1. Cardiac Dysrhythmias

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

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

6. R-R Interval Widens During Expiration
R-R Interval Shortens During Inspiration

7. Sinus Arrest
Sinus Arrest Occurs Because The Sinoatrial Node Ceases To Fire

8. Sinus Arrest

9. Escape Or Rescue Beats
Secondary Pacemakers Rescue The Heart & Create Escape Or Rescue Beats

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

11. 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

12. Atrial Escape Or Rescue Beat

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

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

15. Junctional Rescue Or Escape Beat

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

17. 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

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

19. Ectopic Pacemaker Rates
Atrial Pacemakers ~ BPM
Junctional Pacemakers ~ BPM
Ventricular Pacemakers ~ BPM

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

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

22. 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

23. Wandering Pacemaker

24. Wandering Atrial Pacemaker

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

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

27. Sick Sinus Syndrome

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

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

30. Causes Of PAC’s :
Stress
Caffeine
Tobacco Use

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

32. Premature Atrial Contraction

33. Premature Atrial Contraction

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

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

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

37. Premature Junctional Beat

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

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

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

41. 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 BPM

42. Paroxysmal Atrial Tachycardia

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

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

45. Atrial Flutter
Atrial Flutter Is Also Known As The Sawtooth Pattern

46. Characteristics Of Atrial Flutter :
High Rate Of P Wave Appearance Of
QRS Complex Is Followed By A Regular Pattern Of P Waves - 2:1, 3:1 or 4:1 Block

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

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

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

50. Atrial Flutter

51. Exercise Can I Exercise A Patient With Atrial Flutter ?
No !! This Patient Has An Uncontrolled Atrial Dysrhythmia

52. Atrial Fibrillation Some Causes Are : MI’s Pulmonary Embolism
Hypertension
CAD
Heart Valve Disease

53. Characteristics Are :
High Rates Of Atrial Discharge Of Between BPM
Flat Or Undulating Baseline
Absent P Waves
Irregularly Timed Normal QRS Complexes

54. Atrial Fibrillation

55. Atrial Fibrillation

56. Exercise Can I Exercise A Patient In Atrial Fibrillation ?
NO !! - The Patient Has An Uncontrolled Atrial Dysrhythmia

57. Symptoms
What Will The Patient Feel With A Supraventricular Tachydysrhythmia ?
Lightheadedness
Dizziness Or Syncope
Shortness Of Breath
Palpitations
Angina

58. Can A Patient Chronically Live With These Dysrhythmias ?
Yes, But There Are Some Inherent Dangers !

59. Inherent Dangers
Supraventricular Tachydysrhythmias Can Cause The Formation Of Blood Clots In The Atria.

60. Patients Can Auto-Embolize Organ Systems If The Heart Spontaneously Converts Out Of The Dysrhythmia

61. Patients Must First Be Anti-Coagulated & Then Converted Out Of The Dysrhythmia