Arrhythmia PDF - Dr. Rebar Yahya Abdullah

ARRYTHMIA PREPARED BY ASSIST.PROFESSOR DR. REBAR.Y. ABDULLAH UNIVERSITY OF DUHOK -COLLEGE OF NURSING PHD. FAMILY AND COMMUNITY HE...

ARRYTHMIA PREPARED BY ASSIST.PROFESSOR DR. REBAR.Y. ABDULLAH UNIVERSITY OF DUHOK -COLLEGE OF NURSING PHD. FAMILY AND COMMUNITY HEALTH DR.REBAR YAHYA ABDULLAH Dr.Rebar Yahya Abdullah Dr.Rebar Yahya Abdullah Sinus tachycardia Dr.Rebar Yahya Abdullah Causes of sinus tachycardia Causes of sinus tachycardia may include exercise, anxiety, fever, drugs, anemia, heart failure, hypovolemia, and shock. Sinus tachycardia is often asymptomatic. Management, however is directed at the treatment of the primary cause. Carotid sinus pressure (carotid massage) or a beta-blocker may be used to reduce heart rate. Dr.Rebar Yahya Abdullah Tachyheas T : Temperature A : Aerobic exercise C : Cardiac Diseases H : Hyperthyroidism Y :Yelp ( Pain) H :Hemorrhage ,Hypovolemic E : emotional stress A anemia T therapeutic : epinephrine, dopamine ,dobutamine, atropine Stimulants : caffeine ,alcohol, cocaine Dr.Rebar Yahya Abdullah Dr.Rebar Yahya Abdullah So , the interventions and management Investigations : ECG , Thyroid tests , CBC , Medication history , psychological assessment, behavioral assessment Medication assessment :B blockers, Ca channel blocker , verapamil , diltiazem Pain management , antipyretic Dr.Rebar Yahya Abdullah Sinus Bradycardia Dr.Rebar Yahya Abdullah Dr.Rebar Yahya Abdullah Causes Causes may include drugs, vagal stimulation, hypoendocrine states, hypothermia, or sinus node involvement in MI. This arrhythmia may be normal in athletes as they have quality stroke volume. It is often asymptomatic but manifestations may include: syncope, fatigue, dizziness. Management includes treating the underlying cause and administering anticholinergic drugs like atropine sulfate as prescribed. Dr.Rebar Yahya Abdullah Dr.Rebar Yahya Abdullah  Atrial Fibrillation (A.Fib) Uncontrolled electrical activity in the atria that cause rapid and irregular or disorganized (fibrin) of the atrium muscle. Dr.Rebar Yahya Abdullah Dr.Rebar Yahya Abdullah Atrial Fibrillation (A.Fib) Is the most common rhythms of hospitalized pt. Atria not beating properly They are beating at a fast and irregular rate The atria is quivering instead of contracting properly. So, blood pump is not being pumped properly ,can cause clot Blood clot can lead to MI and Strock Dr.Rebar Yahya Abdullah ECG of AF Dr.Rebar Yahya Abdullah Dr.Rebar Yahya Abdullah Dr.Rebar Yahya Abdullah Dr.Rebar Yahya Abdullah Dr.Rebar Yahya Abdullah Dr.Rebar Yahya Abdullah Causes After heart surgery Hear problem (valve problem, CAD, MI, pericarditis). COPD Sleep apnea Dr.Rebar Yahya Abdullah Treatment Depending on pt (S & S, with S&S, controlled or uncontrolled). If pt with controlled and stable and no S&S AF: Monitoring HR should less than 100 bpm Notify and consult if there is any changes or unstable Dr.Rebar Yahya Abdullah If pt with unstable (dropped Bp, decreased cardiac out put) and uncontrolled (HR more than 100 bpm) AF: Synchronized cardioversion to synchronize R wave that help to reset heart rate. Cardizem (diltiazem) Amiodarone Adenosine Warfarin Beta blockers Calcium channel blockers Ablation Dr.Rebar Yahya Abdullah Medications Rate Control: Beta-blockers (Lol), calcium channel blockers. Rhythm Control: Antiarrhythmic drugs (e.g., amiodarone). Anticoagulants: To prevent clot formation (e.g., warfarin, DOACs). Procedures: Cardioversion: A procedure to reset the heart rhythm. Catheter Ablation: Targeted destruction of abnormal heart tissue causing AFib. Lifestyle Changes: Weight management, exercise, and reducing alcohol consumption. Dr.Rebar Yahya Abdullah Dr.Rebar Yahya Abdullah Supraventricular Tachycardia Dr.Rebar Yahya Abdullah ECG of SVT Dr.Rebar Yahya Abdullah ECG of SVT Dr.Rebar Yahya Abdullah Physiology of SVT Dr.Rebar Yahya Abdullah Typical heartbeat In a typical heart rhythm, a tiny cluster of cells at the sinus node sends out an electrical signal. The signal then travels through the atria to the atrioventricular (AV) node and then passes into the ventricles, causing them to contract and pump out blood. Dr.Rebar Yahya Abdullah Supraventricular tachycardia Supraventricular tachycardia is an irregularly fast heartbeat. It occurs when faulty electrical connections in the heart set off a series of early beats in the upper chambers of the heart (atria). Dr.Rebar Yahya Abdullah Dr.Rebar Yahya Abdullah SVT Management Algorithm Dr.Rebar Yahya Abdullah  What are vagal maneuvers? Vagal maneuvers are physical actions that make vagus nerve act on heart’s natural pacemaker, slowing down its electrical impulses. Vagus nerve which goes from your brainstem to belly plays a major role in parasympathetic nervous system, which controls a number of things in body, including heart rate. Dr.Rebar Yahya Abdullah Vagal maneuvers Dr.Rebar Yahya Abdullah Dr.Rebar Yahya Abdullah  Gag reflex Dr.Rebar Yahya Abdullah lecturer-Rebar Y.Abdullah  Who shouldn’t have vagal maneuvers? Low blood pressure. Chest pain. Shortness of breath. A shortage of oxygen in your body. An inability to get enough blood to your organs. Dr.Rebar Yahya Abdullah Cardioversion Dr.Rebar Yahya Abdullah Catheter ablation Dr.Rebar Yahya Abdullah Atrioventricular Blocks (Heart block) AV blocks are conduction defects within the AV junction that impairs conduction of atrial impulses to ventricular pathways. The three types are first degree, second degree and third degree. So , what's the criteria of First-degree Heart block? Rate is usually less than 60 bpm PR intervals are prolonged for usually 0.20 seconds (slow electric moving from AT to VT creating long PR interval) QRS complex is usually normal Rhythm is regular Dr.Rebar Yahya Abdullah So, what is the difference between sinus bradycardia and heart block ? Dr.Rebar Yahya Abdullah FIRST DEGRE OF HEART BLOCK FIRST = Only has one problem which is prolonged PR interval that’s occurring regularly throughout the rhythm Dr.Rebar Yahya Abdullah Causes Normal in some patients (to be monitored) First degree AV block is asymptomatic and may be caused by MI or ischemia, hyperkalemia, hypokalemia, digoxin toxicity, calcium channel blockers, amiodarone and use of antidysrhythmic. Management Monitoring the patient to ensure it doesn’t progress to worse block (another heart block degree) and abnormal rhythm correction of underlying cause. Dr.Rebar Yahya Abdullah Second Degree AV Block Mobitz I (Wenckebach) The electrical signal going for the atria to the ventricle is slowing down until it doesn’t stimulate the ventricle to contract. Dr.Rebar Yahya Abdullah  What is the point that defers second degree from other types of heart block? PR is prolonged or lengthen gradually ,P waves gets further away from QRS complex until QRS disappear. Dr.Rebar Yahya Abdullah Causes and management Second degree type I heart block caused by MI ,digoxin toxicity, calcium channel blockers, beta blockers, increased vagal tone. Management : Stop or adjust the trigger medications If there is low cardiac output : active team response and may need atropine or temporary pacing. Dr.Rebar Yahya Abdullah  Second degree type II heart block PR is not getting progressively longer until it drop a QRS complex like in second degree type I. In type II, PR interval stay constant until ORS suddenly drop. Dr.Rebar Yahya Abdullah Dr.Rebar Yahya Abdullah Dr.Rebar Yahya Abdullah Dr.Rebar Yahya Abdullah Dr.Rebar Yahya Abdullah Second degree type II heart block causes Advanced ACSs Damage the structure that make up the conduct system Medication that slow av conduction system ,digoxin toxicity, calcium channel blockers, beta blockers Dr.Rebar Yahya Abdullah  Second degree type II heart block treatment Second type of second-degree heart block is worsened than first type Ventricular rate is slower ,lowering cardiac output Patient more likely to have symptoms with type II Assess pt for symptoms of low cardiac output such as low bp, weak pulse ,cold, sweaty, mental status changes. Temporary spacing. Pacemaker temporary. Medication may be adjusted or sopped that slow av conduction system. Dr.Rebar Yahya Abdullah Third degree heart block (Complete heart block) The electrical signal from atria does not reach the ventricle. Dr.Rebar Yahya Abdullah  P waves and QRS complexes are not working together P waves and QRS complexes will be doing their own (Independed each other) Dr.Rebar Yahya Abdullah Dr.Rebar Yahya Abdullah Dr.Rebar Yahya Abdullah Dr.Rebar Yahya Abdullah Causes of third degree of heart block Congenital Hear diseases Mi Medication such as digoxin toxicity Valve problem Structure damage Dr.Rebar Yahya Abdullah Treatment Active emergency team Atropine could help the heart pump efficiently Connect pt to temporary pacemaker Placement of permanent pacemaker. Dr.Rebar Yahya Abdullah Ventricular Fibrillation Called V-fib No cardiac output or pulse. Ventricular rhythm and rate are rapid and chaotic QRS complexes not visible P wave is not seen PR interval is not seen Dr.Rebar Yahya Abdullah Ventricular Fibrillation Abnormal signal from electrical conduction system causing ventricles to quiver. Ventricle are not squeezing properly to pump the blood. Cardiac output is fall. The rhythm can lead to death within minutes. Dr.Rebar Yahya Abdullah Dr.Rebar Yahya Abdullah Dr.Rebar Yahya Abdullah Dr.Rebar Yahya Abdullah Causes Heart diseases Low or high potassium levels Hypoxia Drug overdose Dr.Rebar Yahya Abdullah  Start CPR is pulseless. oxygen Def. Follow ACLS protocol for defibrillation. Epinephrine Antiarrhythmic (Cordarone ) Dr.Rebar Yahya Abdullah Types of Pacemakers: There are different types of pacemakers. Single chamber pacemaker. This type usually sends electrical signals to the lower right chamber of the heart. Dual chamber pacemaker. This type sends electrical signals to the upper and lower right heart chambers. Biventricular pacemaker. This type also is called a cardiac resynchronization pacemaker. It's for people who have heart failure and a slow heartbeat. The device stimulates both lower heart chambers. It helps make the heart muscle stronger. Dr.Rebar Yahya Abdullah Cardiac ablation Cardiac ablation is a treatment for irregular heartbeats, called arrhythmias. It uses heat or cold energy to create tiny scars in the heart. The scars block faulty heart signals and restore a typical heartbeat. Cardiac ablation is most often done using thin, flexible tubes called catheters that are inserted through a blood vessel. Less commonly, ablation is done during heart surgery. Dr.Rebar Yahya Abdullah