1. Arrhythmias

2. Arrhythmia Overview Atrial Arrhythmias Junctional rhythms and Blocks
PAC
Atrial Fib
Junctional rhythms and Blocks
Ventricular arrhythmias
PVC
Ventricular Tachycardia

3. Atrial Arrhythmias

4. Atrial Arrhythmias: Overview
Sinus Arrest
Atrial Tachycardia
Single site ectopic beats
Pre Atrial Contraction (PAC)
Paroxysmal Atrial Tachycardia
Atrial Flutter
Multiple site ectopic beats
Atrial Fibrillation

5. Atrial Arrhythmias are generally NOT immediately life- threatening

6. Sinus Arrest
Hallmarks: Pause, the returning beat is proceeded by a “P” wave.

7. Atrial Ectopic Beats: PAC
Often caused by and irritable focus
Hallmarks: Early Beat, “P” wave may look different, followed by a compensatory pause.

8. Atrial Ectopic Beats: PAT
Hallmarks: Groups of PAC’s then return to normal.

9. Ectopic beats: Atrial Flutter
Hallmarks: Irregular R-R intervals, usually tachycardia, “Saw tooth” P’s in rapid succession

10. Multiple Site Ectopic Beats: Atrial Fibrillation
Hallmarks: Irregular R-R Interval, Usually Tachycardia, indistinguishable (or no) “P’s” present.

11. 9 times out of 10, and irregular and fast rhythm will be atrial fibrillation.

12. Ventricular Arrhythmias

13. Ventricular Arrhythmias: Overview
Ventricular Ectopic Beats
Premature Ventricular Contraction
Ventricular Tachycardia
Ventricular Fibrillation

14. Ventricular Arrhythmias are potentially life- threatening!

15. Single Ventricular Ectopic Beat: Premature Ventricular Contraction (PVC)
Hallmarks: No “P” wave, wide, bizarre QRS. Most often comes early.

16. PVC’s come in a variety of shapes and sizes

17. PVC’s are not immediately life-threatening, but can lead to more serious and deadly rhythms

18. Ventricular Ectopic Beats: Ventricular Tachycardia (V-Tach)
After about 15 seconds of sustained V-Tach, the patient will lose consciousness due to lack of blood flow to the brain. The heart is beating faster than it can refill with blood causing a life-threatening drop in blood pressure.

19. Ventricular Ectopic Beats: Ventricular Fibrillation

20. Death in Minutes
V-Tach and V-Fib must be defibrillated immediately or the patient will die.

21. Junctional Rhythms

22. Junctional Escape Beat
Hallmarks: Long pause, when the beat finally show up, it’s got not “P” wave. The QRS looks normal though.

23. Junctional Rhythms
Hallmarks: Often bradycardic (unless “accelerated junctional”), Exceedingly regular R-R interval, No P waves

24. Blocks: 1st Degree Block
Hallmark: Long PR interval

25. Blocks: 2nd Degree Block type I: Wenckebach or Mobitz I
Hallmarks: P-R gets longer and longer then drops an “R” (non conducted “P”)

26. Blocks: 2nd Degree Block type II: Mobitz II
Hallmarks: P without a QRS (without lengthening)

27. Blocks: 3rd Degree block: Complete Heart block.
Hallmark: “P’s” regular, “R’s” regular, but both ignore the other!

28. Bundle Branch Block ….Have a variety of shapes depending upon:
Whether it is a left or right bundle branch
The lead that you are looking at.
May look like two “R’s” side by side, bunny ears, or just a widened QRS