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Page 1: CARDIAC ARRYTHMIAS - Hadassah · CARDIAC ARRYTHMIAS. Explanations patient and family • ... Non cardiac origin-treat cause e.g hypoxia and –

CARDIAC ARRYTHMIAS

Page 2: CARDIAC ARRYTHMIAS - Hadassah · CARDIAC ARRYTHMIAS. Explanations patient and family • ... Non cardiac origin-treat cause e.g hypoxia and –

•Explanations patient and family

•Reassurance patients and family

•Comfort ,leads restricting

•Limited mobility, R.I.B

•Holters( ambulation possible)

Page 3: CARDIAC ARRYTHMIAS - Hadassah · CARDIAC ARRYTHMIAS. Explanations patient and family • ... Non cardiac origin-treat cause e.g hypoxia and –

ECG

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Calculating heart rate regular rythm

HR=1500/no: small squares R to R

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NORMAL SINUS RHYTHM

Page 23: CARDIAC ARRYTHMIAS - Hadassah · CARDIAC ARRYTHMIAS. Explanations patient and family • ... Non cardiac origin-treat cause e.g hypoxia and –

•P wave upright and rounded•PR interval .12-.20 seconds•P:QRS•QRS .12 seconds•60 -100 beats per minute•Regular rate•T wave

Page 24: CARDIAC ARRYTHMIAS - Hadassah · CARDIAC ARRYTHMIAS. Explanations patient and family • ... Non cardiac origin-treat cause e.g hypoxia and –

Reasons for arrythmias

•Myocardial ischemia•Electrolyte imbalance•Acidosis•Hypothermia•Drug toxicity

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TREATMENT

•Asymptomatic , no treatment•Symptomatic, I.V Atropine 0.5mg-1mg till

3mgs•Pacemaker

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TREATMENT

–Oxygen, monitor observation

–Physiological sinus tacycardia- treat cause–Anxiety,exercise,fever,pain,and

drugs(benzodiazapines)–Shock- treat shock.

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TREATMENT

•Usually hemodynamically stable no treatment required

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Premature atrial contraction

Page 37: CARDIAC ARRYTHMIAS - Hadassah · CARDIAC ARRYTHMIAS. Explanations patient and family • ... Non cardiac origin-treat cause e.g hypoxia and –

TREATMENT

•Correct electrolytes•Treat ischemia•Cut down on caffeine, alchol,nicotine and

stress

Page 38: CARDIAC ARRYTHMIAS - Hadassah · CARDIAC ARRYTHMIAS. Explanations patient and family • ... Non cardiac origin-treat cause e.g hypoxia and –
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TREATMENT

•Hemodynamically stable with AF less than 48 hours,slow ventricular rate with beta or calcium

channel blockers and then pharmicological cardioversion.

•Stable more than 48 hours, slow vent. rate, anti coagulation, then pharmacological or

mechanical cardioversion.

•Unstable immediate cardioversion

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TREATMENT

•See atrial flutter

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TREATMENT

–Cause- acute ischemia, myocarditis cardiomyopathy ,mitral valve prolapse,hypoxia,electrolyte imbalance

mg,k,ca–Rx–Oxygen–Monitor observation–I.V–Treat ischemia,and suppress cardiac irritability-

procainamide–Non cardiac origin-treat cause e.g hypoxia and

electrolytes

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TREATMENT

•VT with pulse-antiarrythmics

•VT with pulse –unstable-syn

cardioversion•VT without pulse

defibrilation

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TREATMENT

•CPR•Intubation•defibilation

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asystole

•Rate- none

•P wave- may be but with no ventricular response

•QRS none•Rythym none

Page 60: CARDIAC ARRYTHMIAS - Hadassah · CARDIAC ARRYTHMIAS. Explanations patient and family • ... Non cardiac origin-treat cause e.g hypoxia and –

TREATMENT

•ABC•CPR•OXYGEN•INTUBATION•I.V•CONSIDER CAUSEAND TREAT

ACCORDINGLY•EXTERNAL PACEMAKER•ADRENALINE•ATROPINE

Page 61: CARDIAC ARRYTHMIAS - Hadassah · CARDIAC ARRYTHMIAS. Explanations patient and family • ... Non cardiac origin-treat cause e.g hypoxia and –
Page 62: CARDIAC ARRYTHMIAS - Hadassah · CARDIAC ARRYTHMIAS. Explanations patient and family • ... Non cardiac origin-treat cause e.g hypoxia and –

TREATMENT

•Monitor observation

•Treat underlying cause

•Causes: myodardial ischemia

•Drugs- beta blockers ca channel blockers

digoxin

Page 63: CARDIAC ARRYTHMIAS - Hadassah · CARDIAC ARRYTHMIAS. Explanations patient and family • ... Non cardiac origin-treat cause e.g hypoxia and –
Page 64: CARDIAC ARRYTHMIAS - Hadassah · CARDIAC ARRYTHMIAS. Explanations patient and family • ... Non cardiac origin-treat cause e.g hypoxia and –

TREATMENT

•Monitor observation

•pacemaker

Page 65: CARDIAC ARRYTHMIAS - Hadassah · CARDIAC ARRYTHMIAS. Explanations patient and family • ... Non cardiac origin-treat cause e.g hypoxia and –

Second degree AV blockMobitz 2

Page 66: CARDIAC ARRYTHMIAS - Hadassah · CARDIAC ARRYTHMIAS. Explanations patient and family • ... Non cardiac origin-treat cause e.g hypoxia and –

TREATMENT

•Monitor observation

•Pacemakers•I.V dopamine or

adrenaline

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TREATMENT

•Transcutaneous pacemaker

•I.V dopamine or adrenaline

•Permanent pacemaker

Page 70: CARDIAC ARRYTHMIAS - Hadassah · CARDIAC ARRYTHMIAS. Explanations patient and family • ... Non cardiac origin-treat cause e.g hypoxia and –

12 LEAD ECG INTERPRETATION

Page 71: CARDIAC ARRYTHMIAS - Hadassah · CARDIAC ARRYTHMIAS. Explanations patient and family • ... Non cardiac origin-treat cause e.g hypoxia and –
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Leads

•Leads II, II, AVF inferior wall•Leads I, AVL, V5.V6 lateral wall•Leads V1, V2, V3, V4 anterior wall

Page 74: CARDIAC ARRYTHMIAS - Hadassah · CARDIAC ARRYTHMIAS. Explanations patient and family • ... Non cardiac origin-treat cause e.g hypoxia and –

WALLS OF THE HEART

Page 75: CARDIAC ARRYTHMIAS - Hadassah · CARDIAC ARRYTHMIAS. Explanations patient and family • ... Non cardiac origin-treat cause e.g hypoxia and –
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MYOCARDIAL INJURY

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ST DEPRESSION

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Q WAVE–MYOCARDIAL INFARCTION

Page 85: CARDIAC ARRYTHMIAS - Hadassah · CARDIAC ARRYTHMIAS. Explanations patient and family • ... Non cardiac origin-treat cause e.g hypoxia and –
Page 86: CARDIAC ARRYTHMIAS - Hadassah · CARDIAC ARRYTHMIAS. Explanations patient and family • ... Non cardiac origin-treat cause e.g hypoxia and –

Q WAVE STAGES

Page 87: CARDIAC ARRYTHMIAS - Hadassah · CARDIAC ARRYTHMIAS. Explanations patient and family • ... Non cardiac origin-treat cause e.g hypoxia and –

Pathological Q waves

Page 88: CARDIAC ARRYTHMIAS - Hadassah · CARDIAC ARRYTHMIAS. Explanations patient and family • ... Non cardiac origin-treat cause e.g hypoxia and –

•Insignificant q wave leads I,II,V5,V6

•Significant Q wave 1mm wide or one third of height of QRS complex.

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ST elevation

Page 93: CARDIAC ARRYTHMIAS - Hadassah · CARDIAC ARRYTHMIAS. Explanations patient and family • ... Non cardiac origin-treat cause e.g hypoxia and –

T wave

Page 94: CARDIAC ARRYTHMIAS - Hadassah · CARDIAC ARRYTHMIAS. Explanations patient and family • ... Non cardiac origin-treat cause e.g hypoxia and –

T wave

Page 95: CARDIAC ARRYTHMIAS - Hadassah · CARDIAC ARRYTHMIAS. Explanations patient and family • ... Non cardiac origin-treat cause e.g hypoxia and –

INFARCTION

Page 96: CARDIAC ARRYTHMIAS - Hadassah · CARDIAC ARRYTHMIAS. Explanations patient and family • ... Non cardiac origin-treat cause e.g hypoxia and –

INJURY

Page 97: CARDIAC ARRYTHMIAS - Hadassah · CARDIAC ARRYTHMIAS. Explanations patient and family • ... Non cardiac origin-treat cause e.g hypoxia and –

ISCHEMIA

Page 98: CARDIAC ARRYTHMIAS - Hadassah · CARDIAC ARRYTHMIAS. Explanations patient and family • ... Non cardiac origin-treat cause e.g hypoxia and –

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