is measured along the horizontal axis. • Each small square is 1 mm in length and represents 0.04 seconds. • Each larger square is 5 mm in length and represents 0.2 seconds. • Voltage is measured along the vertical axis - 10 mm is equal to 1mV in voltage. • Heart rate can be easily calculated from the EKG strip: • Heart rate can be easily calculated from the EKG strip: • When the rhythm is regular: • the heart rate is 300 divided by the number of large squares between the QRS complexes. • e.g., if there are 4 large squares between regular QRS complexes, the heart rate is 75 (300/4=75). • The second method can be used with an irregular rhythm to estimate the rate: • Count the number of R waves in a 6 second strip and multiply by 10. • e.g., if there are 7 R waves in a 6 second strip, the heart rate is 70 (7x10=70).

  7. Cardiac MonitoringCardiac Rate

  8. Cardiac MonitoringAmplitude / Duration

  9. 12 Lead EKG

  10. EKG Leads

  11. 12-Lead EKG

  12. Reciprocal EKG Changes

  13. Cardiac MonitoringChest Lead Placement

  14. Cardiac Monitoring- MCL

  15. Cardiac MonitoringNormal Sinus Rhythm

  16. Cardiac MonitoringPQRS Complex

  17. Cardiac MonitoringCardiac Rhythm Analysis • Analyze the P waves – rate/rhythm • Analyze the QRS complexes – rate/rhythm • Determine the heart rate • Measure the PR Interval • Measure the QRS duration • Interpret the rhythm • Clinical significance? Hemodynamic status? • Appropriate Tx

  18. Cardiac Monitoring Normal Sinus Rhythm

  19. Cardiac MonitoringNormal Sinus Rhythm

  20. EKG / Heart Sounds

  21. Cardiac MonitoringNormal Sinus Rhythm • Atrial & Ventricular rhythms: regular • Rate: 60-100 beats/min • P waves: present consistent configuration, one P wave prior to each QRS complex • PR interval: .12 – .20 sec and constant • QRS duration: -.04 to .10 sec and constant

  22. Cardiac MonitoringSinus Dysrhythmias

  23. Cardiac MonitoringSinus Bradycardia • SA Node discharges < 60 beats/ min • Etiology: >parasympathetic stimulation / vagus nerve • Assess: LOC, Orientation, VS, PO, pain, escaped ventricular ectopy • Tx: If patient is symptomatic – raise legs up, move patient, Atropine – ACLS Bradycardia

  24. Cardiac MonitoringSinus Tachycardia Sinus Bradycardia

  25. Cardiac MonitoringSinus Tachycardia • SA Node discharge > 100 beats/ min • Etiology: Sympathetic stimulation – normal or abnormal response • Tx: Treat underlying cause • Cardiac Supply Problems • Cardiac Demand Problems • E.g., hypovolemia, hypoxemia, anxiety, pain, anemia, angina • Regular Narrow QRS - Adenosine

  26. Sustained Tachy / Brady Dysrhythmias • Chest discomfort, or pain, radiation to jaw, back, shoulder or upper arm • Restlessness, anxiety, nervousness • Dizziness, syncope • Change in pulse strength, rate, rhythm • Pulse deficit • Shortness of breath, dyspnea • Tachypnea, Orthopnea • Pulmonary rales • S3 or S4 heart sounds • Jugular vein distention • Weakness, fatigue • Pale, cool skin, diaphoresis • Nausea, vomiting • Decreased urine output • Hypotension

  27. Cardiac MonitoringPSVT

  28. Cardiac MonitoringParoxysmal Supraventricular Narrow QRS Tachycardia (PSVT) • SA Node rate 100-280 beats/min - Mean 170 beats/min • Etiology: Pre-excitation syndrome, e.g., Wolff-Parkinson White (WPW) Syndrome • Assess: Weakness, fatigue, chest pain, chest wall pain, hypotension, dyspnea, nervousness • Tx: Valsalva maneuvers: bearing down, gagging, ocular pressure, vomiting, carotid sinus massage, • Meds: Adenosine

  29. Cardiac MonitoringInterference

  30. Cardiac MonitoringAtrial Flutter / Fibrillation

  31. Cardiac MonitoringAtrial Flutter / Fibrillation

  32. Cardiac MonitoringAtrial Fibrillation • Most Common dysrhythmia in the US • Multiple rapid impulses from many atrial foci, rate of 350-600/min—depolarize the atrial in a disorganized and chaotic manner – atrial quiver • Results: • No P waves • No atrial contracts • No atrial kick • Irregular ventricular response

  33. Cardiac MonitoringAtrial Fibrillation • Etiology: MI, RHD with Mitral Stenosis, CHF, COPD, Cardiomyopathy, Hyperthyroidism, Pulmonary emboli, WPW Syndrome, Congenital heart disease ** Mural Thrombi – increased risk for pulmonary & systemic thromboemboli to brain & periphery • Assess: VS, PO, Pulse Deficit, chest pain, syncope, hypotension • Symptoms worsen with increased ventricular response

  34. Cardiac MonitoringAtrial Fibrillation • Tx: • TEE – Trans-esophageal echocardiogram • Identifies thrombi on valves • Medications to decrease the ventricular response - Metoprolol (Lopressor) • Oxygen • Prophylactic anticoagulation • Lovenox - Coumadin – long term • Cardioversion

  35. Cardiac MonitoringAtrial Fibrillation • Tx: • Medications to decrease the ventricular response • Narrow QRS irreg rhythm–diltiazem; beta-blockers • Wide QRS reg rhythm – amiodarone • Wide QRS irreg rhythm – digoxin, diltiazem, verapermil, amiodarone • Oxygen • Prophylactic anticoagulation • Cardioversion

  36. Cardiac MonitoringAtrial FibrillationCardioversion • Synchronized countershock • 50 – 100 Joules • Avoids delivering shock during repolarization • Patent intravenous line • Patient sedated – Versed • Oxygenation • ABC • Assess: VS, PO, Monitor cardiac rate - rhythm • Administer antidysrhythmic medication

  37. Cardiac MonitoringJunctional Escape Rhythm

  38. Cardiac MonitoringJunctional Escape Rhythm • Impulse generated from AV nodal cells at the AV Junction • Escape pacemaker • Rate 40-60 beats/ min • Transient • Assess: Patient hemodynamic stability

  39. Cardiac MonitoringPremature Ventricular Contractions

  40. Cardiac MonitoringNSR – V. Tach – V. Fibrillation

  41. Cardiac MonitoringVentricular Tachycardia

  42. Cardiac MonitoringVentricular Dysrhythmias

  43. Cardiac MonitoringPremature Ventricular Contractions

  44. Cardiac MonitoringPremature Ventricular Contractions (PVCs)_ • Early ventricular complexes • Followed by compensatory pause • Fit between two NSR beats - interpolated • Unifocal, multifocal, couplet, triplets, bigeminy, trigeminy, quadrigeminy • 3+ = ventricular tachycardia • Etiology: myocardial ischemia, <K+, CHF, metabolic acidosis, airway obstruction

  45. Cardiac MonitoringPremature Ventricular Contractions (PVCs/ Ventricular Tachycardia with Pulse • Assess: LOC, hemodynamic status-- continuous cardiac monitoring of rhythm & rate, VS, PO, peripheral perfusion • Tx: Underlying cause + Oxygen, Amiodarone IV bolus / Infusion

  46. V. Tachycardia/V. FibrillationPulseless • TX: CPR BLS - Airway, Breathing, Circulation • Shockable Rhythm VT/VF: Defibrillate – 120-200 Joules • CPR x 5 cycles • Check rhythm – shockable? • Defibrillate (biphasic 200 J / monophasic 360 J • Resume CPR • Epinephine 1 mg IV (repeat q3-5 mins) / Vasopressin • CPR x 5 cycles • Check rhythm – shockable? • Defibrillate (biphasic 200 J / monophasic 360 J • Resume CPR • Antiarrhythmics: amiodarone/lidocaine • Magnesium – torsades de pointes • Advanced Cardiac Life Support • Defibrillation – V Fib / pulseless & polymorphic V tach • Meds:

  47. Cardiac MonitoringV Fib - Agonal Rhythm

  48. Common Causes of Dysrhythmias • Cardiac • Accessory pathways, conduction defects, congestive heart failure, left ventricular hypertrophy, myocardial cell degeneration, myocardial infarction • Other Conditions • Acid-base imbalances, alcohol, coffee, tea, tobacco, connective tissue disorders, drug effects or toxicity, electric shock, electrolyte imbalances, emotional crisis, hypoxia, shock, metabolic disorders (e.g. thyroid), near-drowning, poisoning

  49. Cardiac MonitoringHeart Block 1st, 2nd Types I & II

More Related