ELECTROCARDIOGRAM READING AND ITS  Heart rate >100 bpm that originated

NURSING INTERVENTION from the sinus node

 Rate: 100 – 180 beats per minute
ELECTROCARDIOGRAM (EKG)  P waves precede each QRS complex
 One of the most useful and commonly  PR interval is normal
used diagnostic tools which measures  QRS complex is normal
the heart’s electrical activity as  Conduction is normal
waveforms  Rhythm is regular
 It uses electrodes attached to the skin
to detect electric current moving CAUSES:
through the heart  Exercise
 These signals are transmitted to  Anxiety
produce a record of cardiac  Fever
activity  Drugs
 Arrhythmia or dysrhythmia are  Anemia
disturbances in the normal cardiac  Heart failure
rhythm of the heart which occurs as a  Hypovolemia
result of alterations within the  Shock
conduction of electrical impulses  Sinus tachycardia is often asymptomatic
 These impulses stimulate and
coordinate atrial and ventricular MANAGEMENT:
myocardial contractions that provide  It is directed at the treatment of the
cardiac output primary cause
 Carotid sinus pressure (carotid
PARTS OF THE CARDIAC CONDUCTION OF massage) or a beta blocker may be
THE HEART used to reduce heart rate
 SINOATRIAL NODE
 ATRIOVENTRICULAR NODE SINUS BRADYCARDIA
 BUNDLE OF HIS  Heart rate <60 bpm and originates from
(ATRIOVENTRICULAR BUNDLE) the sinus node (sinoatrial node). It has
 PURKINJE FIBERS the following characteristics:
 Rate: <60 beats per minute
STEPS OF THE HEART CONDUCTION  P waves precede each QRS complex
PATHWAY  PR interval is normal
Your heart is a pump that sends blood through  QRS complex is normal
your body. For each heartbeat, electrical signals  Conduction is normal
travel through the conduction pathway of your  Rhythm is regular
heart. It starts when your sinoatrial (SA) node
creates an excitation signal. This electrical signal CAUSES:
is like electricity traveling through wires to an  Drugs
appliance in your home.  Vagal stimulation
 Hypoendocrine states
The excitation signals travels to:  Hypothermia
1. Your atria, telling them to contract  Sinus node involvement in MI
2. The atrioventricular node, delaying the signal  This arrhythmia may be normal in
until your atria are empty of blood athletes as they have quality stroke
3. The bundle of His, carrying the signal to the volume (resting)
Purkinje fibers  It is often asymptomatic but
4. The Purkinje fibers to your ventricles, causing manifestations may include:
them to contract  Syncope
 Fatigue
SINUS TACHYCARDIA  Dizziness

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  Pulmonary embolism
MANAGEMENT:  Cor pulmonale
 Treating the underlying cause and  Inferior wall MI
administering anticholinergic drugs  Carditis
like atropine sulfate as prescribed  digoxin toxicity

MANAGEMENT:
PREMATURE ATRIAL CONTRACTION  If the patient is unstable with ventricular
 Ectopic beats that originates from the rate of >150 bpm, prepare for
atria and they are not rhythms immediate cardioversion
 Heart palpitations – cells in the heart  If the patient is stable, drug therapy
starts to fire or go off before the normal may include calcium channel blocker,
heartbeat is supposed to occur. beta-adrenergic blockers, or
 Premature and abnormal-looking P antiarrhythmics.
waves that differ in configuration from  Anticoagulation may be necessary as
normal P waves there would be pooling of blood in the
 QRS complex after P waves except in atria
very early or blocked PACs
 P waves often buried in the preceding T
wave or identified in the preceding T ATRIAL FIBRILLATION
wave  It is disorganized and uncoordinated
twitching of atrial musculature caused
by overly rapid production of atrial
impulses
CAUSES:  more fatal than atrial flutter; blood
 Coronary or valvular heart diseases stays in the atria = thrombosis will form
 Atrial ischemia  This arrhythmia has the following
 Coronary artery atherosclerosis characteristics:
 Heart failure  Atrial Rate: 350 – 600 bpm
 COPD  Ventricular Rate: 120 – 200 bpm
 Electrolyte imbalance  P wave is not discernible with an
 Hypoxia irregular baseline
 PR interval is not measurable
MANAGEMENT:  QRS complex is normal
 Usually there is no treatment needed but  Rhythm is irregular and usually rapid
may include procainamide and unless controlled
quinidine administration
(antidysrhythmic drugs) and carotid
sinus massage

ATRIAL FLUTTER
 An abnormal rhythm that occurs in the
atria of the heart CAUSES:
 It has an atrial rhythm that is regular but  Atherosclerosis
has an atrial rate of 250 – 400  Heart failure
beats/minute.  Congenital heart disease
 It has sawtooth appearance  Chronic obstructive pulmonary disease
 QRS complexes are uniform in shape  Hypothyroidism
but often irregular in rate  Thyrotoxicosis
CAUSES:
 Heart failure
 Tricuspid valve or mitral valve diseases

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  It may be asymptomatic but clinical  Rate is usually 60-100 bpm
manifestations may include  PR intervals are prolonged for usually
 Palpitations 0.20 seconds
 Dyspnea  QRS complex is usually normal
 Pulmonary edema  Rhythm is regular

MANAGEMENT:
 Administration of prescribed treatment to
decrease ventricular response,
decrease atrial irritability and eliminate
the cause
CAUSES:
Complication of Atrial Fibrillation:  Asymptomatic and may be caused by:
 Cerebral vascular accident or stroke  Inferior wall MI or ischemia
 Hyperkalemia
 Hypokalemia
PREMATURE JUNCTIONAL CONTRACTION  Digoxin toxicity
 It occurs when some regions of the  Calcium channel blockers
heart becomes excitable than normal  Amiodarone and use of
 It has the following characteristics: antidysrhythmic
 PR interval less than 0.12 seconds
if P wave preceded QRS complex MANAGEMENT:
 QRS complex configuration and  Correction of underlying cause
duration is normal  Administer atropine if PR interval
 P wave is inverted exceeds 0.26 second or symptomatic
 Atrial and ventricular rhythms bradycardia develops
irregular
SECOND DEGREE AV BLOCK MOBITZ I
(WENCKEBACH)
 Atrial rhythm is regular
 Ventricular rhythm is irregular
 Atrial rate exceeds ventricular rate
CAUSES:  PR interval progressively but only
 MI or ischemia slightly, longer with each cycle until
 Digoxin toxicity QRS complex disappears (dropped
 Excessive caffeine beat)
 Amphetamine use  PR interval shorter after dropped beat
MANAGEMENT:
 Correction of underlying cause
 Discontinuation of digoxin if appropriate

CAUSES:
ATRIOVENTRICULAR BLOCKS (AV Blocks)  Inferior wall MI
 Conduction defects within the AV  Cardiac surgery
junction that impairs conduction of atrial  Acute rheumatic fever
impulses to ventricular pathways  Vagal stimulation
 3 types:  Clinical manifestations may include:
1. First degree  Vertigo
2. Second degree  Weakness
3. Third degree  Irregular pulse
MANAGEMENT:
FIRST DEGREE AV BLOCK  Correction of underlying cause

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  Atropine or temporary pacemaker for  QRS complex is also wide and
symptomatic bradycardia distorted, usually >0.14 second
 Discontinuation of digoxin if appropriate  Premature QRS complexes occurring
singly, in pairs, or in threes
THIRD DEGREE AV BLOCK (COMPLETE CLINICAL MANIFESTATIONS:
HEART BLOCK)  Palpitations
 Atrial rhythm regular  Weakness
 Ventricular rhythm regular and rate  Lightheadedness but t is most of the
slower than atrial rate time asymptomatic
 No relation between P waves and QRS
complexes MANAGEMENT:
 NO constant PR interval  Assessment of the cause and treat as
 QRS interval normal or wide and bizarre indicated
 Treatment is indicated if the client has
underlying disease because PVCs may
precipitate ventricular tachycardia or
fibrillation
 Assess for life threatening PVCs
CAUSES:  Administer antiarrhythmic medication
 Congenital abnormalities as prescribed (verapamil, diltiazem)
 Rheumatic fever
 Hypoxia
 MI VENTRICULAR TACHYCARDIA
 Lev’s disease/Lenegre’s disease =  Three or more consecutive PVCs.
acquired complete heart block due to  It is considered medical emergency
idiopathic fibrosis and calcification of because cardiac output cannot be
the electrical conduction system of maintained because of decreased
the heart; common in elderly diastolic filling (preload)
 Digoxin toxicity  Rate: 100-250 bpm
 Manifestations: hypotension, angina, HF  P wave is blurred in the QRS complex
but the QRS complex has no associate
MANAGEMENT: with P wave
 Atropine, epinephrine, dopamine for  PR interval is not present
bradycardia  QRS complex is wide and bizarre;
 Installation of pacemaker may also be T wave is in the opposite direction
considered  Rhythm is usually regular
PREMATURE VENTRICULAR
CONTRACTIONS
 Early or premature ventricular
contractions are caused by increased
automaticity of ventricular muscle cells.
 It is usually not considered harmful
but are of concern if more than six
occur in 1 minute, if they occur in
pairs or triplet, if they are multifocal,
or if they occur or near a T wave
 Atrial rhythm is regular
 Ventricular rhythm is irregular
 QRS complex premature, usually
followed by a complete compensatory
pause

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  May start and stop suddenly  It is performed on patients that still
have a pulse but are
hemodynamically unstable.
 It is used to treat both hemodynamically
unstable ventricular and supraventricular
rhythms

CARDIOVERSON VS. DEFIBRILLATION

Elective planned Emergency life -
CLINICAL MANIFESTATIONS: procedure saving procedure
 Lightheadedness Synchronized shock Un-synchronized
 Weakness shock
 Dyspnea Low energy shock High energy shock
 Unconsciousness There can be some No delay, immediate
delay
CAUSES: Anticoagulation No anticoagulation
needed needed
 MI
Less damage to More damage to
 Aneurysm
myocardium myocardium
 CAD Used in most of the Used in VT/VF
 Rheumatic heart diseases arrhythmias except
 Mitral valves prolapse VT/VF
 Hypokalemia
 Hyperkalemia
 Pulmonary metabolism VENTRICULAR FIBRILLATION
 Anxiety may also cause VT  It is rapid, ineffective quivering of
ventricles that may be rapidly fatal
*Once you see Ventricular Tachycardia,  Rate is rapid and uncoordinated, with
check the PULSE immediately ineffective contractions
 Rhythm is chaotic
MANAGEMENT:  QRS complexes are wide and irregular
For pulseless VT:  P wave & PR interval is not seen
 Initiate cardiopulmonary resuscitation
 Follow ACLS protocol for defibrillation
 ET intubation
 Administration of epinephrine or
vasopressin
With pulse VT:
 If hemodynamically stable, follow CLINICAL MANIFESTATIONS:
ACLS protocol for administration of  Loss of consciousness
amiodarone  Pulselessness
 If ineffective, initiate synchronized  Loss of blood pressure
cardioversion  Cessation of respirations
 Possible seizures and sudden death
SYNCHRONIZED CARDIOVERSION
 It is a procedure similar to electrical CAUSES:
defibrillation in that a transthoracic  Myocardial ischemia or infarction
electrical current is applied to the  It may result from untreated ventricular
anterior chest to terminate a life- tachycardia, electrolyte imbalances,
threatening or unstable tachycardic digoxin or quinide toxicity, hypothermia
arrhythmia.
MANAGEMENT:

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  Start CPR in pulseless  If a medication is causing the condition,
 Follow ACLS protocol for defibrillation a doctor may recommend an alternative
 ET intubation treatment
 Administration of epinephrine or  For people with a congenital form of
vasopressin LQTS, treatment includes:
 Beta-adrenergic antagonists
(propranolol)
Torsade de Pointes  Beta-blockers
 French for “twisting of points”  Pacemakers
 When the heart’s two lower chambers  Implantable cardioverter defibrillator
or ventricles, beat faster than the in rare cases
upper chambers (atria)
 Most cases resolve on their own without
treatment. However, it can develop into
ventricular fibrillation, which can lead to
cardiac arrest and may even be fatal

CLINICAL MANIFESTATIONS:
 Heart palpitations
 Dizziness
 Nausea
 Cold sweats
 Chest pain
 Shortness of breath
 Rapid pulse
 Low blood pressure

CAUSES:
 It is usually a complication of Long QT
Syndrome, which can be drug-induced
or congenital, meaning the person is
born with it

MANAGEMENT:
 The first things a doctor will do after
diagnosing torsades de pointes is to
check the person’s calcium,
magnesium, and potassium levels
 If the levels of any are low, then
supplements will be given
 Magnesium can also be an effective
treatment in people who already have
normal magnesium levels
 If torsades de pointes is found to have
an underlying medical cause, this will be
treated first.