Cardiac Part 2Dysrhythmias Shock
Normal EKG
Rate ProblemsRhythm ProblemsConduction Problems◦Heart Blocks◦Origin of Electrical ActivityProblems seen with EKG
TachycardiaBradycardiaAsystoleRate Problems
Atrial Fibrillation:◦Characterized by a total disorganization of atrial electrical activity resulting in loss of effective atrial contraction.◦May be paroxysmal (begins and ends spotaneously), or persistent (lasting more than 7 days)◦Most common,clinically significant with respect to morbidity and mortality rate, as well as economic impact.Atrial Flutter:◦Atrial tachydysrhythmia, characterized by recurring, regular, sawtooth-shapeflutter waves, originates most common in the right atriumAtrial Dysrhythmias
Atrial fibrillationLoss of effective atrial contractionMay come and go or be constantMost common dysrhythmiaManifestations◦Hypotension (30% loss of CO)◦Tachycardia◦Irregular HR◦Palpitations ECG pg 827◦Atrial rate 350-600 beats/min◦Chaotic fibrillatory F wavesbetween the QRS comples◦Controlled < 100◦Uncontrolled > 100◦May alternate with A-flutterCommonly occurs with ◦CAD◦Cardiomyopathy◦Hypertensive heart disease◦HF◦Pericarditis –ST elevation in every lead◦Cardiac surgery (acute)
Decrease in Cardiac Output up to 30% - loss of ‘atrial kick’Blood clot formation due to blood stasis, an embolized clot that may travel to the brain which results in a stroke.Stroke – accounts for 20% of all strokesClinical Significance with A-Fib
Decrease HR to < 100Prevention of clot formationVentricular rate control is priority Conversion back to sinus rhythm◦Cardioversion ◦Amiodarone – most commonfor conversion and maintenance◦Ablation ◦Beta blockers◦Calcium channel blockersTreatment goal of A-Fib
Atrial Flutter
Saw-tooth shaped flutter wavesRarely occurs in a healthy heartIs associated with CAD, hypertension, mitral valve disorders, cardiomyopathy, and the use of drugs such as digoxin, quinidine and epinephrineECG characteristics◦Atrial rate is 200-350 beats/min◦Atrial and ventricular rhythm is regular◦QRS complex is normalAtrial Flutter
High ventricular rates and loss of the atrial ‘kick’ decrease CO and cause serious consequences such as HF, increased risk of stroke (thrombus formation)Coumadin is given to prevent the possibility of stroke.Clinical Significance of Atrial Flutter
Primary – to slow the ventricular response by increasing AV blockMedications: calcium channel blockers, beta-blockers, antidysrhythmias to convert to sinus rhythmCardioversion to covert flutter to sinus rhythm in an emergencyRadiofrequency catheter ablation is the treatment of choice for atrial flutterTreatment Goal of Atrial Flutter
Premature Ventricular Contraction (PVCs)- premature occurrence of a QRS complexV-tach – occurs when there are three or more consecutive PVC’sV-fib – severe derangement of the heart rhythm characterized by irregular waveforms of various shapes and amplitude.
