ELECTROCARDIOGRAPHIC MONITORING

1. ELECTROCARDIOGRAPHIC MONITORING Various rhythms and dysrhythmias: • Ventricular Fibrillation • Ventricular Tachycardia • Atrial Fibrillation • Atrial Flutter • Supraventricular Tachycardia • Paroxysmal Supraventricular Tachycardia • Sinus Tachycardia • Normal Sinus Rhythm • Asystole • Sinus Bradycardia • Junctional rhythm • First degree AV block • Second degree AV block Type I aka second-degree mobitz and aka wenckebach • Second degree AV block type II • Third degree AV block or complete heart block • PVCs: Unifocal, multi-focal, couplets, bigeminy, trigeminy • PACs

2. Atrial Fibrillation • Irregular heart beat • The most common cardiac arrhythmia • Affects the atria Causes • HTN • Heart disease • Lung disease • Excessive alcohol comsumption

3. Causes • Hyperthyroidism • CO poisoning • Dual chamber pacemakers • Friedreich’s ataxia progressive damage to the nervous system

4. Pathophysiology • Absence of P waves • Electrical impulses are inundated by chaotic impulses originating in the atria and pulmonary veins thus……… • Irregular impulses sent to ventricles creating an irregular pulse

7. May result in • Palpitations • Fainting • Chest pain • CHF • Stroke Due to clots forming in the poorly contracted artria forming blood clots

8. Controlled • Uncontrolled

9. Ventricular Tachycardia Arrhythmia, or irregular type of heartbeat. It causes a rapid heartbeat, usually 150 to 200 beats per minute. It is usually indicative of a serious medical problem which may or may not relate directly to the heart. If untreated, it often progresses to cardiac arrest and death.

11. Causes • Early or late complication after having an MI • Cardiomyopathy • Heart failure • Heart surgery • Myocarditis • Valvular Heart Disease

12. Causes • Anti-arrhythmic medications • Changes in blood chemistry (such as a low potassium level) • Changes in pH (acid-base) • Lack of enough oxygen

13. Symptoms • Chest discomfort • Syncope • Light-headedness or dizziness • Palpations • Shortness of breath

14. Atrial Flutter • Atrial flutter occurs when an abnormal conduction circuit develops inside the right atrium, allowing the atria to beat excessively fast, about 250-300 beats per minute.  • These rapid contractions are slowed when they reach the AV node, but are still too fast (typically about 150 beats per minute, or every other atrial beat getting through the AV node to the ventricles).

15. Causes Atrial flutter may be caused by abnormalities or diseases of the heart itself, by a disease elsewhere in the body that affects the heart, or by consuming substances that change the way electrical impulses are transmitted through the heart. In a few people, no underlying cause is ever found.

16. Causes • Ischemia • CAD • HTN • Cardiomyopathy • Abnormalities of the heart valves (especially the mitral valve) • An abnormally enlarged chamber of the heart (hypertrophy) • After open heart surgery

17. Diseases elsewhere in the body that affect the heart include the following: • Hyperthyroidism • PE • COPD Substances that may contribute to atrial flutter include the following: • Alcohol (wine, beer, or hard liquor) • Stimulants such as cocaine, amphetamines, diet pills, cold medicines, even caffeine

19. Supraventricular Tachycardia • Above the ventricles

20. Causes • Atherosclerosis • Heart Failure • Thyroid disease • Chronic lung disease • Pneumonia • Pulmonary emboli, or blood clots migrating into the lung arteries from elsewhere in the body • Pericarditis

21. Certain drugs and social habits • Cocaine abuse • Alcohol abuse • Smoking • Drinking too much caffeine in coffee, tea, or soft drinks • Emotional stress • Structural abnormalities, such as Wolff Parkinson White syndrome, in which extra electrical tissue sets up abnormal electrical circuits • Supraventricular tachycardia may also be a side effect of medications such as digitalis, asthma medications, or cold remedies. In some cases, the cause of supraventricular tachycardia is unknown

23. Sinus Tachycardia • Fast heart beat • Commonly asymptomatic

24. Causes • Sinus tachycardia is usually a response to normal physiological situations, such as exercise and an increased sympathetic tone with increased catecholamine release—stress, fright, flight, anger. Other causes include: • Fever • Anxiety • Dehydration • Malignant hyperthermia • Hypovolemia with hypotension and shock

25. Causes • Hyperthyroidism • Mercury poisoning • Kawasaki disease • Pheochromocytoma • Sepsis • Pulmonary embolism • Acute coronary ischemia and myocardial infarction

26. Causes • Chronic pulmonary disease • Hypoxia • Intake of stimulants such as caffeine, nicotine, cocaine, or amphetamines • Hyperdynamic circulation • Electric shock • Drug Withdrawal

27. Causes • Anemia • Heart Failure

28. Kawasaki Disease Pheochromocytoma

30. Sinus Bradycardia • heart rhythm that originates from the sinus node and has a rate of under 60 bpm.

31. Causes • Increased vagal tone. • Sleep • Hypothermia • Hypothyroidism • Intrinsic disease of the SA Node (Eg. Sick Sinus Syndrome).

33. Junctional Rhythm • Impulse generated at the AV node but does not happen by the normal pathway and instead is due to retrograde conduction (conduction comes from the ventricles or from the AV node into and through the atria) • P wave is absent or inverted

34. Causes • Sick sinus syndrome (including drug-induced) • Digoxin toxicity • acute inferior infarction • Acutely after cardiac surgery • Acute inflammatory processes

36. Heart Blocks

37. First Degree Heart Block

38. Second Degree Heart Block Type I

39. Second Degree Heart Block Type II

40. Third Degree or Complete Heart Block

41. Premature Ventricular Contractions (PVC) • Impulse generated in the ventricle

42. Causes • Premature ventricular contraction can occur in a healthy person of any age, but becomes more frequent in the elderly, and is more commonly found in men. PVC frequently occurs spontaneously with no cause.

43. Possible causes:

44. Bigeminy

45. Trigeminy

46. Couplets

47. Triplet

48. Unifocal

49. R-On-T

50. PACs • Ectopic beats within the atria • Benign Causes • unknown