King Saud University

College of Nursing

Hatem Alsrour
Cardiac Arrhythmia
Definition: a disorder of impulse formation.
An abnormal electrical conduction that
changes the heart rate and rhythm. A
disturbance in the heart’s rhythm.
Signs and symptoms
• Symptoms of arrhythmias vary from person to
person, and depend largely on the source of the
abnormality. Some people have no symptoms at
all. If symptoms are experienced, these may
include any of the following:
• Palpitations (strong or “galloping” heartbeat)
• Skipped heartbeat
• Dizziness, fatigue or fainting (syncope) as a
result of the brain not getting enough oxygen-rich
blood
• Unexplained falls, particularly in elderly
individuals
• Angina (chest pain, pressure or discomfort)
Diagnosis
Electrocardiogram ECG (best test)
Another:
exercise stress test
Holter monitor
Intracardiac electrophysiology study (EPS)
echocardiogram
Ventricular Arrhythmia
Arrhythmia happen in lower champers of
heart.
Major ventricular arrhythmia:
 Premature Ventricular Contractions (PVCs)
 Ventricular Tachycardia
 Ventricular fibrillation
Premature Ventricular Contraction
(PVCs)

Premature ventricular contractions (PVCs) are

due to impulses originating from single or
multiple areas in the ventricles.
There is three type PVCs
unifocal PVC, interpolated PVC, and multifocal
PVCs
Causes
o Ischemic heart disease
o acute myocardial infarction
o Digoxin toxicity
o Congestive heart failure
o Hypokalemia
o Alkalosis
o Hypoxia
PVCs
Signs and Symptoms
- Palpitation
- Chest pain
- Lightheadness
- Syncope
Diagnosis
- ECG
PVCs
Treatment
- Most acute patients with PVCs will respond to
intravenous lidocaine (1 mg/kg IV).
- some patients may require procainamide.
Ventricular Tachycardia
Ventricular tachycardia is the occurrence of 3
or more beats from a ventricular ectopic
pacemaker at a rate greater than 100.
Called V-tach or VT
 Ventricular tachycardia

 120-150 beats/min
 Wide QRS
 3 or more consecutive beats from
the ventricle
 3 or More PVCs =
Ventricular Tachycardia
“Sustained V Tach”
V-Tach
- Causes:
• Cardiomyopathy
• Heart failure
• Heart surgery
• Myocarditis
• Valvular heart disease
• Anti-arrhythmic medications
• Changes in blood chemistry (such as a low
potassium level)
• Changes in pH (acid-base)
• Lack of enough oxygen
V-Tach
- Symptoms and signs
• Chest discomfort (angina)
• Fainting (syncope)
• Light-headedness or dizziness
• (palpitations)
• Shortness of breath
• Absent pulse
• Loss of consciousness
• Normal or low blood pressure
• Rapid pulse
V-Tach
Diagnosis (how we can diagnose V-Tach?)
Treatment
- ACLS and cardiopulmonary resuscitation (CPR)
- Electrical defibrillation or cardioversion
(electric shock)
- Anti-arrhythmic medications (such as
lidocaine, procainamide, sotalol, or
amiodarone) given IV
 Torsades de pointes
Multiform Vtach with progressive
changes in amplitude of QRS
complexes separated by narrow
transition QRS
Polarity of QRS repetitively twists
around an iso-electric baseline
Can progress to VFib
Long QT syndrome:
disorder of cardiac K
or Na channel protein
structure or function
Correct electrolyte
imbalance, esp Mag
Ventricular Fibrillation
Ventricular fibrillation is the totally
disorganized depolarization and contraction of
small areas of ventricular myocardium—there
is no effective ventricular pumping activity.
Ventricular fibrillation is never accompanied
by a pulse or blood pressure.
Called V-Fib or VF
 Ventricular Fibrillation

Rapid and irregular  MI, post-op, myocarditis, severe

ventricular hypoxia
arrhythmia
 Digitalis and quinidine toxicity,
Low amplitude QRS catecholamines
 primary form or
from degeneration of
unstable SVT
V-Fib
• Causes
- Congenital heart disease
- Electrocution accidents or injury to the heart
- Heart attack
- Heart muscle disease, including cardiomyopathies
- Heart surgery
- Ischemia (lack of oxygen to the heart muscle
because of narrowed coronary arteries or shock)
- Sudden cardiac death (commotio cordis), typically
occurring in athletes after a trauma over the
surface of the heart
V-Fib
• Signs and symptoms
- A person who has a VF episode will suddenly
collapse or become unconscious, because the
brain and muscles have stopped receiving blood
from the heart.
- The following symptoms may occur within 1 hour
before the collapse:
• Chest pain
• Dizziness
• Nausea
• Rapid heartbeat
• Shortness of breath
V-Fib
• Diagnosis (how we can diagnose V-fib?)
• Treatment
- ACLS and cardiopulmonary resuscitation (CPR)
- Electrical defibrillation
- Epinephrine 1 mg IV
- Anti-arrhythmia drugs (lidocaine 1.5 mg/kg,
bretylium 5 mg/kg)
- Magnesium, procainamide, Amidrone
Pulseless Electrical activity
& Asystole
Pulseless Electrical Activity (PEA) is the
presence of electrical complexes without
accompanying mechanical contraction of the
heart.

Asystole is the complete absence of cardiac

electrical activity.
PEA & Asystole
Causes
causes should be diagnosed and treated:
- severe hypovolemia
- cardiac tamponade
- Tension
- Pneumothorax
- Massive pulmonary embolus
- Rupture of the ventricular wall
PEA & Asystole
Treatment
- CPR
- Epinephrine 1 mg IV, followed by high-dose
therapy of 0.1 mg/kg if the first dose is not
successful. Repeat epinephrine every 3 to 5
min.
- Atropine 1 mg IV, up to 3 mg total, is also
acceptable therapy if the electrical conduction
is slow