BUDDLE,JANINA PATRICIA B.

DYSRRYTH
MIAS

DESCRIPTION

CAUSES

ECG CHANGES

TREATMENT

Sinus node
Arrhythmias

Sinus
Bradycardiaoccurs when the
sinus node creates
an impulse at a
slower-thannormal rate

Lower metabolic
needs(eg. Sleep,athletic
training,hypothyroidism),
vagal stimulaton,
increased intracranial
pressure and ,myocardial
infarction,hypokalemia or
hyperkalemia,hypoxia,
hypoglycaemia

Ventricular and atrial

rate:less than 60 in the
adult
Ventricular and atrial
rhythm: Usually
normal,but may be
regularly abnormal
QRS shape and
duration: Usually
normal,but may be
regularly abnormal
P wave: Normal and
consistent
shape;always in front
of QRS
PR interval:
Consistent interval
between 0.12 and 0.20

Atropine,0.5 mg
given rapidly as an
intravenous bolus
every 3 to 5 minutes
to a maximum of 3
mg.

Sinus
Tachycardiaoccurs when the

Physiologic and
psychological stress(eg
acute blood

Ventricular and atrial

rate:greater than 100
in adult but usually

Beta blockers and

calcium channel
blockers may be

NURSING
INTERVENTI
ON

sinus node creates

an impulse at a
faster-than-normal
rate

Sinus Arrhythmiaoccurs when the

sinus node creates
an impulse at an
irregular rhythm
:the rate usually
increases with
inspiration and
decreases with
expiration

loss,anemia,shock,hyperv
olemia,hypovolemia),me
dications that stimulate
the sympathetic
response(eg
catecholamines,aminophy
lline,atropine),stimulants
and illicit drugs

Heart disease and

valvular disease

less than 120

Ventricular and atrial
rhythm:regular
QRS shape and
duration:Usually
normal,but may be
regularly abnormal
P wave: Normal and
consistent
shape;always in front
of the QRS,but may be
buried in the
preceding T wave
PR Interval:
Consistent interval
between 0.12 and 0.20
seconds
P:QRS ratio: 1:1
Ventricualr and atrial
rate:60 to 100 in the
adult
Ventricular and atrial
rate : Irregular
QRS shape and
duration: Usually
normal,but may be
regularly abnormal
P wave: Normal and

administered to
reduce the heart rate
quickly.Catheter
ablation of the SA
node may be used in
the cases of persistent
inappropriate sinus
tachycardia
unresponsive to other
treatments.
Usually not treated

Atrial
Arryhthmias

Premature Atrial
Complex- occurs
when ab electrical
impulse starts in
the atrium before
the next normal
impulse of the
sinus node

Caffeine,alcohol,nicotine,
stretched atrial
myocardium( eg. As in
hypervolemia),anxiety,hy
pokalemia,hypermetaboli
c states or atrial
ischemia,injury or
infarction.

consistent
shape;always in front
of the QRS
PR interval :
Consistent interval
between 0.12 to 0.20
Ventricular and atrial
rate: depends on the
underlying rhythm
Ventricular and atrial
rhythm: Irregular due
to early P
waves,creating a PP
interval that is shorter
than the others. This is
sometimes followed
by a longer-thannormal PP interval,but
one that is less than
twice the normal PP
interval.
QRS shape and
duration: The QRS
that follows the early
P wave is usually
normal,but it may be
abnormal .It may even
be absent

Atrial Flutteroccurs because of

a conduction
defect in the
atrium and causes
a rapid,regular
atrial rate,usually
between 250 to
400 times per
minute.Because
the atrial rate is
faster than thr AV
node can conduct,
not all atrial
impulses are
conducted into the
ventricle,causing a
therapeutic block
at the AV node

Often occurs in patients

with Chronic Obstructive
pulmonary
disease,Valvular disease
and thyrotoxicosis

Ventricular and atrials

rate: Atrial rate ranges
between 250 and
400;ventricular rate
usually ranges
between 75 and 150
Ventricular and atrial
rhythm: The atrial
rhythm is regular;the
ventricular rhythm is
usually regular but
may be irregular
because of a change in
the AV conduction
QRS shape and
duration: Usually
normal, but may be
abnormal or may be
absent
P wave: saw-toothed
shape
PR interval: Multiple
F waves may make it
difficult to determing
the PR interval
P;QRS ratio: 2:1,3:1
or4:1

Vagal maneuvers or
administration of
adenosine,which
causes sympathetic
block and slowing of
conduction in the AV
node, may allow
better visualization of
flutter
waves.Adenosine
should be rapidly
administered
intravenously,followe
d by a 20-ml saline
flush and elevation of
the arm with the IV
line to promote rapid
circulation of the
medication.Catheter
ablation rather than
antiarrhythmic
medications is now
the long term
treatment of choice.

Atrial Fibrilationuncoordinated
atrial electrical
activation that
causes a
rapid,disorganized
and uncoordinated
twitching of atrial
musculature.The
ventricular rate
response is
dependent on the
ability of the
a=AV node to
conduct the atrial
impulses,the level
of sympathetic
and
parasympathetic
tone.presence of
accessory
pathways.

Usually occurs in people

with advanced age with
structural heart
disease,such as valvular
heart
disease,inflammatory or
infiltrative
disease,coronary artery
disease,hypertension,con
genital disorder.May also
be found in pts with
diabetes,obesity
,hyperthyroidism,pheochr
omocytoma,pulmonary
hypertension and
embolism

Ventricular and atrial

rate: Atrial rate is 300
to 600; ventricular
rate is usually 120 to
200 in untreated atrial
fibrillation
Ventricular and atrial
rhythm: Highly
irregular
QRS shape and
duration: Usually
normal, but may be
abnormal
P wave: No
discernible P waves;
irregular undulating
waves that vary in
amplitude and shape
are seen and
are referred to as
fibrillatory or f waves
PR interval: Cannot
be measured
P:QRS ratio: Many:1

Treatment of atrial
fibrillation depends
on the cause, pattern,
and duration of the
dysrhythmia; the
ventricular
response rate; and the
patients symptoms,
age, and
comorbidities.
Patients may be given
amiodarone
(Cordarone),
flecainide
(Tambocor), ibutilide
(Corvert),
propafenone
(Rythmol), or sotalol
(Betapace) prior to
cardioversion to
prevent relapse of the
atrial fibrillation

AV block
Junction
Arrythmias

premature
junctional
complex -an
impulse that starts
in the AV nodal
area before
the next normal
sinus impulse
reaches the AV
node.
Premature
junctional
complexes are less
common than
PACs.

Junctional or
idionodal rhythm
occurs
when the AV node,
instead of the
sinus node,
becomes the

digitalis toxicity, heart

failure, and
coronary artery disease.

The ECG criteria for

premature
junctional complex are
the same as for PACs,
except for
the P wave and the PR
interval. The P wave
may be absent,
may follow the QRS,
or may occur before
the QRS but
with a PR interval of
less than 0.12 seconds.

Ventricular and atrial

rate: Ventricular rate
40 to 60; atrial
rate also 40 to 60 if P
waves are discernible
Ventricular and atrial
rhythm: Regular

Atropine,0.5 mg
given rapidly as an
intravenous bolus
every 3 to 5 minutes
to a maximum of 3
mg.

pacemaker of the
heart. When the
sinus node slows
(eg, from
increased vagal
tone) or when the
impulse cannot be
conducted
through the AV
node (eg, because
of complete heart
block), the AV
node
automatically
discharges an
impulse.

Nonparoxysmal
Junctional
Tachycardia.-

QRS shape and

duration: Usually
normal, but may be
abnormal
P wave: May be
absent, after the QRS
complex, or before
the QRS; may be
inverted, especially in
lead II
PR interval: If the P
wave is in front of the
QRS, the PR
interval is less than
0.12 seconds
P:QRS ratio: 1:1 or
0:1

enhanced automaticity in
the junctional
area may
indicate a serious
underlying condition,
such as digitalis toxicity,
myocardial ischemia,
hypokalemia, or chronic
obstructive
pulmonary disease

rhythm similar to
junctional rhythm,
except
at a rate of 70 to 120a

Atrioventricular
nodal reentry
tachycardia
(AVNRT) is a
common
dysrhythmia that
occurs when an
impulse is
conducted to
an area in the AV
node that causes
the impulse to be
rerouted back into
the same area over
and over again at a
very fast rate.
Each time the
impulse is
conducted through
this area, it is also
conducted down
into the ventricles,
causing a fast
ventricular rate

caffeine, nicotine,
hypoxemia,
and stress. Underlying
pathologies include
coronary
artery disease and
cardiomyopathy;
however, it occurs more
often in females and not
in association with
underlying
structural heart disease

Ventricular and atrial

rate: Atrial rate
usually 150 to 250;
ventricular rate
usually 120 to 200
Ventricular and atrial
rhythm: Regular;
sudden onset and
termination of the
tachycardia
QRS shape and
duration: Usually
normal, but may be
abnormal
P wave: Usually very
difficult to discern
PR interval: If the P
wave is in front of the
QRS, the PR
interval is less than

The aim of therapy is

to break the reentry
of the impulse.
Catheter ablation is
the initial treatment
of choice and is used
to eliminate the area
that permits the
rerouting of the
impulse
that causes the
tachycardia. Vagal
maneuvers, such as
carotid
sinus massage
,gagging, breath
holding, and
immersing
the face in ice water,
may be used to
interrupt
AVNRT. These
techniques increase
parasympathetic
stimulation,
causing slower
conduction through

the AV node and

blocking the reentry
of the rerouted
impulse

Ventricular
Arrythmias

premature
ventricular
complex (PVC) is
an impulse that
starts in a ventricle
and is
conducted through
the ventricles
before the next
normal sinus
impulse.

caused by cardiac
ischemia or infarction,
increased workload
on the heart (eg, heart
failure, and tachycardia),
digitalis
toxicity, hypoxia,
acidosis, or electrolyte
imbalances, especially
hypokalemia

Ventricular and atrial

rate: Depends on the
underlying
rhythm (eg, sinus
rhythm)
Ventricular and atrial
rhythm: Irregular due
to early QRS,
creating one RR
interval that is shorter
than the others.
PP interval may be
regular, indicating that
the
PVC did not
depolarize the sinus
node.

PVCs that are

frequent and
persistent may be
treated with
amiodarone or
sotalol. Lidocaine
(Xylocaine) may
be used in the patient
with acute MI.
Patients with acute
MI
who did not receive
thrombolytics and
had more than 10
PVCs per hour and
those who did receive
thrombolytics and

Ventricular
Tachycardia. VT
is defined as three
or more

Patients with larger MIs

and lower ejection
fractions are at higher
risk of lethal ventricular

QRS shape and

duration: Duration is
0.12 seconds or
longer; shape is
bizarre and abnormal
P wave: Visibility of P
wave depends on the
timing of the
PVC; may be absent
(hidden in the QRS or
T wave)
or in front of the QRS.
If the P wave follows
the QRS,
the shape of the P
wave may be different.
PR interval: If the P
wave is in front of the
QRS, the PR
interval is less than
0.12 seconds
P:QRS ratio: 0:1; 1:1

had more than 25

PVCS per hour were
found to be at the
greatest risk for
sudden cardiac death

Ventricular and atrial

rate: Ventricular rate
is 100 to 200
bpm; atrial rate

However, the patient

may need
antiarrhythmic
medications,

PVCs in a row,
occurring at a rate
exceeding 100
bpm. The
causes are similar
to those of PVC

tachycardia

depends on the
underlying rhythm
(eg, sinus rhythm)
Ventricular and atrial
rhythm: Usually
regular; atrial
rhythm may also be
regular
QRS shape and
duration: Duration is
0.12 seconds or
more; bizarre,
abnormal shape
P wave: Very difficult
to detect, so atrial rate
and rhythm
may be indeterminable
PR interval: Very
irregular, if P waves
are seen
P:QRS ratio: Difficult
to determine, but if P
waves are
apparent, there are
usually more QRS
complexes than
P waves

antitachycardia
pacing, or direct
cardioversion. IV
procainamide is the
antiarrhythmic
medication of choice
for a patient with
stable acute MI with
VT, whereas IV
amiodarone is the
medication of choice
for a patient with
unstable VT or
impaired cardiac
function. Sotalol may
also
be used.

Ventricular
Fibrillation. The
most common
dysrhythmia
in patients with
cardiac arrest is
ventricular
fibrillation,
which is a rapid,
disorganized
ventricular rhythm
that causes
ineffective
quivering of the
ventricles. No
atrial
activity is seen on
the ECG.

most common cause of

ventricular fibrillation is
coronary artery disease
and resulting
acute MI. Other causes
include untreated or
unsuccessfully
treated VT,
cardiomyopathy, valvular
heart disease,
several proarrhythmic
medications, acid-base
and electrolyte
abnormalities, and
electrical shock. Another
cause is
Brugada syndrome, in
which the patient
(frequently of
Asian descent) has a
structurally normal heart,
few or no
risk factors for coronary
artery disease, and a
family history
of sudden cardiac death

Ventricular rate:
Greater than 300 per
minute
Ventricular rhythm:
Extremely irregular,
without a specific
pattern
QRS shape and
duration: Irregular,
undulating waves
without recognizable
QRS complexes

five cycles of CPR

may be given prior to
defibrillation After
the
initial defibrillation,
five additional cycles
of CPR (about 2
minutes of
continuous chest
compressions in the
intubated
patient), beginning
with chest
compression and
alternating
with a rhythm check
and defibrillation, are
used to convert
ventricular
fibrillation to an
electrical rhythm that
produces
a pulse.
Cardiocerebral
resuscitation for
cardiac arrest with
continuous chest
compressions,

interrupted only with

defibrillation,
and its de-emphasis
on the use of
positive-pressure
ventilation continues
to be explored as a
better method for
improving survival
Epinephrine should
be administered as
soon as possible after
the second rhythm
check (immediately
before or after the
second defibrillation)
and then every 3 to 5
minutes.

Idioventricular
rhythm, also
called ventricular
escape rhythm,
occurs when the
impulse
starts in the
conduction system

Ventricular rate: 20
and 40; if the rate
exceeds 40, the
rhythm is known as
accelerated
idioventricular
rhythm (AIVR)
Ventricular rhythm:

the treatment
is the same as for
asystole and pulseless
electrical activity
(PEA) if the patient is
in cardiac arrest or
for bradycardia if
the patient is not in

below the AV
node. When
the sinus node
fails to create an
impulse (eg, from
increased
vagal tone) or
when the impulse
is created but
cannot be
conducted through
the AV node (eg,
due to complete
AV
block), the
Purkinje fibers
automatically
discharge an
impulse.

Ventricular
Asystole.
Commonly called
flatline,
ventricular
asystole (Fig. 2719) is

Regular
QRS shape and
duration: Bizarre,
abnormal shape;
duration
is 0.12 seconds or
more

acidosis, severe
electrolyte imbalance,
drug overdose,
hypovolemia,
cardiac tamponade,
tension pneumothorax,
coronary

cardiac arrest.
Interventions include
identifying the
underlying cause;
administering IV
epinephrine,
atropine, and
vasopressor
medications; and
initiating
emergency
transcutaneous
pacing. In some
cases, idioventricular
rhythm may cause no
symptoms of reduced
cardiac output.
However, bed rest is
prescribed so as not
to
increase the
cardiac workload.
treated the same as
PEA, focusing
on high-quality CPR
with minimal
interruptions and
identifying
underlying

characterized by
absent QRS
complexes
confirmed in two
different leads,
although P
waves may be
apparent for a
short duration.

or pulmonary
thrombosis, trauma, or
hypothermia

and contributing
factor