ELECTROCARDIOGRAPHIC MONITORING Various rhythms and dysrhythmias: Ventricular Fibrillation Ventricular Tachycardia Atrial Fibrillation Atrial Flutter Supraventricular Tachycardia Paroxysmal Supraventricular Tachycardia Sinus Tachycardia Normal Sinus Rhythm Asystole Sinus Bradycardia Junctional rhythm First degree AV block Second degree AV block Type I aka second-degree mobitz and aka wenckebach Second degree AV block type II Third degree AV block or complete heart block PVCs: Unifocal, multi-focal, couplets, bigeminy, trigeminy PACs

Atrial Fibrillation Irregular heart beat The most common cardiac arrhythmia Affects the atria Causes HTN Heart disease Lung disease Excessive alcohol comsumption

Causes Hyperthyroidism CO poisoning Dual chamber pacemakers Friedreich’s ataxia progressive damage to the nervous system

Pathophysiology Absence of P waves Electrical impulses are inundated by chaotic impulses originating in the atria and pulmonary veins thus……… Irregular impulses sent to ventricles creating an irregular pulse

May result in Palpitations Fainting Chest pain CHF Stroke Due to clots forming in the poorly contracted artria forming blood clots

Controlled Uncontrolled

Ventricular Tachycardia Arrhythmia, or irregular type of heartbeat. It causes a rapid heartbeat, usually 150 to 200 beats per minute. It is usually indicative of a serious medical problem which may or may not relate directly to the heart. If untreated, it often progresses to cardiac arrest and death.

Causes Early or late complication after having an MI Cardiomyopathy Heart failure Heart surgery Myocarditis Valvular Heart Disease

Causes Anti-arrhythmic medications Changes in blood chemistry (such as a low potassium level) Changes in pH (acid-base) Lack of enough oxygen

Symptoms Chest discomfort Syncope Light-headedness or dizziness Palpations Shortness of breath

Atrial Flutter Atrial flutter occurs when an abnormal conduction circuit develops inside the right atrium, allowing the atria to beat excessively fast, about 250-300 beats per minute.  These rapid contractions are slowed when they reach the AV node, but are still too fast (typically about 150 beats per minute, or every other atrial beat getting through the AV node to the ventricles).

Causes Atrial flutter may be caused by abnormalities or diseases of the heart itself, by a disease elsewhere in the body that affects the heart, or by consuming substances that change the way electrical impulses are transmitted through the heart. In a few people, no underlying cause is ever found.

Causes Ischemia CAD HTN Cardiomyopathy Abnormalities of the heart valves (especially the mitral valve) An abnormally enlarged chamber of the heart (hypertrophy) After open heart surgery

Diseases elsewhere in the body that affect the heart include the following: Hyperthyroidism PE COPD Substances that may contribute to atrial flutter include the following: Alcohol (wine, beer, or hard liquor) Stimulants such as cocaine, amphetamines, diet pills, cold medicines, even caffeine

Supraventricular Tachycardia Above the ventricles

Causes Atherosclerosis Heart Failure Thyroid disease Chronic lung disease Pneumonia Pulmonary emboli, or blood clots migrating into the lung arteries from elsewhere in the body Pericarditis

Certain drugs and social habits Cocaine abuse Alcohol abuse Smoking Drinking too much caffeine in coffee, tea, or soft drinks Emotional stress Structural abnormalities, such as Wolff Parkinson White syndrome, in which extra electrical tissue sets up abnormal electrical circuits Supraventricular tachycardia may also be a side effect of medications such as digitalis, asthma medications, or cold remedies. In some cases, the cause of supraventricular tachycardia is unknown

Sinus Tachycardia Fast heart beat Commonly asymptomatic

Causes Sinus tachycardia is usually a response to normal physiological situations, such as exercise and an increased sympathetic tone with increased catecholamine release—stress, fright, flight, anger. Other causes include: Fever Anxiety Dehydration Malignant hyperthermia Hypovolemia with hypotension and shock

Causes Hyperthyroidism Mercury poisoning Kawasaki disease Pheochromocytoma Sepsis Pulmonary embolism Acute coronary ischemia and myocardial infarction

Causes Chronic pulmonary disease Hypoxia Intake of stimulants such as caffeine, nicotine, cocaine, or amphetamines Hyperdynamic circulation Electric shock Drug Withdrawal

Causes Anemia Heart Failure

Kawasaki Disease Pheochromocytoma

Sinus Bradycardia heart rhythm that originates from the sinus node and has a rate of under 60 bpm.

Causes Increased vagal tone. Sleep Hypothermia Hypothyroidism Intrinsic disease of the SA Node (Eg. Sick Sinus Syndrome).

Junctional Rhythm Impulse generated at the AV node but does not happen by the normal pathway and instead is due to retrograde conduction (conduction comes from the ventricles or from the AV node into and through the atria) P wave is absent or inverted

Causes Sick sinus syndrome (including drug-induced) Digoxin toxicity acute inferior infarction Acutely after cardiac surgery Acute inflammatory processes

Heart Blocks

First Degree Heart Block

Second Degree Heart Block Type I

Second Degree Heart Block Type II

Third Degree or Complete Heart Block

Premature Ventricular Contractions (PVC) Impulse generated in the ventricle

Causes Premature ventricular contraction can occur in a healthy person of any age, but becomes more frequent in the elderly, and is more commonly found in men. PVC frequently occurs spontaneously with no cause.

Possible causes:

Bigeminy

Trigeminy

Couplets

Triplet

Unifocal

R-On-T

PACs Ectopic beats within the atria Benign Causes unknown

PAC