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CARDIAC ARRYTHMIAS
•Explanations patient and family
•Reassurance patients and family
•Comfort ,leads restricting
•Limited mobility, R.I.B
•Holters( ambulation possible)
ECG
Calculating heart rate regular rythm
HR=1500/no: small squares R to R
NORMAL SINUS RHYTHM
•P wave upright and rounded•PR interval .12-.20 seconds•P:QRS•QRS .12 seconds•60 -100 beats per minute•Regular rate•T wave
Reasons for arrythmias
•Myocardial ischemia•Electrolyte imbalance•Acidosis•Hypothermia•Drug toxicity
TREATMENT
•Asymptomatic , no treatment•Symptomatic, I.V Atropine 0.5mg-1mg till
3mgs•Pacemaker
TREATMENT
–Oxygen, monitor observation
–Physiological sinus tacycardia- treat cause–Anxiety,exercise,fever,pain,and
drugs(benzodiazapines)–Shock- treat shock.
TREATMENT
•Usually hemodynamically stable no treatment required
Premature atrial contraction
TREATMENT
•Correct electrolytes•Treat ischemia•Cut down on caffeine, alchol,nicotine and
stress
TREATMENT
•Hemodynamically stable with AF less than 48 hours,slow ventricular rate with beta or calcium
channel blockers and then pharmicological cardioversion.
•Stable more than 48 hours, slow vent. rate, anti coagulation, then pharmacological or
mechanical cardioversion.
•Unstable immediate cardioversion
TREATMENT
•See atrial flutter
TREATMENT
–Cause- acute ischemia, myocarditis cardiomyopathy ,mitral valve prolapse,hypoxia,electrolyte imbalance
mg,k,ca–Rx–Oxygen–Monitor observation–I.V–Treat ischemia,and suppress cardiac irritability-
procainamide–Non cardiac origin-treat cause e.g hypoxia and
electrolytes
TREATMENT
•VT with pulse-antiarrythmics
•VT with pulse –unstable-syn
cardioversion•VT without pulse
defibrilation
TREATMENT
•CPR•Intubation•defibilation
asystole
•Rate- none
•P wave- may be but with no ventricular response
•QRS none•Rythym none
TREATMENT
•ABC•CPR•OXYGEN•INTUBATION•I.V•CONSIDER CAUSEAND TREAT
ACCORDINGLY•EXTERNAL PACEMAKER•ADRENALINE•ATROPINE
TREATMENT
•Monitor observation
•Treat underlying cause
•Causes: myodardial ischemia
•Drugs- beta blockers ca channel blockers
digoxin
TREATMENT
•Monitor observation
•pacemaker
Second degree AV blockMobitz 2
TREATMENT
•Monitor observation
•Pacemakers•I.V dopamine or
adrenaline
TREATMENT
•Transcutaneous pacemaker
•I.V dopamine or adrenaline
•Permanent pacemaker
12 LEAD ECG INTERPRETATION
Leads
•Leads II, II, AVF inferior wall•Leads I, AVL, V5.V6 lateral wall•Leads V1, V2, V3, V4 anterior wall
WALLS OF THE HEART
MYOCARDIAL INJURY
ST DEPRESSION
Q WAVE–MYOCARDIAL INFARCTION
Q WAVE STAGES
Pathological Q waves
•Insignificant q wave leads I,II,V5,V6
•Significant Q wave 1mm wide or one third of height of QRS complex.
ST elevation
T wave
T wave
INFARCTION
INJURY
ISCHEMIA
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