Delos Reyes, Maria Margueretti S.

BSN III - D3

I. SINUS DYSRHYTHMIAS DESCRIPTION MANAGEMENT
Sinus Bradycardia Occurs when the sinus node creates
an impulse at a slower-than-normal
rate. A heart rate less than 60 beats
per minute.
Atropine, 0.5 to 1.0 mg given
rapidly as an intravenous (IV)
bolus.
Pacemaker, if damage to the
hearts electrical system causes
your heart to beat too slowly.
Discontinuation of the drug if
sinus bradycardia is due to
therapeutic use of digitalis, beta-
blockers, or calcium channel
blockers.
Sinus Tachycardia Occurs when the sinus node creates
an impulse at a faster-than-normal
rate. A heart rate of more than 100
beats per minute (BPM) in adults.
Calcium channel blockers and
beta-blockers
Carotid sinus massage
Pressing gently on the eyeballs
with eyes closed.
Valsalva maneuver: holding your
nostrils closed while blowing air
through your nose.
Dive reflex: the body's response
to sudden immersion in water,
especially cold water.
Sedation
Cutting down on coffee
Cutting down on alcohol
Quitting tobacco use
Getting more rest
Sinus Arrhythmias Occurs when the sinus node creates
an impulse at an irregular rhythm;
the rate usually increases with
inspiration and decreases with
expiration.
Sinus arrhythmia does not cause
any significant hemodynamic
effect and usually is not treated.
II. ATRIAL DYSRHYTHMIAS DESCRIPTION MANAGEMENT
Atrial Flutter Occurs in the atrium and creates
impulses at an atrial rate between
250 and 400 times per minute.
Because the atrial rate is faster than
the AV node can conduct, not all
atrial impulses are conducted into
the ventricle, causing a therapeutic
block at the AV node.
If the patient is stable, diltiazem,
verapamil, beta-blockers, or
digitalis may be administered
intravenously to slow the
ventricular rate.
Flecainide, ibutilide, dofetilide,
quinidine, disopyramide, or
Amiodarone may be given to
promote conversion to sinus
rhythm
Electrical cardioversion
Atrial Fibrillation A rapid, disorganized, and
uncoordinated twitching of atrial
musculature. Occur for a very short
time (paroxysmal), or it may be
chronic. Usually associated with
advanced age, valvular heart disease,
coronary artery disease,
hypertension, cardiomyopathy,
hyperthyroidism, pulmonary disease,
acute moderate to heavy ingestion of
alcohol (holiday heart syndrome),
or the aftermath of open heart
surgery.
Cardioversion
Quinidine, ibutilide, flecainide,
dofetilide, propafenone,
procainamide
(Pronestyl), disopyramide, or
amiodarone
Intravenous adenosine
Digoxin
Pacemaker implantation
III. CONDUCTION DISTURBANCES DESCRIPTION MANAGEMENT
First-Degree Atrioventricular Block Occurs when all the atrial impulses
are conducted through the AV node
into the ventricles at a rate slower
than normal.
Discontinue medications with
potential for AV block
Admission may be indicated for
associated conditions
Pacemaker
Second-Degree Atrioventricular Block,
Type I

Occurs when all but one of the atrial
impulses are conducted through the
AV node into the ventricles. Each
atrial impulse takes a longer time for
conduction than the one before, until
one impulse is fully blocked. Because
the AV node is not depolarized by the
blocked atrial impulse, the AV node
has time to fully repolarize, so that
the next atrial impulse can be
conducted within the shortest
amount of time.
Asymptomatic patient does not
require any specific therapy in
the prehospital setting.
If the patient is symptomatic,
standard advanced cardiac life
support (ACLS)
No specific therapy is required in
the emergency department (ED)
Anti-ischemic regimen
Discontinuing digoxin, beta-
blockers, or calcium channel
blockers medications
Second-Degree Atrioventricular Block,
Type II

Occurs when only some of the atrial
impulses are conducted through the
AV node into the ventricles.
Permanent pacing
Urgent cardiology consultation
Apply transcutaneous pacing
pads
Third-Degree Atrioventricular Block

Occurs when no atrial impulse is
conducted through the AV node into
the ventricles. In third-degree heart
block, two impulses stimulate the
heart: one stimulates the ventricles
represented by the QRS complex, and
one stimulates the atria represented
by the P wave. P waves may be seen,
but the atrial electrical activity is not
conducted down into the ventricles
to cause the QRS complex, the
ventricular electrical activity. This is
Withdrawal of any potentially
aggravating or causative
medications
Pacemaker
Administration of IV fluids,
calcium, glucagons, vasopressors,
and high-dose insulin
Delos Reyes, Maria Margueretti S.
BSN III - D3

called AV dissociation.
B. Bundle Branch Blocks Occurs if there is a blockage in one of
these branches, the electrical impulse
must travel to the ventricle by a
different route. When this happens,
the rate and rhythm of your
heartbeat are not affected, but the
impulse is slowed. Your ventricle will
still contract, but it will take longer
because of the slowed impulse. This
slowed impulse causes one ventricle
to contract a fraction of a second
slower than the other.
Cardiac resynchronization
treatment (CRT)
Pacemaker
In most cases, bundle branch
block does not need
treatment.
IV. VENTRICULAR DYSRHYTHMIAS DESCRIPTION MANAGEMENT
A. Premature Ventricular Contractions

An impulse that starts in a ventricle
and is conducted through the
ventricles before the next normal
sinus impulse. PVCs can occur in
healthy people, especially with the
use of caffeine, nicotine, or alcohol.
Perform telemetry
Secure intravenous (IV) access
Administer oxygen
Complex ectopy in the setting of
myocardial ischemia or causing
hemodynamic instability should
be suppressed
Use lidocaine for patients with
myocardial ischemia.
a) Unifocal

b) Multifocal


c) Bigeminy

Trigeminy


d) Coupled PVC / Triplet
more frequent than 6 per minute

having different shapes, occur two
in a row (pair)

is a rhythm in which every other
complex is a PVC.
is a rhythm in which every third
complex is a PVC

is a rhythm in which every fourth
complex is a PVC
B. Ventricular Tachycardia

Three or more PVCs in a row,
occurring at a rate exceeding 100
beats per minute. Usually associated
with coronary artery disease and may
precede ventricular fibrillation. VT is
an emergency because the patient is
usually (although not always)
unresponsive and pulseless.
Cardioversion
Antiarrhythmic drugs
Implantable cardioverter-
defibrillator (ICD)
Catheter ablation
C. Ventricular Fibrillation

Rapid but disorganized ventricular
rhythm that causes ineffective
quivering of the ventricles. It may
also result from untreated or
unsuccessfully treated VT.
Defibrillator
CPR
Radiofrequency ablation
Surgical treatment (eg, operable
coronary artery disease)
Implantable cardioverter-
defibrillators (ICDs)

D. Asystole

Commonly called flatline, ventricular
asystole is characterized by absent
QRS complexes, although P waves
may be apparent for a short duration
in two different leads. There is no
heartbeat, no palpable pulse, and no
respiration.
Electrical defibrillation
Calcium chloride
Oxygenation and ventilation via
endotracheal intubation
Cardiopulmonary resuscitation
(CPR)

References:
1995-2014 Healthwise, Incorporated. Healthwise, Healthwise for every health decision, and the Healthwise logo are trademarks of
Healthwise, Incorporated.
Epstein AE, DiMarco JP, Ellenbogen KA, et al. ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities:
a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to
Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices) developed in
collaboration with the American Association for Thoracic Surgery and Society of Thoracic Surgeons. J Am Coll Cardiol. May 27 2008
http://www.heart.org/HEARTORG/Conditions/Arrhythmia/AboutArrhythmia/Tachycardia-Fast-Heart-Rate_UCM_302018_Article.jsp#
Brunner and Suddarths Textbook of Medical-Surgical Nursing, 10
th
edition.