Thea Laurene T.

Tonelada
BSN IV-C

DYSRHYTHMIA

- Means disturbance in cardiac rhythm.

- Any disorders of the cardiac beat

It can result from the ff:

 A disturbance in the relationship between electrical conductivity & mechanical

response of myocardium
 A disturbance in impulse formation (either from an abnormal rate of an ectopic
focus)
 A disturbance in impulse conduction (delay & blocks)

DYSRHTHMIA TERMINOLOGY

Tachydysrhythmias

- Heart rates greater than 100 beats per minute

3 points to consider
in the seriousness of Tachydysrhythmias

- Tachydysrhytmias shorten the diastolic time & the coronary perfusion time.
- It initially increases cardiac output & blood pressure; however a continued rise in HR
decreases the ventricular filling time because of shortened diastole, decreasing the stroke
volume.
- Increase the work of the heart, increasing myocardial oxygen demand.

Bradydysrhythmias

- Characterized by a heart rate less than 60 beats per minute.

3 points to consider
in the seriousness of Bradydysrhythmias

 Myocardial oxygen demand is reduced from the slowed HR.

 Coronary perfusion time may be adequate because of a prolonged diastole.
 Coronary perfusion pressure may decrease if the HR is too slow to provide adequate
cardiac output & blood pressure.
 Key features of
Bradydysrhythmias & Tachydysrhythmias

o Chest discomfort, pressure or pain

o Restlessness, anxiety, nervousness, confusion
o Dizziness, syncope
o Pulse deficit
o SOB, dyspnea
o Tachypnea
o Pulmonary crackles
o Jugular vein distention
o Weakness, fatigue
o Decreased urine output
o Pale, cool skin
o Delayed capillary refill
o Hypotension

Premature Complexes

- Occurs when a cardiac cell or cell group, other than the SA node, becomes irritable & fires an
impulse before the next sinus impulse is generated.
Ectopic focus - abnormal focus generated by the atrial, junctional, or ventricular tissue.
- Following the premature complex, there is a pause before the next normal complex, creating
an irregularity in the rhythm.
- Client having this may be unaware or may feel palpitations or a “skipping” of the heartbeat.

Repetitive Rhythms

 Bigeminy - exists when normal complexes & premature complexes occur alternately in
repetitive two beat patterns with a pause occurring after each premature complex so
that complexes occur in pairs.
 Trigeminy - repetitive three-beat-pattern, usually occurring after each premature
complex followed by a premature complex & a pause, with a same pattern repeating
itself in triplets.
 Quadrigeminy - repetitive-four-beat-pattern.

Escape complexes & Rhythms

- Occurs when SA node fails to discharge or is blocked or when a sinus impulse fails to
depolarize the ventricles because of an AV nodal block.
- Serves as a secondary or escape pacemaker & are seen after pause.
- Pauses followed by escape beats or rhythms, client feels light-headed, dizzy, faint during the
pause.
 Classification of Dysrhythmias

 SINUS TACHYCARDIA
- Rate of SA node discharge exceeds 100 beats per minute.
- HR of 200 – 220 beats per minute is normal in infants & children.

Note: Ages 10 years to adulthood, the heart rate normally does not exceed 100 bpm except
in response to activity, & then doesn’t exceed at 160 bpm.

At rare cases, ST is a compensatory response to decreased CO or BP.

Patho: Dominant sympathetic nervous system stimulation of the heart or vagal inhibition
result in an increased in SA node discharge which increases the HR.

Causes: anxiety, pain, fever, stress, anemia, pulmonary embolism

Drugs: caffeine, alcohol, nicotine

Signs & Symptoms:

-client is asymptomatic except for increased pulse rate.

Assess: fatigue, weakness, SOB, orthopnea, neck vein distention, restlessness,

decreased cerebral perfusion, decreased U.O, decreased renal perfusion
ECG: T-wave inversion, ST segment elevation or depression

Management:
 Administer O2, help to have rest, give morphine or nitrogly – if with angina
 Give diuretics & inotropic agents- for heart failure
 Analgesics or oipiods with non cardiac pain clients
 Beta adrenergic blocking agents
 Emotional support & relevant teachings for the client & the family

 PREMATURE ATRIAL COMPLEXES (PAC)

- Atrial depolarization that occurs earlier than expected.

Patho: Occurs when atrial tissue becomes irritable. Ectopic focus fires an impulse before the
next sinus impulse is due, thus unsurping the sinus pacemaker.
Usually followed by a pause.

Causes: stress, fatigue, anxiety, inflammation, infection intake of caffeine, nicotine, alcohol
Drugs: catecholamines, digitalis, anesthetic agents

Signs & Symptoms:

-client is usually asymptomatic except for possible heart palpitations

Management:
  No intervention is needed except to treat the cause.
 teach the client measures to manage stress & substances to avoid that are
known to cause atrial irritability

 ATRIAL FIBRILLATION
- Most common dysrhytmia found in clinical practice.
- Occurs most commonly in clients with underlying cardiac disease.
- Disorganized electrical activity in the atria accompanied by an irregular ventricular response
that is usually rapid.

Patho: Multiple rapid impulses from many atrial foci, at a rate of 350 – 600 times per minute,
depolarize the atria in a totally disorganized manner. The result is chaos, with no P
waves, no atrial contractions, loss of atrial kick, & an irregular ventricular response.

Note: Dilation & blood stagnation in the atria can lead to thrombus formation, & this
increases the risk of stroke or other embolic events.
Causes decrease CO further compromising the heart’s perfusion ability.
Commonly occurs following cardiac surgery, in which it is most often transient &
usually responds to treatment.

Signs & Symptoms:

-may be intermittent or rapid.
If it is rapid:
-weakness, fatigue, SOB, hypotension, syncope, pulse deficit, palpitations,
chest pain

Also, risk for pulmonary embolism:

-SOB, chest pain, hemoptysis, feeling of impending doom

Thromboemboli @ risk:
-changes in mentation, speech, motor function, U.O, pulses, back pain, GI
disturbances

Management:
 Administer anticoagulants for clients considered at high risk for emboli
 Anticoagulation therapy for 6 weeks to prevent thromboembolic event
 Transesophageal echocardiogram to assess for presence of atrial clots
 Radiofrequency catheter ablation is done with client’s having recurrent,
symptomatic AF to interrupt all conduction between atria & the ventricles.
 Maze procedure can also be done in which it is an open chest surgical
technique, electrophysiologic mapping studies are done to confirm the
diagnosis of AF.
 VENTRICULAR SYSTOLE
- The contraction of the heart ventricles. It begins with the first heart sound.

 VENTRICULAR ASYSTOLE “ventricular standstill”

- Complete absence of ventricular rhythm.
- There are no electrical impulses in the ventricle & no ventricular depolarization, no QRS
complex, no contraction, no CO, no pulse, respiration, BP.
- Client is in full cardiac arrest.

Patho: Sinus impulses do not conduct to the ventricles, & QRS complex remains absent.

Cause: Severe hyperkalemia & acidosis

Signs & Symptoms:
-loss of consciousness, absence of pulse, RR & BP

Emergency Care:
-Initiates CPR immediately
-ECG lead to ensure that rhythm is asystole and not VF, which warrants immediate
defibrillation
-DO NOT shock asystole.
-Administer O2, epinephrine, & atropine