Arrhythmias

Arrhythmia Overview Atrial Arrhythmias Junctional rhythms and Blocks PAC Atrial Fib Junctional rhythms and Blocks Ventricular arrhythmias PVC Ventricular Tachycardia

Atrial Arrhythmias

Atrial Arrhythmias: Overview Sinus Arrest Atrial Tachycardia Single site ectopic beats Pre Atrial Contraction (PAC) Paroxysmal Atrial Tachycardia Atrial Flutter Multiple site ectopic beats Atrial Fibrillation

Atrial Arrhythmias are generally NOT immediately life- threatening

Sinus Arrest Hallmarks: Pause, the returning beat is proceeded by a “P” wave.

Atrial Ectopic Beats: PAC Often caused by and irritable focus Hallmarks: Early Beat, “P” wave may look different, followed by a compensatory pause.

Atrial Ectopic Beats: PAT Hallmarks: Groups of PAC’s then return to normal.

Ectopic beats: Atrial Flutter Hallmarks: Irregular R-R intervals, usually tachycardia, “Saw tooth” P’s in rapid succession

Multiple Site Ectopic Beats: Atrial Fibrillation Hallmarks: Irregular R-R Interval, Usually Tachycardia, indistinguishable (or no) “P’s” present.

9 times out of 10, and irregular and fast rhythm will be atrial fibrillation.

Ventricular Arrhythmias

Ventricular Arrhythmias: Overview Ventricular Ectopic Beats Premature Ventricular Contraction Ventricular Tachycardia Ventricular Fibrillation

Ventricular Arrhythmias are potentially life- threatening!

Single Ventricular Ectopic Beat: Premature Ventricular Contraction (PVC) Hallmarks: No “P” wave, wide, bizarre QRS. Most often comes early.

PVC’s come in a variety of shapes and sizes

PVC’s are not immediately life-threatening, but can lead to more serious and deadly rhythms

Ventricular Ectopic Beats: Ventricular Tachycardia (V-Tach) After about 15 seconds of sustained V-Tach, the patient will lose consciousness due to lack of blood flow to the brain. The heart is beating faster than it can refill with blood causing a life-threatening drop in blood pressure.

Ventricular Ectopic Beats: Ventricular Fibrillation

Death in Minutes V-Tach and V-Fib must be defibrillated immediately or the patient will die.

Junctional Rhythms

Junctional Escape Beat Hallmarks: Long pause, when the beat finally show up, it’s got not “P” wave. The QRS looks normal though.

Junctional Rhythms Hallmarks: Often bradycardic (unless “accelerated junctional”), Exceedingly regular R-R interval, No P waves

Blocks: 1st Degree Block Hallmark: Long PR interval

Blocks: 2nd Degree Block type I: Wenckebach or Mobitz I Hallmarks: P-R gets longer and longer then drops an “R” (non conducted “P”)

Blocks: 2nd Degree Block type II: Mobitz II Hallmarks: P without a QRS (without lengthening)

Blocks: 3rd Degree block: Complete Heart block. Hallmark: “P’s” regular, “R’s” regular, but both ignore the other!

Bundle Branch Block ….Have a variety of shapes depending upon: Whether it is a left or right bundle branch The lead that you are looking at. May look like two “R’s” side by side, bunny ears, or just a widened QRS