Cardiac DysrhythmiasCardiac Dysrhythmias

Sinus DysrhythmiasSinus Dysrhythmias

Bradycardia - A Sinus Rhythm Bradycardia - A Sinus Rhythm That Is That Is <<60 BPM60 BPM

Tachycardia - A Sinus Rhythm Tachycardia - A Sinus Rhythm That Is That Is >> 100 BPM 100 BPM

Respiratory ArrhythmiaRespiratory Arrhythmia• During Inspiration & Expiration, During Inspiration & Expiration,

The R-R Interval Expands & The R-R Interval Expands & ContractsContracts

• R-R Interval Widens During R-R Interval Widens During Expiration Expiration

• R-R Interval Shortens During R-R Interval Shortens During InspirationInspiration

Sinus ArrestSinus Arrest

Sinus Arrest Occurs Because Sinus Arrest Occurs Because The Sinoatrial Node Ceases The Sinoatrial Node Ceases To FireTo Fire

Sinus ArrestSinus Arrest

Escape Or Rescue BeatsEscape Or Rescue Beats

Secondary Pacemakers Rescue Secondary Pacemakers Rescue The Heart & Create Escape Or The Heart & Create Escape Or Rescue BeatsRescue Beats

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

If The Ectopic Pacemaker Is If The Ectopic Pacemaker Is Close To The SA Node, It Will Close To The SA Node, It Will Be An Atrial Escape Beat. It Will Be An Atrial Escape Beat. It Will Have These Features :Have These Features :The Escape Beat Is DelayedThe Escape Beat Is DelayedP Wave Is Irregularly ShapedP Wave Is Irregularly ShapedA Normal QRS Complex A Normal QRS Complex

Atrial Escape Or Rescue BeatAtrial Escape Or Rescue Beat

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

Characteristics Of A Junctional Characteristics Of A Junctional Escape Beat :Escape Beat :A Rescue Beat Is DelayedA Rescue Beat Is DelayedNo P WaveNo P WaveThe QRS Is NormalThe QRS Is NormalRate Will Be SlowerRate Will Be Slower

Junctional Rescue Or Escape BeatJunctional Rescue Or Escape Beat

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

Characteristics Of A Ventricular Characteristics Of A Ventricular Rescue Beat Are :Rescue Beat Are :No P WaveNo P WaveA Rescue Beat Is A Delayed BeatA Rescue Beat Is A Delayed BeatWide Bizarre QRS ComplexWide Bizarre QRS ComplexRate Will Be Very SlowRate Will Be Very Slow

Ectopic Pacemakers Have Their Ectopic Pacemakers Have Their Own Firing RatesOwn Firing Rates

A MaximA Maxim : The Lower Your Go Into : The Lower Your Go Into The Heart To Find A Pacemaker, The Heart To Find A Pacemaker, The Slower The RateThe Slower The Rate

Ectopic Pacemaker RatesEctopic Pacemaker Rates

Atrial Pacemakers Atrial Pacemakers ~~ 60-80 BPM 60-80 BPMJunctional Pacemakers Junctional Pacemakers ~~ 40-60 BPM 40-60 BPMVentricular Pacemakers Ventricular Pacemakers ~~ 30-45 BPM 30-45 BPM

What Can Cause The SA Node What Can Cause The SA Node To Go Into Sinus Arrest ?To Go Into Sinus Arrest ?Cardiovascular DiseaseCardiovascular DiseaseIncreased Vagal ToneIncreased Vagal ToneInfectionInfectionDrugs - Digitalis, QuinidineDrugs - Digitalis, Quinidine

Wandering PacemakerWandering Pacemaker

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

Characteristics Of A Wandering Characteristics Of A Wandering Pacemaker :Pacemaker :P Waves Have Different ShapesP Waves Have Different ShapesPR Intervals Are Grossly Within PR Intervals Are Grossly Within

Normal Limits But Are Slightly Normal Limits But Are Slightly Variant From Each OtherVariant From Each Other

QRS Complexes Are NormalQRS Complexes Are Normal

Wandering PacemakerWandering Pacemaker

Wandering Atrial PacemakerWandering Atrial Pacemaker

Sick Sinus SyndromeSick Sinus Syndrome

Patient Hx. Of Supraventricular Patient Hx. Of Supraventricular Tachdysrhythmias Like Atrial Tachdysrhythmias Like Atrial Fibrillation Or Atrial FlutterFibrillation Or Atrial Flutter

Significant Ischemic Heart DiseaseSignificant Ischemic Heart Disease

Sick Sinus Syndrome Characterized Sick Sinus Syndrome Characterized By :By :Irregular Heart Rate Deteriorating Irregular Heart Rate Deteriorating

Into Extreme BradycardiaInto Extreme BradycardiaEpisodes Of SyncopeEpisodes Of SyncopeLeads To Pacemaker ImplantLeads To Pacemaker Implant

Sick Sinus SyndromeSick Sinus Syndrome

Ectopic Supraventricular Ectopic Supraventricular DysrhythmiasDysrhythmias

Unsustained SVTD’s:Unsustained SVTD’s:PAC’s Or APB’sPAC’s Or APB’sPJB’sPJB’s

Premature Atrial Contractions Premature Atrial Contractions (PAC’s Or APB’s)(PAC’s Or APB’s)

Characteristics Of PAC’s :Characteristics Of PAC’s :It Is A It Is A PrematurePremature Beat BeatP Wave Is Irregularly ShapedP Wave Is Irregularly ShapedNormal QRSNormal QRS

Causes Of PAC’s :Causes Of PAC’s :StressStressCaffeineCaffeineTobacco UseTobacco Use

Digitalis ToxicityDigitalis ToxicityOld MI’sOld MI’sLow Blood Potassium LevelsLow Blood Potassium LevelsLow Blood Magnesium LevelsLow Blood Magnesium Levels

Premature Atrial ContractionPremature Atrial Contraction

Premature Atrial ContractionPremature Atrial Contraction

PAC’s Can Deteriorate Into :PAC’s Can Deteriorate Into :Atrial FlutterAtrial FlutterAtrial FibrillationAtrial FibrillationSupraventricular TachycardiaSupraventricular Tachycardia

Premature Junctional Premature Junctional Beats (PJB’s)Beats (PJB’s)

PJB’s Occur from An Ectopic PJB’s Occur from An Ectopic Focus Close To The AV NodeFocus Close To The AV Node

Characteristics Of PJB’s :Characteristics Of PJB’s :The Beat Is The Beat Is PrematurePrematureThere is No P WaveThere is No P WaveQRS Complex Is NormalQRS Complex Is Normal

Premature Junctional BeatPremature Junctional Beat

Sustained Supraventricular Sustained Supraventricular DysrhythmiasDysrhythmias

Sustained SVTD’s Are :Sustained SVTD’s Are :PSVT or PATPSVT or PATAtrial FlutterAtrial FlutterAtrial FibrillationAtrial Fibrillation

PSVT Or PAT’sPSVT Or PAT’s

Common DysrhythmiaCommon Dysrhythmia Instigated Often By A Premature Instigated Often By A Premature

Atrial Beat Or A Premature Atrial Beat Or A Premature Junctional BeatJunctional Beat

Causes Are :Causes Are :Ischemic Heart DiseaseIschemic Heart DiseaseRe-Entry PhenomenonRe-Entry PhenomenonStressStressDrugsDrugs

Characteristics Of PSVT Are :Characteristics Of PSVT Are :P Waves Are Absent - P Waves P Waves Are Absent - P Waves

Are Hidden If They Are PresentAre Hidden If They Are PresentRepeating Pattern Of QRS-TRepeating Pattern Of QRS-TVery High Heart Rates Of 150 - Very High Heart Rates Of 150 -

250 BPM250 BPM

Paroxysmal Atrial TachycardiaParoxysmal Atrial Tachycardia

Carotid Massage Can Bring A Carotid Massage Can Bring A Person Out Of PSVTPerson Out Of PSVT

PSVT Can Be Stopped With PSVT Can Be Stopped With Cardioversion, Valsalva & Cardioversion, Valsalva & CoughingCoughing

ExerciseExercise

Can I Exercise A Patient With Can I Exercise A Patient With PSVT Or SVT ?PSVT Or SVT ?

No !! This Patient Has An No !! This Patient Has An Uncontrolled Atrial DysrhythmiaUncontrolled Atrial Dysrhythmia

Atrial FlutterAtrial Flutter

Atrial Flutter Is Also Known As Atrial Flutter Is Also Known As The Sawtooth PatternThe Sawtooth Pattern

Characteristics Of Atrial Flutter :Characteristics Of Atrial Flutter :High Rate Of P Wave Appearance High Rate Of P Wave Appearance

Of 250-350Of 250-350QRS Complex Is Followed By A QRS Complex Is Followed By A

Regular Pattern Of P Waves - 2:1, Regular Pattern Of P Waves - 2:1, 3:1 or 4:1 Block3:1 or 4:1 Block

QRS Complexes Are Normal QRS Complexes Are Normal & Regular& Regular

No Visible T WavesNo Visible T Waves No Visible S-T SegmentNo Visible S-T Segment No Visible PR IntervalNo Visible PR Interval

Causes Of Atrial Flutter :Causes Of Atrial Flutter :Ischemic Heart DiseaseIschemic Heart DiseasePAC’sPAC’sRe-Entry PhenomenonRe-Entry Phenomenon

Pulmonary EmboliPulmonary EmboliStressStressMI’sMI’sCor PulmonaleCor PulmonaleValvular Heart DiseaseValvular Heart Disease

Atrial FlutterAtrial Flutter

ExerciseExercise

Can I Exercise A Patient With Can I Exercise A Patient With Atrial Flutter ?Atrial Flutter ?

No !! This Patient Has An No !! This Patient Has An Uncontrolled Atrial DysrhythmiaUncontrolled Atrial Dysrhythmia

Atrial FibrillationAtrial Fibrillation

Some Causes Are :Some Causes Are :MI’sMI’sPulmonary EmbolismPulmonary EmbolismHypertensionHypertensionCADCADHeart Valve DiseaseHeart Valve Disease

Characteristics Are :Characteristics Are :High Rates Of Atrial Discharge Of High Rates Of Atrial Discharge Of

Between 350-500 BPMBetween 350-500 BPMFlat Or Undulating BaselineFlat Or Undulating BaselineAbsent P WavesAbsent P WavesIrregularly Timed Normal QRS Irregularly Timed Normal QRS

ComplexesComplexes

Atrial FibrillationAtrial Fibrillation

Atrial FibrillationAtrial Fibrillation

ExerciseExercise

Can I Exercise A Patient In Atrial Can I Exercise A Patient In Atrial Fibrillation ?Fibrillation ?

NO !! - The Patient Has An NO !! - The Patient Has An Uncontrolled Atrial DysrhythmiaUncontrolled Atrial Dysrhythmia

SymptomsSymptoms What Will The Patient Feel With A What Will The Patient Feel With A

Supraventricular Tachydysrhythmia ?Supraventricular Tachydysrhythmia ?LightheadednessLightheadednessDizziness Or SyncopeDizziness Or SyncopeShortness Of BreathShortness Of BreathPalpitationsPalpitationsAnginaAngina

Can A Patient Chronically Live Can A Patient Chronically Live With These Dysrhythmias ?With These Dysrhythmias ?

Yes, But There Are Some Yes, But There Are Some Inherent Dangers !Inherent Dangers !

Inherent DangersInherent Dangers

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

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

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