De Jesus, Wynton

What is Dysrhythmia?
Disorders of the formation or conduction (or
both) of the electrical impulse within the
heart
Can be diagnosed through ECG
They are named according to the site of origin
of the impulse and the mechanism of
formation
A patient with dysrhythmia is assessed for the occurence of the
following:

Pale and cool skin
Signs of fluid retention (neck vein distention)
Decreased cardiac output
Syncope
Lightheadedness
Chest discomfort
Palpitations
History of heart disease and COPD
Medications prescribed (OTC drugs or herbal) and medication route
History of anemia


How to Identify Cardiac Rhythm
Sites of Origin
Sinus (SA) node
Atria
Atrioventricular (AV)
node
Ventricles
Mechanisms of
Formation
Normal (idio) rhythm
Bradycardia
Tachycardia
Dysrhythmia
Flutter
Fibrilation
Premature Complexes
Conduction blocks
NORMAL ELECTRICAL CONDUCTION
Sinus Node Dysrhythmia
* Sinus Bradycardia occurs when the sinus node creates an impulse at a slower
than normal rate (less than 60bpm in adults)
* Sinus Tachycardia occurs when the sinus node creates an impulse at a faster than
normal rate (greater than 100 but less than 120 bpm)
* Sinus Arrthymia occurs when the sinus node creates an impulse at an irregular
rhythm
Atrial Dysrhythmia
* Premature Atrial Complex occurs when an electrical impulse starts in the atrium
before the next normal impulse of the sinus node
* Atrial Fibrillation uncoordinated atrial electrical activation that causes a rapid,
disorganized and uncoordinated twitching of atrial musculature
Junctional Dysrhythmia
* Premature Junctional Complex an impulse that starts in the AV nodal area before
the next normal sinus impulse reaches the AV node
* Junctional Rhythm (Idionodal Rhythm) occurs when the AV node, instead of the
sinus node, becomes the pacemaker of the heart (40 to 60 bpm)
* Nonparoxysmal Junctional Tachycardia caused by enhanced automaticity in the
junctional area, results in a rhythm similar to junctional rhythm (70 to 120 bpm)
* Atrioventricular Nodal Reentry Tachycardia occurs when an impulse is conducted
to an area in the AV node causing an impulse to be rerouted back back in the same
area at a very fast rate

Ventricular Dysrhythmia
* Premature Ventricular Complex an impulse that starts in a ventricle and is
conducted through the ventricles before the next normal sinus impulse
* Ventricular Tachycardia it is a three or more PVCs in a row, occurs at a rate
exceeding 100 bpm
* Ventricular Fibrillation a rapid, disorganized ventricular rhythm that causes
ineffective quivering of the ventricles
* Idioventricular Rhythm usually occurs when the sinus node fails to create an
impulse
* Ventricular Asystole it is an absent QRS complexes confirmed in two different
leads
* Conduction Abnormalities occurs when the condcution of the impulse through
the AV nodal is decreased or stopped
* First-Degree AV Block occurs when all the atrial impulses are conducted
through the Av node at a slower rate
* Second-Degree AV Block occurs when there is a repeating pattern in which all
but one of a series of atrial impulses are conducted through the AV node
* Third-Degree AV Block occurs when no atrial impulse is conducted through the
AV node
Management
Electrical Cardioversion
Antiarrythmic Medications (beta-blockers-propranolol,
calcium channel blockers-verapamil)
Defibrillation
Use of Pacemaker
Implantable Cardioverter Defibrillator
Electrophysiologic Studies
Cardiac Conduction Sugery (Maze Procedure, Catheter
Ablation Therapy)

Nursing management
Minimize anxiety
Prevent infection (due to implantable devices)
Promote effective coping