Boot Camp Day 2 Arrhythmias handout - Cardiovascular Nursing

109 Pages·2014·3.71 MB·English

by  Karen Marzlin

6/12/2014
Cardiovascular Boot Camp Basic

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Emergency Trea tment Overview

NTI 2014
Denver
Karen Marzlin DNP, RN, CCNS, CCRN-CMC, CHFN
Contact Information: [email protected]
2014 1
Knowing is not enough;
we must apply.
Willing is not enough;
we must do
.
Johann Wolfgang von Goethe

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Electrical Conduction Pathway
• SA Node
• Interatrial pathways
• AV Node
• Bundle of His
• AV Junction
• Right and Left Bundle
Branches
• Anterior and
Posterior Fascicles
• Purkinge Fibers
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• P wave: atrial depolarization
WAVES and
• QRS: ventricular depolarization
• T wave: ventricular repolarization
COMPLEXES
• PR interval: AV conduction time
• QRS width: intraventricular conduction
time
QRS • ST Segment: sustained ventricular
depolarization
• QT interval: used to reflect ventricular
repolarization time
T
P QT Interval
PR Interval
ST Segment
QRS
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Overview of Bradyarrhythmias
• Sinus bradycardia • Second Degree Type I

• Sinus exist block • Second Degree Type II

• Sinus Pause or Arrest • High Grade AV Block

• Junctional Rhythm / • Complete Heart Block
Escape

• Idioventricular Rhythm /
Ventricular Escape
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SA Block or SA Exit Block
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SA Block or SA Exit Block
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Sinus Arrest or Sinus Pause
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Junctional Escape and Rhythm
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Wenckebach (2nd Degree Type I)
Note:
 Progressive lengthening of the
PR interval (problem in the AV
node)
 Normal QRS width (no problem
in the His Perkinge System)

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2nd Degree Type II
Both of these examples:
1. One P wave at a time fails to conduct
2. There is a fixed PR interval
3. There is a wider than normal QRS 11
Heart Blocks - High Grade AV Block
• Two or more consecutive atrial impulses are blocked.
• This is not 2nd degree heart block by definition because more
than one P wave in a row fails to conduct.
• However, this is not complete heart block because there is not
complete AV dissociation.
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Third Degree AV Block – Complete

• No atrial impulses are conducted to the ventricles
• One form of AV dissociation
• Ventricular Rate: Maintained by ventricular escape
(wide QRS) or by pacemaker coming from His bundle
(narrow QRS – less common)
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Ventricular Escape Beats

II
V
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Idioventricular Ventricular Rhythm
II
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Classification of SVT
• Sinus Tachycardia
– Physiological • AV Nodal Reentrant
Tachycardia
– Inappropriate
– SANRT
• AV Reentrant Tachycardia
• Atrial Tachycardia
– Orthodromic
– Focal
– Antidromic
– Intra-atrial reentrant
– Multi-focal

• Atrial Flutter

• Atrial Fibrillation

• Junctional Tachycardia
– Nonparoxysmal JT
– Junctional ectopic tachycardia
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Two Reasons Why a Patient Develops a
Tachyarrhythmia
Ectopic Foci Conduction Disturbance
• Focus other than sinus node • An impulse does not travel
takes over as pacemaker of normally down the
heart. conducting pathways but
• Enhanced or abnormal rather finds a way to re-
automaticity. enter the conducting
pathways
• Tachycardias with this
etiology are called re-
entrant tachycardias
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Understanding the Origin of
Arrhythmias

• Disorder of impulse initiation
• Abnormal automaticity
– Enhanced
– Abnormal
• Triggered mechanism: disturbance in recovery or
repolarization (less common)
–Early or delayed after depolarizations

• Disorder of impulse conduction
• Reentrant Circuit (Most common)

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Atrial Arrhythmias
Organized Disorganized
• Atrial tachycardia • Atrial fibrillation
• Atrial Flutter

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Paroxysmal Atrial Tachycardia (PAT) with
Block
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