Cardiac dysrhythmia management & pacemakers

Cardiac dysrhythmia management & pacemakers
Cardiac dysrhythmias
 Students to review slides 4-29 prior to class: this content will not be covered in NUR 4120
 Normal sinus rhythm
 Answers to evaluation of rhythm will always be within normal limits
 Rate: 60-100bpm




Sinus node dysrhythmias
 Sinus bradycardia
 HR < 60 bpm
 Sinus node creates impulse at slower than normal rate
 Characteristics of NSR but a slower rate




 Etiology: sinus bradycardia
 Sleep  Medication
 Athletic training  CCB (decrease HR/BP), amiodarone,
 Hypothyroidism beta-blockers
 Vagal stimulation  Increased intracranial pressure
 Vomiting, suctioning, pain  CAD/Acute MI
 Hypoxemia  Acute decompensated heart failure
 Altered mental status
 Sinus bradycardia: clinical manifestations and management
 Clinical manifestations:
 SOB altered LOC
 Hypotension
 EKG changes (ST segment changes PVC’s)
 Management:
 Resolve causative factors
 Atropine 0.5 mg IV every 3-5 minutes
◊ Maximum dose of 3 mg
◊ Atropine won’t work on a patient with a heart transplant
 Emergency transcutaneous pacing
 Catecholamines

, Sinus tachycardia
 HR: 100-120
 Sinus node creates impulse at faster than normal rate
 Does not start or stop suddenly




 Etiology: sinus tachycardia
 Physiologic stress
 Acute blood loss, anemia
 Shock
 Hyper/hypovolemia
 Heart failure
 Pain
 Hypermetabolic states
 Fever
 Exercise
 Anxiety
 Medications
 Catecholamine
 Atropine
 Stimulants (caffeine, nicotine)
 Illicit drugs (Ecstasy, cocaine)
 Sinus tachycardia: clinical manifestations and management
 Clinical manifestations
 Decreased filling time of heart
◊ Reduces cardiac output
 Syncope
 Hypotension
 Acute pulmonary edema (assess lung sounds, diff. breathing)
 Management
 Abolish the cause
 Synchronized cardioversion (hemodynamic instability)
 Vagal maneuvers  recharges SA node
 Adenosine (only for narrow QRS)
 Narrow QRS?
◊ Beta-blockers (rare)
◊ Calcium-channel blockers (rare)
◊ Adenosine
 Wide QRS?
◊ sotalol, amiodarone
 Increased fluid/sodium (POTS) postural orthostatic tachycardia
Atrial dysrhythmias
 Atrial flutter

,  Conduction defect in the atrium, filling time is affected, risk = coagulation
 Creates atrial rate between 250-400 times/minute (ventricular rate 75-150)
 Not all impulses conducted to ventricle: therapeutic block at AV node
 2:1, 3:1, 4:1




 Regular atrial activity
 P wave = “saw tooth” appearance
 HR > 100 bpm
 “uncontrolled”
 HR > 150 bpm
 “rapid ventricular rate”
 Etiology: atrial flutter**
 COPD
 Pulmonary HTN
 Valvular disease
 Thyrotoxicosis
 Open heart surgery
 Atrial flutter: clinical manifestations and management
 Clinical manifestations:
 Chest pain
 Dyspnea
 Hypotension
 Management:
 Electrical cardioversion for unstable patient
 See treatment for atrial fibrillation
 Medications to slow the ventricular response:
◊ Beta blockers
◊ Calcium channel blockers
◊ Digitalis (digoxin) decreases HR
◊ Diltiazem
 Usually resolves on own but if it doesn’t resolve within 48 hours, look out for a blood
clot/coagulation
 Atrial fibrillation (more disorganized than atrial flutter)
 Rapid, disorganized and uncoordinated twitching of atrial muscle
 Paroxysmal or chronic
 Rapid ventricular response; loss of atrial kick (25-30% of cardiac output)
 Atrial rate 300-600 BPM
 Ventricular rate: 120-200 BPM