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Relias Assessments Assistance Material DYSRHYTHMIAS 2023/2024 already graded A+
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Relias Assessments Assistance MaterialDYSRHYTHMIAS
EKG interpretation - ANSOne of the most useful and commonly used diagnostic tools is
electrocardiography (EKG) which measures the heart's electrical activity as waveforms. An EKG
uses electrodes attached to the skin to detect electric current moving through the heart. These
signals are transmitted to produce a record of cardiac activity. Arrhythmia or dysrhythmia are
disturbances in the normal cardiac rhythm of the heart which occurs as a result of alterations
within the conduction of electrical impulses. These impulses stimulate and coordinate atrial and
ventricular myocardial contractions that provide cardiac output.
Sinus Tachycardia - ANSSinus tachycardia is a heart rate greater than 100 beats per minute
that originated from the sinus node.
Rate: 100 to 180 beats per minute
P Waves precede each QRS complex
PR interval is normal
QRS complex is normal
Conduction is normal
Rhythm is regular
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.
Sinus Bradycardia - ANSSinus bradycardia is a heart rate less than 60 beats per minute and
originates from the sinus node (as the term "sinus" refers to sinoatrial node). It has the following
characteristics
Rate is less than 60 beats per minute
P Waves precede each QRS complex
PR interval is normal
QRS complex is normal
Conduction is normal
Rhythm is regular
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.
Premature Atrial Contraction - ANSPremature Atrial Contraction are ectopic beats that
originates from the atria and they are not rhythms. Cells in the heart starts to fire or go off before
, the normal heartbeat is supposed to occur. These are called heart palpitations and has the
following characteristics:
Premature and abnormal-looking P waves that differ in configuration from normal P waves
QRS complex after P waves except in very early or blocked PACs
P waves often buried in the preceding T wave or identified in the preceding T wave.
Causes includes coronary or valvular heart diseases, atrial ischemia, coronary artery
atherosclerosis, heart failure, COPD, electrolyte imbalance and hypoxia. Usually there is no
treatment needed but may include procainamide and quinidine administration (antidysrhythmic
drugs) and carotid sinus massage.
Atrial Flutter - ANSAtrial flutter is an abnormal rhythm that occurs in the atria of the heart. Atrial
flutter has an atrial rhythm that is regular but has an atrial rate of 250 to 400 beats/minute. It has
sawtooth appearance. QRS complexes are uniform in shape but often irregular in rate.
Normal atrial rhythm
Abnormal atrial rate: 250 to 400 beats/minute
Sawtooth P wave configuration
QRS complexes uniform in shape but irregular in rate
Causes includes heart failure, tricuspid valve or mitral valve diseases, pulmonary embolism, cor
pulmonale, inferior wall MI, carditis and digoxin toxicity.
Management if the patient is unstable with ventricular rate of greater than 150 bpm, prepare for
immediate cardioversion. If patient is stable, drug therapy may include calcium channel blocker,
beta-adrenergic blockers, or antiarhythmics. Anticoagulation may be necessary as there would
be pooling of blood in the atria.
Atrial Fibrillation - ANSAtrial fibrillation is disorganized and uncoordinated twitching of atrial
musculature caused by overly rapid production of atrial impulses. This arrhythmia has the
following characteristics:
Atrial Rate: 350 to 600 bpm
Ventricular Rate: 120 to 200 bpm
P wave is not discernible with an irregular baseline
PR interval is not measurable
QRS complex is normal
Rhythm is irregular and usually rapid unless controlled.
Causes includes atherosclerosis, heart failure, congenital heart disease, chronic obstructive
pulmonary disease, hypothyroidism and thyrotoxicosis. Atrial fibrillation may be asymptomatic
but clinical manifestation may include palpitations, dyspnea, and pulmonary edema. Nursing
goal is towards administration of prescribed treatment to decrease ventricular response,
decrease atrial irritability and eliminate the cause.
Premature Junctional Contraction - ANSPremature Junctional Contraction (PJC) occurs when
some regions of the heart becomes excitable than normal. It has the following characteristics.
PR interval less than 0.12 seconds if P wave precedes QRS complex
QRS complex configuration and duration is normal
P wave is inverted
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