CARDIAC CONDITIONS

Medications:
-Prescribed Digitalis administration
Cardiac Dysrhythmias -Isoprenaline, or isoproterenol
are disorders of the formation or conduction (or -Propranolol
both) of the electrical impulse within the heart. >This is to slow down the heart rate
These disorders can cause disturbances of the
heart rate, the heart rhythm, or both.

Identifying dysrhythmias b. Sinus Bradycardia

 Sites of Origin Stimulates parasympathetic fibers
Sinus (SA) node Vagal stimulations: delivering electrical
Atria impulses to the vagus nerve that causes the
Atrioventricular (AV) node or junction Sinus node to slow down
Ventricles *Normal variations in athletes
>Rate of below 60 bpm
 Mechanisms of Formation or
Conduction
Normal (idio) rhythm Clinical Manifestations:
Bradycardia T >Below 60 bpm c regular rhythm
achycardia >P Wave: PQRS is in normal contour
Dysrhythmia >Everything in ECG is normal
Flutter =but have slow rate
Fibrillation
Premature complexes Management:
Blocks >Administer Atropine Sulfate
-0.5 to 1mg IV Push
-This is to block the vagal stimulations
SINUS NODE DYSRHYTHMIAS:
a. Sinus Tachycardia Risk factors:
Stimulates sympathetic fibers >Myocardial Infarction
>Rate of 100-160 bpm >Meningitis
>PR; QRS is in normal contour >Hyperthyroidism
>Normal ECG
=But have fast rhythm Incase the AP is not effective
-Administer Atropine Sulfate +
Common Cause: isoproterenol injection via IV
 Fever
 ECG is above cardiac rate If ineffective again,
 Taking stimulants such as: Coffee, teas Pacemaker is advised
and energy drinks
 Excessive physical activities Atrial dysrhythmias
 Medical conditions:
-Hyperthyroidism 1. Premature Atrial
-Mycocardial ischemia Contractions (PAC)
-Anemic -a single ECG complex that occurs when
-Taking drugs such as: Epi and an electrical impulse starts in the atrium
Theophylline before the next normal impulse of the
sinus node.
Nursing Management: -Ectopic beat discharged at the
>Treat underlying cause/condition rate faster than the Sinus node
>If the pt is taking stimulants: *Does not require treatment
-Advise to limit the intake of stimulants
If treatment is badly needed,
>Calcium channel blockers: This is a
hypertensive c antidysrhthmias action
>Kynedine
 CARDIAC CONDITIONS
2. Paroxysmal Atrial
Clinical manifestations:
Tachycardia  Rate is faster
-Sudden onset  P wave: No definite
-Episode of arrhythmia begins and ends  PR interval – Not measurable
abruptly (0.08 secs) – too long/short
>Range of 140-250 bpm  PRS: Generally normal
Management: Management:
>Valsalva maneuver -Prescribed Digitalis administration
- breathing method that may slow -Beta adrenergic Blockers
your heart when it's beating too fast. To do -Propranolol
it, you breathe out strongly through your >If ineffective, Cardioversion
mouth while holding your nose tightly
closed. This creates a forceful strain that can
trigger your heart to react and go back into
VENTRICULAR DYSRHYTHMIAS:
normal rhythm. 1. Premature Ventricular
>Digitalis administration Contraction (PVC)
- Monitor the PR, if below 60, don’t administer
-Most common dysrhythmias
>Beta adrenergic blockers
-Lifethreatening
- Hypertensive with anti dsyrhythmias
-Impulse that starts in a ventricle and is
>If not effective, do a Cardioversion
conducted through the ventricles
before the next normal sinus impulse.
Advise patient to stop
>6 or more per/min
 Smoking
 Drinking
How to define PVC:
 Taking stimulants (Caffeine)
-Ectopic beat originate in the ventricle
and then discharged by a faster than
that by an occurring beat.
3. Atrial Flutter >PVC in bigenemy – 2 PVC/min
- Atrial flutter occurs in the atrium and >PVC in trigeminy – 3 PVC/min
creates impulses at an atrial rate >PVC in quadrgeminy – 4 PVC/min
between 250- 400 bpm
- Dysrhythmias in which an ectopic Causes of PVC:
atrial focuses in the heart rhythm and  Hypokalemia
discharge in the pulses  Electrolyte imbalances
 Digitalis theraphy
Management:  Stimulants SA: Coffee and teas
>Digitalis  Hypoxia
>Calcium Channel Blockers  Hx of Congestive Heart Failure
>If ineffective, Cardioversion
Clinical Manifestations:
4. Atrial Fibrillation -Rate varies depends upon the patients
-Irregular P wave Is normal
- It may start and stop suddenly.
-PR not measurable
-Ectopic focus cause rapid irregular
-QRS usually 0.12 seconds wide
contractions of the heart above the
 Lidocaine IV:
atrium
75 to 100 mg (1-4 mg/min)
>Rate of atrium 350-600 bpm
 Procainamide
>Rate of ventricular 100-160 bpm
300 mg IV
=Rhythm is regular
 Kynedine
 Preprylliuf- Continous infusion
Causes:
 Treat the underlying cause
 Prematic Heart Disease
 Mitral Stenosis (Valvular HD)
 Cardiomyopathy 2. Ventricular Tachycardia
 Hypertensive Heart Disease - Ventricular tachycardia (VT) is defined
 Pericarditis as three or more PVCs in a row,
 Thyrotoxicosis occurring at a rate exceeding 100 beats
 Coronary Heart Disease per minute.
 CARDIAC CONDITIONS
>Rate 60-100 bpm (Atrial) >Before defib:
>Rate of 110-210 bpm (Ventricular) -Push 0.1 of Epi
>Rhythm: Regular in ventricular, To bring back the VS of the pt
irregular in atrial (Epinephrine depends on the extent of
>P wave: QRS complex: Not visible the reviving) MAX: 1 ampule in 5 mins
>PR interval: Not Measurable
> QRS: greater tha 0.12 seconds wide
VT is an emergency because the patient is CONDUCTION DEFECTS:
usually (although not always) unresponsive and
Heart Blocks: Altered at the level of
pulseless.
AV Node
Causes of VT: AV blocks occur when the conduction of
 Myocardial Infarction the impulse through the AV nodal area
 Digitalis toxicity is decreased or stopped.
 Coronary Artery Disease
 Hypokalemia 1. 1st Degree AV Block
First-degree heart block occurs
Clinical Manifestations: when all the atrial impulses are
>Lidocaine IV conducted through the AV node
50mg – 100mg (1-4mg/min) into the ventricles at a rate slower
>Procainamide IV than normal.
300 mg IV infusion >Pulse normally transmitted but
>If ineffective: delayed in level of the AV node
 Cardioversion may be the treatment of >No treatment needed
choice, especially if the patient is
 unstable. (Conscious)
 VT in a patient who is (unconscious) and
2. 2nd Degree AV Block
without a pulse is treated in the same Some but not all of the impulses are
manner as ventricular fibrillation (VFIB): transmitted to the AV node
immediate defibrillation is the action of >AV node – Conducted to the
choice. ventriculation
>AV node: Selectively
This is a life threatening dysrhythmias
-Emergency Management:
-Requires treatment if ventricular
rate becomes too low to maintain
3. Ventricular Fibrillation effective cardiac output
-Most Severe
-Dysrhythmias characterize by the
random chaotic discharging within
ventricular
3. 3rd Degree AV Block
-There is no atrial activity seen on the Third-degree heart block occurs
ECG. when no atrial impulse is conducted
through the AV node into the
Ventricular rate: Greater than 300/min ventricles.
Ventricular rhythm: Extremely irregular, >Cardiac output is compromised
without specific pattern >Administer Pacemaker
QRS shape and duration: Irregular,
undulating waves without recognizable
QRS complexes CARDIOVERSION &
Produces clinical death
DEFIBRILLATION
 Cardioversion (Conversion)
Clinical Manifestations - In cardioversion, the defibrillator is set to
>STAT Defib (200-400 joules/seconds) synchronize with the ECG on a cardiac
monitor so that the electrical impulse
Medications: discharges during ventricular depolarization
>Sodium Bicarbonate (QRS complex).
-This is to relieve lactic acidosis
 CARDIAC CONDITIONS
- Before cardioversion, the patient receives buttons until paddles or pads are on the chest
intravenous sedation as well as an analgesic and ready to deliver the electrical charge.
medication or anesthesia. • Exert 20 to 25 pounds of pressure on the
- The amount of voltage used varies from 25 paddles to ensure good skin contact.
to 150p joules, depending on the • Before pressing the discharge button, call
defibrillator’s technology and the type of “Clear!” three times: As “Clear” is called the first
dysrhythmia time, ensure that you are not touching the
patient, bed or equipment; as “Clear” is called
the second time, ensure that no one is touching
 Defibrillation the bed, the patient, or equipment, including
the endotracheal tube or adjuncts; and as
- used in emergency situations as the
“Clear” is called the third time, perform a final
treatment of choice for ventricular
visual check to ensure you and everyone else
fibrillation and pulseless VT.
are clear of the patient and anything touching
- The electrical voltage required to
the patient.
defibrillate the heart is usually greater
• Record the delivered energy and the results
than that required for cardioversion. If
(cardiac rhythm, pulse).
three defibrillations of increasing
• After the event is complete, inspect the skin
voltage have been unsuccessful,
under the pads or paddles for burns; if any are
cardiopulmonary resuscitation is
detected, consult with the physician or a wound
initiated and advanced life support
care nurse about treatment.
treatments are begun.
- The use of epinephrine or vasopressin
Nursing Management:
may make it easier to convert the
>Place patient in the flat firm surface
dysrhythmia to a normal rhythm with
-Apply cardiac board on the patients bed
defibrillation. These drugs may also
-If none,place the pt to the floor
increase cerebral and coronary artery
>Apply interface material
blood flow. After the medication is
-Apply Lubricant to the paddles before
administered and 1 minute of
Contacting the pt’s skin to prevent burning
cardiopulmonary resuscitation is
The patient’s skin
performed, defibrillation is again
>Hold the handle of the paddle to prevent
administered
Electrocution
- This treatment continues until a stable
>State clear, and make sure that all of the
rhythm resumes or until it is
people in the room are going to distance
determined that the patient cannot be
themselves at the patient’s bed
revived.
>Position the paddle:
- -200-360 joules/sec
-Right of the sternum (3rd ICS)
-Left mid axillary (5th ICS)
When performing defibrillation or
cardioversion, the nurse should remember
these key points: Cardiopulmonary Resuscitation
-Usually perform in cardiopulmonary arrest
• Use multifunction conductor pads or paddles -Clinical death
with a conducting agent between the paddles -Pulselessness
and the skin (the conducting agent is available -Breathlessness
as a sheet, gel, or paste).
• Place paddles or pads so that they do not >Within 4-6 minutes after the onset of the
touch the patient’s clothing or bed linen and are arrest – more than 6 mins indicates brain dead
not near medication patches or direct oxygen
flow. Basic Life Support (BLS)
• If cardioverting, ensure that the monitor leads -Use of hands and mouth
are attached to the patient and that the -Sincere desire of giving the patient a 2 nd
defibrillator is in sync mode. If defibrillating, chance of life
ensure that the defibrillator is not in sync mode
(most machines default to the “not-sync” Advanced Cardiac Life Support (ACLS)
mode). -Requires BLS
• Do not charge the device until ready to shock; -Use of advanced equipment
then keep thumbs and fingers off the discharge -Emergency drug
-fluids
 CARDIAC CONDITIONS
>To stabilize the patient  Observe the pacemaker malfunction: Pt
c dizziness, Chest pain, dyspnea,
CPR performs ABCD: prolong hiccups
 Practice sterile technique when
Airway cleaning the incisions dressing to
Breathing prevent infection
Circulation  Provide psychosocial support
Definitive drugs -Concerns of the patient
-Coping mechanism
-Ensures pt’s comfort
When to stop CPR?  Maintain a positive body image
 When the client is revived  Provide health teaching:
 When EMS (Emergency Medical -Advise patient to take his/her pulse
Services) activated/arrived upon awakening for full minute
 If the rescuer/responder is exhausted -Report for any sudden change in the
 When the client is dead Pulse Rate, Any increasing indicates
malfunctions
-Report S/SX: Palpitations, Dizziness,
Pacemaker Insertion Chest pain, Dyspnea, prolong hiccups
-Advise to use Electrical device
- Electronic device that provides electrical
-If dizziness occurs, stops the device
stimuli to the heart muscle.
- Battery operated generator, time electric
Sources of Electromagnetic Inferences that
signals to trigger contractions of the heart
may effect the pulse generator:
muscle and controlling heart rate
 High energy radar
- Pacemakers can be permanent or temporary.
 Radiotransmitters
 Electrodevices
Temporary:
 Airport screening device
 CPR
 Antidepth device
 Open heart surgery
 Microwaves
 Sinus Arrest
 Complete heart block
*Distance yourself for about 5-10 feet
 Symptomatic sinus bradycardia
 Myocardial Infarction

Permanent:
 Irreversible complete heart block

2 techniques:

1. Transvenous (Endocardial)
-Cephalic vein (Along arm) or
externaljugular vein (Around neck)
-Endocardial transvenous technology
peripheral end is connected to the
pulse generator, implanted to the skin
to the R/L pectoral region
-Size of the box of cigarette

2. Transthoracic
-Surrounding the heart
-Open (Anterior chest) to the surface of
The R/L ventricle or atrium then
Treaded subcutaneous on the
abdominal wall above or below the
ambilitus (waist)

Nursing Management:
 Monitor the ECG and VS