Dysrythmia CONTENT

Sinus bradycardia

A slower than normal heart rate, typically defined as a resting heart rate of less than 60 beats per minute

Bradycardia clinical presentation

Lightheadedness or dizziness with exertion, easy fatiguability, syncope, dyspnea (SOB), chest pain / discomfort, confusion

-WORRIED ABOUT FALLS

-Rx factors: Older age, impairing heart disease, certain medications

Sinus brady labs

Electrolytes, thyroid hormone panel, troponin, blood and urine toxicology

Sinus brady role of the nurse

Fall precautions for symptomatic patients

-Identify cause, lifestyle changes that decrease potential injury

-Recognize cues for manifestations of decreased CO

Nursing process of sinus brady

-Analyze: obtain pulse / ECG

-Prioritize hypothesis: is the client stable or unstable?

-Solutions: is the CO adequate to provide perfusion to the vital organs? (Check VS, ECG, fluids, pacemaker)

-Action: Monitor for hemodynamic stability, saline lock, pacemaker

-Evaluate outcomes: Stabilize the HR to over 60 BPM

Sinus tachy / SVT txt

IV atropine 1 mg repeat every 3-5 minutes. CANNOT exceed a total of 3 mg

-Monitor for changes in HR

-Temporary transcutaneous pacemaker

Sinus tachycardia

An increased heart rate over 100 beats per minute

Tachycardia risk factors

Family hx, e- imbalance, htn, hyperthyroidism, heart disease, obesity, uncontrolled DM, age, excessive alcohol, excessive caffeine

Tachycadia symptoms

Feeling of fatigue, lightheadedness/dizziness/fainting, SOB, sustained rapid heartbeat, chest pain / pressure / tightness, a fluttering sensation in your chest

Sinus tachy precipitating factors

Recent infection or illness, chronic health conditions, stress, pain, anxiety, medications

Sinus tachy: nursing process

-Assess for instability

-Analyze cues: HR, ECG, Hemodynamic stability

-Prioritize hypothesis: Root cause

-Generate solutions: Ensure adequate perfusion to vial organs

-Take action: Underying cause, vasovagal maneuvers

Sinus tachy txt and therapies

Identify underlying cause of tachycardia

-Decrease fever, pain, stress, fear, or anxiety

-Catheter ablation to destroy abnormally excited cardiac cells responsible for increased heart rate

Sinus tachy med

-Adenosine: Temporarily blocks conduction at the AV node to help SVT / high heart rate

-Beta-blockers

Atrial fibrilation

Arrhythmia characterized by an irregular and often rapid heartbeat, leading to poor blood flow

-Can increase the risk of strokes, heart failure, and other heart-related complications

Rx factors of a-fib

Htn, CAD, here defects / HF, Rheuatic Heart Disease / pericarditis, hyperthyroidism, obesity, diabetes or metabolic syndrome, lung/kidney disease, sleep apnea, family hx of AFib

-Triggers: excessive caffeine and energy drinks, poor sleep / apnea, excessive alcohol, stress / anxiety

A-Fib Clinical Presentation

-S/Sx: Fatigue, SOB, chest pain, lightheadedness, dizziness, palpitations-IRREGULAR PULSE

-Safety considerations: Client at risk for stroke, risk for spontaneous bleeding

A-Fib labs and diagnostics

Echocardiogram: measures the size of the atria and ventricles

-Transesophageal echocardiogram: development of blood clots in the left atrium

-Blood tests, TSH, thyroxine, CBC, creatinine, glucose, INR

A-Fib ECG interpretation

Irregular rhythm

-P waves replaced by atrial activities between QRS conducts (absence of P waves)

-Ventricular HR can be normal or increased to 100-200 bpm, rapid heart rate greater than 100/min is referred to as rapid ventricular response

A-Fib role of the nurse

Bleeding precautions for clients on anticoagulant therapy (falls, shaving, vigorous teeth breaking and flooding, contact sports)

-Client ed: report manifestations, take meds, healthy lifestyle, avoid stimulants / herbal supplements

A-Fib nursing process

-Recognize cues: Auscultate heart sounds, BP, pulses, assess for pulse deficit, interpret ECG

-Analyze cues: interpret ECG, analyze clinical manifestations for potential of clot

-Prioritize hypothesis: improve cardiac perfusion to prevent complications

-Generate solutions: monitor VS, anti arrhythmic / anticoagulant ,plan for client education

-Take actions: control HR and rhythm, prevent blood clots development or dislodgment

-Evaluate outcomes

A-Fib txt and therapies

Interventions for rhythm control

-Electrocardioversion, catheter ablation, anticoagulation a, diet modification

Atrial Flutter

A type of abnormal heart rhythm where the atrias of the heart beat too fast. There is circular movement of electrical activity around atrium at rate of 300 x per minute, DOESN’T GO THROUGH THE AV NODE (block)

-Regular rhythm, atrial rate 240-320 bpm, “sawtooth” appearance of P waves

-“That ECG looks sharp and gives me palpitations of excitement”

Atrial Flutter Risk Factors

Heart disease, age, high BP, chronic lung disease, thyroid disorders, heart valve disorders, previous heart surgery

Atrial fibrillation vs atrial flutter

A-Fib involves irregular and chaotic electrical activity, while Atrial Flutter typically has a more organized pattern. A-Fib increases the risk of stroke more significantly than Atrial Flutter

A-Flutter clinical presentation

Lightheadedness, palpitations, hypotension, dizziness, chest discomfort, SOB

-Fainting, fast but regular heart rate

A-Flutter txt

-Rate Control: Betablockers, diltiazem, verapamil (class I)

-Rhythm Control:

-Class I: Catheter ablation

-Class IIa: amiodarone, dofetilide, or sotalol

-Class IIb: flecainide or propafenone IF class I is ineffective

Supraventricular Tachycardia

A rapid heart rate originating above the ventricles, often caused by abnormal electrical pathways in the heart

-Medications such as decongestants and asthma inhalers

SVT clinical presentations

SUDDEN Dizziness, lightheadedness, syncopal episodes, hypotension, SOB, palpitations, increased risk of falls

SVT txt and therapies

Vagal maneuvers

-IV adenosine 6 mg IV over 1-3 seconds then flush with 20 mL NS. No change - 12 mg followed by 20 mL NS

-IV diltiazem, esmolol, metoprolol

Vagal maneuvers

Techniques used to stimulate the vagus nerve, which can help slow down the heart rate and restore normal rhythm during episodes of supraventricular tachycardia

IV adenosine in cardiac health

A medication used to treat certain types of supraventricular tachycardia by temporarily blocking the electrical signals in the heart

-Must be followed by IV saline because the drug will degrade before it reaches the AV node to correct the abnormal rhythm (SHORT HL)and is not effective if given alone.

Nonpharmacologic management

Treat cause if known, like fluid for dehydration

-Valsalva maneuver for SVT

-Defibrilation for V-Fib

-Catheter Ablation

-Pacemaker

-Implantable cardioverter defibrillator

AV node block

A type of heart block resulting from a delay or interruption in the electrical signals passing through the atrioventricular (AV) node, which can lead to bradycardia or abnormal heart rhythms

Loss of atrial kick

A reduction in the final contraction of the atria that pumps blood into the ventricles

-Loss = drop overall efficiency by 30%=decreased CO

-Seen in afib

Why does SVT occur?

SVT occurs due to abnormal electrical activity in the heart, often resulting from reentrant circuits, which can be triggered by stress, caffeine, or structural heart issues

-Can be congenital defects or acquired later in life because of caffeine , stress, thyroid hormone, etc

Narrow QRS rhythm in cardiac health

Indication of SVT