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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 druginduced)
• 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