Dysrhythmias (arrhythmias):
Most common complication post MI
Disturbance of rate, rhythm or conduction of electrical impulses within the heart
Prompt assessment of dysrhythmias and the patient’s response to the rhythm is critical
Classifications of arrhythmias:
Sites:
o SA node (sinus rhythm)
o Atrial (atrial rhythms)
o AV node (nodal or junctional rhythm)
o Ventricles (ventricular rhythms)
Type:
o Flutter
o Fibrillation
o Block
Prognosis:
Minor – no immediate concern
Major – reduction of efficiency of the heart
Lethal – requires immediate treatment or resuscitation, death producing
Dysrhythmias symptoms:
Some dysrhythmias no symptoms
Some dysrhythmias life threatening (sudden collapse, death)
Typical symptoms:
o Dizziness
o Weakness
o Decreased exercise tolerance
o Shortness of breath
o Fainting
o Palpitations or “heart has skipped a beat”
Common causes of dysrhythmias:
Cardiac causes
o Accessory pathways, conduction defects
o Cardiomyopathy, heart failure
o Myocardial cell degeneration (ischemia, injury, infarction)
o Valve disease
Other conditions
o Acid-base imbalances
o Electrolyte disturbances
o Caffeine, tobacco, alcohol
o Drug effects (antidysrhythmia, stimulants, beta-blockers)
o Emotional crisis, herbal supplements, connective tissue disorders
o Hypoxia, shock
o Metabolic conditions (thyroid dysfunction)
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2
o Near-drowning, poisoning
Sinus Bradycardia
Identifying EKG characteristics:
▪ Rate: < 60 beats a minute
▪ Rhythm: Regular
▪ P waves: Normal and precede each QRS
▪ PR interval: Normal range (0.12 – 0.20)
▪ QRS: Normal (< 0.12)
Etiology:
▪ May be normal in physically conditioned adults and during sleep
▪ Increased vagal tone (Valsalva maneuver, endotracheal suctioning, vomiting, gagging)
▪ Medication effect (narcotics, cardiac glycoside, beta blockers, calcium channel blockers)
▪ Pathology (hypothermia, hypothyroidism, increased intracranial pressure, obstructive jaundice,
MI--- inferior wall MI involves right coronary artery). Ischemia of sinus node slows rate.
Clinical significance:
▪ May be asymptomatic.
▪ Symptoms are associated with decreased cardiac output:
o Hypotension, dizziness, syncope
o Pale, cool skin
o Weakness
o Confusion or disorientation
o Shortness of breath
o Angina
o Decreased urinary output
Treatment:
▪ Treat only is symptomatic
▪ Atropine IVP (0.5 – 1 mg)
▪ If due to medication discontinue or reduce dose
▪ Pacemaker may be required
Nursing implications:
▪ Assess for signs and symptoms of decreased cardiac output
▪ Observe for premature ventricular contractions (PVCs) or other ectopic beats
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