Heart Rhythms

1. Heart Rhythms Wikinursing2012

2. Normal sinus rhythm • 60-100 bpm

3. characteristics • Normal sinus rhythm: p-waves followed by a QRS complex, then a T-wave.In a normal HR, sinus node creates an electrical impulse to right and left atrial muscles creating electrical impulses on the electrocardiogram (ECG) shown as the p-wave. An impulse travels through the atrioventicular node causing a slower rate. A pause (PR interval) is created before the ventricles are stimulated. Blood from the atria and into the ventricles and into the body. Ventricular contraction are represented as QRS waves. T-wave follows representing ventriclesrelaxing. Normal sinus rhythm indicates the rhythm of the heart, which can be up to 110-160bpm for a newborn, 70-110bpm for a child and 60-100bpm for an adult.

4. Manifestations/treatment • no problems typically associated with rhythm • no treatment generally associated with this rhythm

5. Sinus bradycardia • Less than 60 bpm

6. characteristics • Rate: 60bpm, P-P interval, regular, R-R interval regular. P wave-positive (upright) in Lead II one P wave precedes each QRS complex. P waves look alike. PR interval 0.12 to 0.20 seconds and constant from beat to beat. QRS duration 0.10 seconds or less unless an intraventricular conduction delay exists

7. causes • •Heart tissue damage related to aging, heart disease or heart attack • Heart disorder present at birth (congenital heart defect) • Infection of heart tissue (myocarditis) • A complication of heart surgery • Underactive thyroid gland (hypothyroidism) • Imbalance of electrolytes, mineral-related substances necessary for conducting electrical impulses • Obstructive sleep apnea, the repeated disruption of breathing during sleep • Medications, including some drugs for other heart rhythm disorders, high blood pressure and psycho

8. Sinus bradycardia Manifestations • •Sinus bradycardia is most often asymptomatic. However, symptoms may include the following: • ◦Syncope • ◦Dizziness • ◦Lightheadedness • ◦Chest pain • ◦Shortness of breath • ◦Exercise intolerance

9. Sinus Bradycardia Treatment • Only Treated if symptomatic • Some of the different medications used in the treatment of sinus bradycardia include: • •Atropine • •AtroPen • •Atropine-Care • •Isopto Atropine • •Sal-Tropine • •Dioptic's Atropine Solution • •Minim's Atropine Solution • •Tropyn Z

10. Sinus Tachycardia • More than 100 bpm

11. Handy tip!!! • With very fast heart rates the P waves may be hidden in the preceding T wave, producing a ‘camel hump’ appearance.

12. characteristics • Rate is 101 to 180 bpm, Rhythm P-P interval regular R-R interval regular, Pwave positive (upright) in lead II, one precedes each QRS complex. P waves look alike. PR interval 0.12-0.20 seconds, QRS duration 0.10 sec or less

13. Common causes • Exercise • Pain, anxiety • Hypoxia, hypercarbia • Acidaemia • Sepsis, pyrexia • Pulmonary embolism • Hyperthyroidism

14. manifestations • Usually asymptomatic, if symptoms are present they may include the following: • •A racing heart rate or palpitations • •The feeling of the heart pounding in the chest. • •Dizziness in some cases • •Actual syncope (fainting) • •Consistently fast heart rate (above 100 BPM) even at rest, although some nights it seems to slow to around 80 BPM • •Periodic chest pain, sometimes sharp, others constraining and chest "pressure" • •Out of breath most times • •Increased fatigue • •Intolerance to exercise or any type of physical activity, even walking up a few stairs • •Severe anxiety

15. treatment • beta blockers • calcium channel blockers • antiarrhythmic drugs.