Cardiac Rhythms

The Conduction System

1. SA Node ( depolarization of the atria)

2. AV Node

3. Bundle of Hus

4. Left & Right Bundle branches

5. Purkinje Fibers

Sinoatrial(SA) Node

• right atrium

• pr

What is the Primary pacemaker of the heart

SA

What is the back up pacemaker of the heart

AV

Ventricular has ..

• bundles of HIS

• R &L Bundle Branches

• Punkinje Fibers

• 20-20 beats/mins

EKG Monitoring

shows the conduction of the the electrical impulses through the heart. NOT CONTACTION OF THE CARDIAC

Normal Sinus Rhythm (NSR)

• SA node initiates all the electrical impulses a normal pathway

• REGULAR RHYTHM

• 60-100

• P WAVES: upright, rounded” only for each QRS complex

• PR interval: normal. <0.20 sec

• ORS intervals: normal, <0.12 sec

NSR

Pulseless Electrical activity (PEA)

Electrical activity is seen on the EKG , but there is not mechanical heart activity Activity

PATIENT DOES NOT HAVE A PULSE

Sinus Bradycardia

pulse : present

regular rhythm

rate: LESS THAN 60 BPM

p waves: upright ,rounded, 1 for each QRS complex

PR interval : less than or equal to 0.20 secs

ORS complex: less than or equal to 0.12 secs

Sinus Bradycardia S/S

• can be asymptomatic

• pales

• cool

• clammy skin

• hypotension

• weakness

• angina

• dizziness,confusion

• SOB

Sinus bradycardia treatment

• evaluate medications

• IV atropine

• Pacing

Sinus bradycardia causes

• trained athlete

• vagal response

• hypothermia

• medications

Sinus tachycardia

pulse “ present

regular rhythm

rate :101-180 bpm

p waves: upright ,rounded , 1 for each QRS complex

Pr: Interval : less than or equal to 0.20 secs

QRS complex: less than or equal to 0.12 sec

Sinus tacchycardia s/s

• can be asymptomatic

• dizziness

• dyspnea

• hypotension

• angina

sinus tachycardia causes

• exercise

• fever

• pain

• hypotension

• hypovolemia

• anemia

• anxiety

• fear

• medications

sinus tachycardia treatments

• treat underlying cause

• vagal maneuver

• HR reducing medications

Ventricular pacemaker

Atrial Pacemaker

Dual Chamber-Atrial Ventricular ( AV) Pacemaker

Sinus bradycardia

Sinus tachycardia

Ventricular Standstill/Asystole

• absence of all electrical activity within the ventricles

• without contraction

• DEATH IS IMMINENT ARRHYTHMIA IS REVERSED.

Asystoles ECG

• straight lines

• No QRS complexes

• Agonal rhythm

  ( heart rate less than 20 bpm) (

Asystole Tx:

CPR/MEDS

Agonal /Asystole

Ventricular Fibrillation (VF)

• ventricles is quivering

• rate: unmeasurable

• QRS: not measurable

VF Tx

• Cardiopulmonary

• resuscitation

• defibrillation

Ventricular Fibrillation

Premature Ventricular Contraction

• ectopic beat

• not a rhythm( must identify rhythm )

• no p wave

• QRS >/ =0.2

• followed b pause

• unifocal vs multifocal

pVC

Ventricular Tachycardia (VT)

• run of 3 or more PVC’s

• Monomorphic vs polymorphic

• sustained vs nonsustained

• stable v.s unstable

• rate 150-250 bpm

• wide QRS

VT tx

• cardiopulmonary resuscitation

• rapid defibrillation

Ventricular tachycardia

Atrial Fibrillation

pulse: present

usually iregular

rates: varies

pwaves: fibrillatory waves

pr interval: not measurable

Qrs complex : less than or equal to

0.12 secs

Atrial Fibrillation s/s

*asymptomatic

• decreases cardiac output

• dizziness

• hypotension

• chest discomfort ( fluttering)

Atrial FIB Tx

• slow ventricular rate(CCB,B-blockers, amiodarone, digoxin)

• synchronized cardioversion after anticoagulation

• ablation

Atrial FIB complications

• thrombus formation

• stroke

Atrial Flutter

pulse: present

regular

rate: varies

p waves: saw tooth/flutter waves

PR interval; not measurable

QRS complex: less than or equal to 0.12 secs

AFIB

A Flutter causes

• unhealthy heart

• respiratory causes

• cardiac causes

• hyperthyroidism

A flutter s/s

decreased CO

Aflutter tx

• slow ventricular rate by decreasing conduction of electrical impulses ( CCB,B-blockers, amiodarone, digoxin)

• medications

• synchronized cardioversion ablation

Aflutter complications

thrombus formation

stroke

heart failure

AFLUTTER