Cardiovascular System Alterations Module B

INHERENT RATES
Sinoatrial Node (SA)
60-100

Atrioventricular Junctional Area (AV)

40-60

Bundle Branch System

20-40

PR INTERVAL
Represents

time from the beginning of atrial depolarization to the beginning of ventricular depolarization Measured from the beginning of the P wave to the beginning of the QRS complex 0.12-0.20

QRS INTERVAL
Represents the length of time for depolarization of the ventricular muscle Measured from the beginning of the QRS complex to the end of the S wave Should measure between 0.06-0.10 seconds in duration

ST INTERVAL
Represents

the total length of time for ventricular muscle to be depolarized and repolarized Measured from the beginning of the QRS complex to the end of the T wave Normal range I s 0.32-0.42

Heart Rate
Calculating the Heart Rate
6 Big

Second Strip Method Block Method

Rhythm Analysis
Five Step Method Determine the Heart Rate Determine the Heart Rhythm Analyze the P Waves Measure the PR Interval Measure the QRS Duration

Rhythm

Node SA Node

Rate 60-100 bpm

Rhythm PR Interval Regular 0.12 to

0.20 seconds

QRS P wave Interval

0.04 to 0.10 seconds One P wave before each QRS

Etiology
May be a normal variation in athletes and healthy young adults Excessive vagal stimulation Medical Conditions Anorexia Atherosclerotic heart disease
Hypothermia

Medications Antihypertensives

Symptoms
Symptoms relate to decreased cardiac output Chest pressure and pain Hypotension Dizziness Seizures Syncope Confusion Diaphoresis Ventricular ectopy

Treatment
Interventions

Normal Sinus Rhythm

Beta blockers Calcium channel blockers CNS

depressants

only if
symptomatic

Aimed at
increasing

the heart rate

Atropine Oxygen External Pacemaker
Intravascular Volume Replacement

Digoxin

Myocardial Infarction Increased intracranial pressure

Sinus Bradycardia

SA Node

below 60 bpm

Regular

0.12 to 0.20 seconds

0.04 to 0.10 seconds

Rhythm
Sinus Tachycardia

Node SA Node

Rate
above 100 bpm

Rhythm PR Interval Regular 0.12 to

0.20 seconds

QRS P wave Interval

0.04 to 0.10 seconds

Etiology
Diet caffeine Lifestyle Smoking/ nicotine Medical conditions Anemia hemorrhage fever hypotension pain shock Medications Central nervous stimulants Myocardial damage

Medications
Antipyretics and antibiotics for fever and infection Beta Blockers Nitrates or Morphine for Angina

Symptoms
Assessment
Normal response to physical activity Anxiety Fear Fever Anemia Hypoxemia
Hyperthyroidism

Treatment
Interventions
Treat underlying cause Oxygen Rest
Intravascular Volume replacement in Hypovolemia

Pulmonary Emboli Medications May be asymptomatic or symptomatic Symptoms may include

Fatigue Weakness SOB Decreased BP Angina or Palpitations May have Twave inversion or ST segment elevation or depression in response to myocardial ischemia

Atrial Fibrillation
(most common AND in men more than women)

350-600 bpm <100 = controlled >100 = uncontrolled (rapid ventricular response)

None

Digoxin Beta blockers Calcium channel blockers

Assessment
ECG Intermittent or chronic Symptoms depend on ventricular rate Risk for inadequate cardiac output May have Pulse deficit Fatigue Weakness SOB Dizziness Anxiety Hypotension Risk for systemic emboli

Interventions

Oxygen

Medications
Cardioversion
Radiofrequency

Catheter Ablation
Maze Procedure

Rhythm Atrial Flutter

(Rapid atrial depolarization)

Node

Rate
250-350 bpm

Rhythm PR Interval

QRS P wave Interval

Etiology
Rheumatic or ischemic heart disease CHF Valvular Disease Pulmonary Emboli

Medications
Digitalis Beta blocker Calcium channel blocker

Symptoms
Assessment
ECG Symptoms depend on ventricular response Palpitations Weakness Fatigue SOB Anxiety Syncope Angina CHF ECG Symptoms depend on the duration and the rate Palpitations Weakness Fatigue SOB Anxiety Hypotension Syncope

Treatment
Interventions

Oxygen

Medications

Radiofrequency Catheter Ablation

Cardioversion

Paroxysmal
Supraventricular

100- 280

Tachycardia
(Rapid stimulation of atrial tissue)

shaped differently or not visible

Assessment

Interventions
If terminated spontaneously, no intervention

EP Study Radiofrequency Catheter Ablation Treat the cause Oxygen

Medications
Cardioversion

Impulses are blocked Different types of AV Blocks

Atrio-Ventricular Block

First Degree AV Block Second Degree AV Block, Type I Second Degree AV Block, Type II Third Degree AV Block

First Degree AV Block

Conduction delay AV node conduction is slow

> 0.20 seconds

Common occurrence in normal hearts Cardiac disease including:

Arteriosclero tic heart disease Myocarditis Myocardial infarction Medications

Medications
Beta blockers Calcium channel blockers Dig toxicity

Usually not treated unless the cause is related to a med that can be modified or withheld

Rhythm Second Degree AV Block, Type I

Node

Rate

Rhythm PR Interval

QRS P wave Interval

Etiology

Medications

Symptoms
Assessment
ECG Usually
asymptomatic

Treatment
Interve

Wenckebach or Mobitz Type I Sinus impulse takes a little longer to conduct through the impaired AV node until one impulse is completely blocked

ntions
None

Usually transient

if stable Symptom s may need

Oxygen Atropine External

pacer

Second Degree AV Block, Type II

Mobitz Type II Occurs below the Bundle of His Impulses may be blocked randomly, making the ventricular rhythm irregular Could progress to a more serious block

Assessment
Atropine (usually ineffective)

ECG Symptoms depend on number of dropped beats and the overall ventricular rate If Cardiac Output is inadequate, the client may be symptomatic

Interventions Pacing Oxygen Atropine ineffective

Third Degree AV Block

Complete Heart Block None of the sinus impulses conduct to the ventricles

Assessment
Atropine
ECG Confusion Syncope Stokes-Adams Syndrome CHF Hypotension May lead to cardiac arrest

Interventions

Oxygen Atropine Pacing

Rhythm Atrioventricular Tachycardia

Node

Rate

Rhythm PR Interval

QRS P wave Interval

Etiology

Medications
Diltiazem Verapamil Digoxin Propranolol Procainamide Quinidine vasopressor

Symptoms
Assessment

Treatment
Interventions Vagal maneuvers Carotid sinus pressure Medications

Irritable area of tissue in the atria that dominates the SA node and takes over as the pacemaker Usually preceded by premature atrial contractions Begins and ends abruptly The rapid rate prevents adequate ventricular filling

Chest pain SOB Hypotension Palpitations Dizziness

Assessment
May be asymptomatic Palpitations Chest pain Peripheral pulses may be diminished or absent May be a warning sign

Interventions

Premature Ventricular Complex

Irritability of ventricular cells Unifocal or multifocal

Eliminate cause Oxygen

Medications

Bigeminy unifocal

Bigeminy Multifocal

Trigeminy Quadrigiminy

Rhythm
Ventricular Tachycardia

Node

Rate

Rhythm PR Interval

QRS P wave Interval

Etiology

Medications

Symptoms
Assessment
ECG Assess ABCs LOC

Treatment
Interventions

VT is commonly the initial rhythm in cardiac arrest

ACLS

Ventricular Fibrillation

Electrical chaos in the ventricles No recognizable deflections Ventricles quiver No cardiac output Fatal

Nonsurgical treatment
Medication Therapy Vagal Maneuvers Temporary Pacing CPR Cardioversion Defibrillation

Surgical Management
PPM CABG Implantable Cardioverter/Difibrillator Open-Chest Cardiac Massage

Assessment
ECG ABCs Interventions ACLS

Nursing Process
Diagnoses Decreased Cardiac Output Anxiety related to fear of the unknown Knowledge deficient about the dysrhythmia and treatment Planning and Goals Eradicating or decreasing the incidence of the dysrhythmia Acquire knowledge about the dysrhythmia and treatment Interventions Monitor BP, Pulse Rate and Rhythm, Respirations, Breath Sounds Episodes of dizziness Rhythm strips Medication Administration Assist in developing a plan to modify lifestyle Minimize anxiety Teach self care Evaluation Expected outcomes Maintain Cardiac Output Expresses decreased anxiety Expresses understanding of dysrhythmia