By

Group 6
HINA BABAR, MEHEK SAJJAD, RAHEELA
BANO, SHAHEEN AKHTER, Zarish Fazil

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 By the end of this presentation learners will be able
to know about
 Conduction system
 Normal ECG rhythem
 Cardiac Arrhythmias
 Management of Arrhythmias
 Heart block

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 P wave should be positive in lead two/ three/AVF ( limbs
leads) and negative in AVR
 Heart rate should be between 60bpm to 80bpm
 QRS complex should be narrow, measures 0.06 to
0.12 seconds
 Every p should followed by QRS complex
 P-P R-R P-R should b constant
 Normal values for waves and intervals are as
follows
 RR interval: 0.6-1.2 seconds.
 P wave: 80 milliseconds.
 PR interval: 120-200 milliseconds.

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 An abnormality of the cardiac rhythm is called
cardiac arrhythmia.
 Arrhythmias may cause sudden death,
syncope, heart failure, dizziness, palpitations
or no symptoms at all.
 There are two main types of arrhythmia:
 bradycardia: the heart rate is slow (< 60
bpm).
 tachycardia: the heart rate is fast (> 100
bpm).

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1. ATRIAL FLUTTER
2. ATRIAL FIBRILLATION

3. JUNCTIONAL RHYTHM
4. VENTRICULAR TACHYCARDIAS
5. VENTRICULAR FIBRILLATION
6. VENTRICULAR ASYSTOLE
7. FIRST DEGREE ATRIOVENTRICULAR BLOCK TYPE
1
8. SECOND DEGREE ATRIOVENTRICULAR BLOCK
TYPE 2
9. THIRD DEGREE ATRIOVENTRICULAR BLOCK TYPE

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 The two
 "shockable" rhythms are
 Ventricular fibrillation and
 Pulseless ventricular tachycardia
 while the two
 "non–shockable" rhythms are
 Asystole and
 Pulseless electrical activity

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 Atrial flutter is a common abnormal heart
rhythm that starts in the atrial chambers of the
heart. When it first occurs, it is usually associated
with a fast heart rate and is classified as a type of
supraventricular tachycardia
 Occurs in atrium and creates impulses at regular
rate between 250 and 400 times per minute.
 Because the atrial rate is faster than the AV node
can conduct, all atrial impulses are not
conducted into the ventricle, causing a
therapeutic block at AV node.

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Ventricula Ventricula QRS P wave PR interval P:QRS
r and r and ratio
Atrial rate atrial
rhythm
Atrial rate Atrial Usually Saw- Multiple F 2:1
range rhythm is normal, toothed waves 3:1or may
between regular may be shape; make it be
250- ventricle abnormal These difficult to 4:1
400bpm rhythm is or may be waves are determine
Ventricula usually absent referred PR
r rate regular to as F intervals.
ranges but may waves
between change in
75- AV
150bpm conductio
n

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 Atrial fibrillation causes a rapid, disorganized
, and uncoordinated twitching of atrial
musculature.
 Can increase your risk of strokes, heart
failure and other heart-related complications.
 Can be transient, starting and stopping
suddenly and occurring for short time.

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Ventricula Ventricula QRS P wave PR interval P:QRS
r and r and ratio
Atrial rate atrial
rhythm
Atrial rate Highly Usually No Can not Many:1
300 to irregular normal, discernibl be
600bpm may be e P wave. measured
Ventricula abnormal Irregular
r rate undulatin
ranges g waves
between are seen
120- and are
200bpm referred
to as
fibrillatory
or F waves

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 Commonly called flat line ventricular asystole
is characterized by ABSCENT QRS COMPLEX
confirmed in two different leads
 Although P waves may be apparent for short
duration.
 There is no heart beat, no palpable pulse, and
no respiration.

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 Junctional rhythm or idioventricular rhythm
occur when the AV node, instead of the sinus
node becomes the pacemaker of the heart.

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Ventricula Ventricula QRS P wave PR interval P:QRS
r and r and ratio
Atrial rate atrial
rhythm

Atrial and Regular Usually May be If the P 1:1 or 0:1

ventricular normal, absent, wave is in
rate 40- may be after the front of
60 bpm if abnormal QRS QRS, the
P waves complex, PR interval
are or before is less
discernibl QRS; may than 0.12
e be seconds
inverted
specially
in lead 2

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 No pharmacologic therapy is needed for
asymptomatic, otherwise healthy individuals
with junctional rhythms that result from
increased vagal tone. In patients with
complete AV block, high-grade AV block, or
symptomatic sick sinus syndrome (ie, sinus
node dysfunction), a permanent pacemaker
may be needed.

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 If P wave can not be identified, the rhythm
may be called supraventricular tachycardia
SVT, or proximal supraventricular tachycardia
(PSVT), if it had an abrupt onset, until the
underlying rhythm and resulting diagnosis is
determined.
 SVT and PSVT indicate only that the rhythm is
not ventricular tachycardia (VT) . SVT could
be atrial fibrillation, atrial flutter, or
atrioventricular reentry tachycardia among
others.

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 VT is defined as three or more PVCs in a row,
occurring at a rate exceeding 100 bpm.
 Usually associated with coronary artery
disease, and may precede ventricular
fibrillations.
 Ventricular tachycardia is SHOCKABLE
RHYTHM if pulseless

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Ventricula Ventricula QRS P wave PR interval P:QRS
r and r and ratio
Atrial rate atrial
rhythm
Ventricula Usually Duration Difficult to If the P Difficult to
r rate is regular is 0.12 detect. wave are determine
100- seconds seen If P waves
200bpm or longer; interval is are
Atrial rate shape is very apparent,
depends more irregular there are
on the bizarre usually
underlying and more QRS
rhythm. abnormal than P
wave

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 Ventricular fibrillation is a rapid, disorganized
ventricular rhythm that causes ineffective
quivering of the ventricle.
 No atrial activity is seen on ECG.
 This arrhythmia is always characterized by
the absence of an audible heart beat, a
palpable pulse, and respiration, because of
no coordinated cardiac activity.
 ITS SHOCKABLE RHYTHM

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Ventricular and Atrial Ventricular and atrial QRS
rate rhythm

Ventricular rate is Extremely irregular Irregular waves, without

greater than 300bpm without any specific recognizable QRS
pattern complex

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 Treatment for VF
 starts with early and effective CPR. Keeping
the brain, heart and other vital organs
perfused is very important in an arrest.
 Once the rhythm is identified as ventricular
fibrillation, a shock should be delivered
immediately. After the shock is delivered,
begin CPR again for two minutes.

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 Commonly called flat line ventricular asystole
is characterized by ABSCENT QRS COMPLEX
confirmed in two different leads
 Although P waves may be apparent for short
duration.
 There is no heart beat, no palpable pulse, and
no respiration.

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 Ventricular asystole is treated with high quality CPR with
minimum interruption
 After the initiation of CPR, intubation and establishment of
IV access are the next recommended actions with no or
minimum interruptions in chest compressions.
 After 2 minutes or five cycles of CPR, a bolus of IV
epinephrine is administered and repeated at 3 to 5
minutes intervals.
 One dose of vasopressin may be administered for the first
or second does of epinephrine.
 1 mg bolus of IV atropine
 If patient still not respond resuscitation efforts are ended
 The code is called

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 First degree AV block occurs when all the atrial
impulses are conducted through the AV node
into the Ventricles at a rate slower than normal.
 Second degree AV block occur when there is a
repeating pattern in which a series of atrial
impulses are conducted through the AV node
into the ventricles (eg every 4 of 5 impulses are
conducted)
 Each atrial impulse takes a longer time for the
conduction than before. Until one impulse is fully
blocked

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 First degree AV block occurs when all the
atrial impulses are conducted through the AV
node into the Ventricles at a rate slower than
normal.

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 Second degree AV block occur when there is a
repeating pattern in which a series of atrial
impulses are conducted through the AV node
into the ventricles (eg every 4 of 5 impulses
are conducted)
 Each atrial impulse takes a longer time for the
conduction than before. Until one impulse is
fully blocked

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 Occurs when only some of the atrial impulses are
conducted through the av node into the ventricles
 Ventricular and atrial rate: depends on underlying
rhythm.
 Ventricular & atrial rhythm: PP interval is regular if the
patient has normal underlying sinus rhythm.PR
interval is usually regular but depends on P:QRS
 QRS shape and duration: usually abnormal, but may
be normal
 P wave: In front of QRS complex
 PR interval: constant for those P waves just before
QRS complexes.
 P:QRS; 2:1, 3:1, 4:1, and so forth

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 Occurs when the atrial impulse is conducted
through the AV node into the ventricles.
 IN 3rd degree AV block, two impulses stimulate
the heart: one stimulates ventricles represented
by QRS complex, and the other stimulates the
atria represented by the P wave.
 P wave may be seen, but atrial electrical activity is
not conducted down into ventricles to cause the
QRS complex.this is called AV dissociation.

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 Ventricular and atrial rate: depends on escape
and underlying atrial rhythm.
 Ventricular & atrial rhythm: PP interval is regular,
RR interval is also regular but both are not equal
to each other.
 QRS shape and duration: depends on escape
rhythm: in junctional escape QRS are normal, in
ventricular escape QRS are abnormal.
 P wave: depends on underlying rhythm.
 PR interval: very irregular.
 P:QRS; more P waves then QRS complexes

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 For second- and third-degree heart block,
you may get a small device called
a pacemaker in your chest. This is considered
“minor” surgery and you’ll be sedated for it.
Like a backup electrical system, it reminds
the heart to beat at a normal rate if it slows
or stops.

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 O2 inhalation
 Maintain i/v line
 Continuously cardiac monitoring
 Regularly evaluate the patients blood pressure, pulse
rate, and rhythm, and rate and depth of respiration
 Ask the patient about episodes of lightheadedness,
dizziness, or fainting.
 Obtain 12 lead ECG to track dysrhythmias, and also to
see results of antiarrhythmic medication.

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 Assess for the beneficial and adverse effects of each
medication
 Nurse may also administer a 6 minutes walk test
 Ask patient if any medication is being taken prior,
which can cause dysrhythmia
 eg digoxin
 Preparedness of equipment for invasive procedure
 Access patient for dizziness ,chest pain, sweating any
other symptoms

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 DECREASED CARDIAC OUTPUT
 ANXIETY RELATED TO FEAR OF UNKNOWN
OR DEATH
 DEFICIT KNOWLEDGE ABOUT DYSRHYTHMIAS
AND ITS TREATMENT

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 Burnner & Suddarth’s m/s nursing textbook
eleventh edition. Pg 824-840
 Carol Matison Porth, pathophisiological concepts
of altered health. Seventh edition pg 586
 https://medlineplus.gov/arrhythmia.html
 https://www.medicalnewstoday.com/articles/88
87.php
 https://www.heart.org/en/health-
topics/arrhythmia/about-arrhythmia
 https://www.searchnewworld.com/search/search
2.html?partid=imnsknsch&p=heart+block&subid
=62212345

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