2. Cardiac Arrhythmia

3. Definition: The pumping action of the heart is coordinated by
an electrical system within the heart tissue. An
irregularity in this electrical system is called an
arrhythmia, or heart rhythm disorder.

4. Causes:
-Congenital.
-Myocardial ischemia.
-MI.
-Organic heart disease.
-Drugs effects and toxicity.
-Conductive tissue deterioration.
-Electrolyte imbalance.
-Acid-base imbalances.
-Cellular hypoxia.

5. Pathophysiology:
-Results from a disturbance in conductivity.
-Heart rate and rhythm are altered, reducing cardiac
output.
Assessment finding:
-Palpitations.
-Chest pain.
-Weakness, fatigue.

6. -Irregular heart rhythm.
-Bradycardia or tachycardia.
-Dizziness.
-Hypotension.
-Altered level of consciousness.
-Pallor.
-Nausea, vomiting.
-Cold skin.

7. Possible diagnostic findings:
* ECG: changes in heart rate, rhythm.
* Blood chemistry: electrolyte imbalance.
Nursing intervention:
Monitor pulse for irregular pattern or abnormally rapid
or slow rate.
Observe for arrhythmias if the patient is receiving
continuous cardiac monitoring.
Assess cardiovascular, respiratory, and neurovascular
status.
Initiate cardiopulmonary resuscitation (CPR), if
indicated, until other advanced cardiac life support
measures are available and successful.
Perform defibrillation early for ventricular tachycardia
and ventricular fibrillation.

8. Administer medications, oxygen, and I.V fluids, as
needed.
Prepare for procedures, such as cardioversion or
pacemaker insertion, if indicated.
Monitor for predisposing factors (such as fluid and
electrolyte imbalance) and signs of drug toxicity,
especially digoxin.
* Monitor and record vital signs.
* Maintain prescribed diet.
* Maintain bed rest, until patient is stable.
* Provide support to the patient and family.

9. Characteristics of normal rhythm include:
-Ventricular and atrial rates of 60 to 100 beats/
minute.
-Regular and uniform QRS complexes and P
waves.
-PR interval of 0.12 to 0.2 second.
-QRS duration <0.12 second.

12. Causes
-Fever, anxiety, pain, dehydration, may also left ventricular failure, hyperthyroidism, anemia, hypovolemia, pulmonary embolism, and anterior wall MI.
-May also occur with atropine, epinephrine, alcohol,
caffeine, and nicotine use.

13. Treatment
-Correction of underlying cause.
-Beta and calcium blockers.

15. -Increased intracranial pressure, increased vagal
Causes:
-Normal, in well-conditioned heart, as in an athlete.
-Increased intracranial pressure, increased vagal
tone due to straining during defecation, vomiting,
intubation, mechanical ventilation, sick sinus
syndrome, hypothyroidism, inferior wall MI.
-Morphine use.

16. Treatment:
-Correction of underlying cause.
-Administration of atropine.
-Temporary or permanent pacemaker.
-Dopamine or epinephrine infusion.

18. Causes:
-Heart failure (HF), tricuspid or mitral valve
disease, pulmonary embolism, inferior wall MI and
carditis.
-Digoxin toxicity.

19. Treatment:
-If patient is unstable with a ventricular rate
>150 b/m, immediate cardioversion.
If patient is stable, drug therapy may include calcium blockers, or antiarrhythmics.
-Anticoagulation therapy (heparin).

21. Causes:
-H.F., COPD, thyrotoxicosis, Pericarditis,
(IHD), sepsis, pulmonary embolism, (RHD),
hypertension, mitral stenosis, complication
of coronary bypass or valve replacement
surgery.
- Digoxin use.

22. Treatment:
-If patient is unstable with a ventricular rate
>150 b/m, immediate cardioversion.
- If patient is stable, drug therapy may include calcium and beta blockers, or antiarrhythmics.
-Anticoagulation therapy (heparin).

24. Causes: Myocardial ischemia or infarction,
untreated ventricular tachycardia,
hyperkalemia ,
hypercalcemia ,
Hypothermia,
Digoxin or epinephrine toxicity.

25. Treatment:
Administration of epinephrine ,if ineffective magnesium sulfate is given.

26. Ventricular tachycardia

27. Causes: Myocardial ischemia infarction , Coronary artery disease ,
Rheumatic heart disease,
Heart failure ,
Hypokalemia ;
Hypercalcemia,
Digoxin toxicity,
Anxiety.

28. Treatment:
Initiate cardiopulmonary resuscitation and administration of epinephrine.

29. Correction of underlying cause
Treatment
Causes
Arrhythmia And Feature
Correction of underlying cause
Possibly atropine if severe bradycardia develops and the patient is symptomatic
Cautious use of digoxin and beta –adrenergic blockers
May be seen in a healthy person
Inferior wall MI, or Ischemia, hypothyroidism, hypokalemia , hyperkalemia.
Digoxin toxicity
First – degree AV block
Atrial and ventricular rhythms regular
PR interval > second
QSR complex normal

30. Treatment of underlying cause
Atropine for symptomatic
Bradycardia
Discontinuation of digoxin .
Inferior wall MI ,cardiac surgery acute rheumatic fever ,and vagal stimulation
Digoxin toxicity
Second- degree AV block
Atrial rhythm regular
Ventricular rhythm irregular
Atrial rate exceeds ventricular rate
PR interval progressively longer

31. Atropine , dopamine , or epinephrine for symptomatic bradycardia
Temporary or permanent pacemaker
Inferior or anterior wall MI , congenital abnormality , rheumatic fever ,hypoxia , postoperative complication of mitral valve replacement
Digoxin toxicity
Third – degree AVblock
Atrial rhythm regular
Ventricular rate slow and rhythm regular
No relation between P waves and QRS complex
No stable PR interval
QRS interval normal or wide
PR interval varies
P wave may be covered in QRS complexes or T wave
QSR complex normal

32. Possible surgical intervention
Complications:
Stroke
Death
MI Hypotension
Shock
Heart failure
Possible surgical intervention
-Pacemaker insertion
-Catheter ablation therapy

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