Heart---------Block presentation in detail
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Heart---------Block presentation in detail
- 1. HEART BLOCK OR ATRIO VENTRICULAR BLOCK ANUSIKTA PANDA
- 2. Definition It occur when the conduction of impulses through the AV nodal area is decreased or stopped. Etiology Medications e.g. Digitalis, calcium channel blocker, beta blockers Myocardial ischemia Myocardial infraction Increased vagal tone e.g. suctioning, pressure over eye.
- 3. Classification First Degree Heart Block It occurs when all the atrial impulses are conducted through the AV node into the ventricle at a rate slower than the normal. ECG Characteristics Ventricular and artrial rate QRS Complex: Normal PR Interval more than 0.20 sec. P wave : Normal
- 4. Cont… Second Degree Heart Block It occurs when all but one of the atrial impulses are conducted through the AV node into the ventricle. Each impulse takes a longer time than the previous impulse ECG characteristics Ventricular and atrial rate Rhythm:RR interval gradually shorten QRS Complex: normal/abnormal PR interval: longer with every ECG P wave: Normal P:QRS-3:2,4:3,5:4.
- 5. Cont…. Treatment Inj.Atropine is administered to increase heart rate Temporary pacemaker may be used If patients is asymptomatic monitor the rhythm slowly.
- 6. Third Degree Heart Block It occurs when no atrial impulse is conducted through the AV node into the ventricles. Here 2 impulses stimulate heart, one stimulate the ventricle and other the atria. ECG characteristics Ventricular and atrial rate Rhythm:PP and RR interval are regular but not equal PR interval :irregular P:QRS-P waves are more than QRS complexes.
- 7. Clinical Manifestation Activity Intolerance Weakness Hypotension Dizziness Shortness of Breath Dyspnea Palpitation Altered mental status Anxiety Respiratory Insufficiency Syncope Seizures Pallor Decreased urine output
- 8. Diagnostic Evaluation History Collection Physical Examination 12 lead ECG Serum Electrolyte level Exercise stress testing Holter monitoring Atrial Electrogram (It is similar to an ECG but is used to monitor atrial rhythm)
- 9. Management Medical Management Defibrillation and Cardioversion CPR Automatic External Defrillator Cardiac Pacing Antirhythmic Drugs Class-1 Sodium channel blocker e.g. disopramide Class-2 Beta adrenergic blocker e.g. Metoprolol Class-3 Potassium channel Blocker e.g. Verapamil Oxygen Administration Implantable cardioverter defibrillator Anti coagulation Reduce intake of caffeine, low fat and cholesterol
- 10. Surgical Management Left Ventricular Infarctectomy Myocardial Revascularization Encircling Ventriculotomy
- 11. Nursing Management Monitor the pt heart rhythm Properly Monitor CO Document dysrhythmias in ECG Monitor the patients lab value Administer anti dysrhythmias agents Administer Oxygen Minimize the anxiety
- 12. DYSARRHYTHMIAS It is the disorder of the formation or conduction of electrical impulses within the heart altering the heart rate ,rhythm or both potentially causing altered blood flow.
- 13. Etiology Cardiac Condition Cardiomyopathy Heart Failure Myocardial cell degeneration Myocardial infarction Valve Disease Other Condition Acid Base Imbalance Alcohol Caffeine and tobacco intake Connective tissue disorder Drugs toxicity Electric shock Electrolyte Imbalance Hypoxia Shock Metabolic Disorders Poisoning
- 14. Pathophysiology Cardiac cycle depends on a balance of basic regulatory substance (Na,K,Ca and catecholamine) Imbalance in the regulator can cause disturb pacing function, conduction or myocardial contractility Dysarrythmias
- 15. Classification They are classified as the following; Sinus node Atrial node Normal Junctional Ventricular dysarrhythmias
- 16. Sinus Node Arrhythmias Sinus Bradycardia It occures when the sinus node creates an impulse at a slower than normal rate Causes Low metabolic demand Vagal Stimulation Increased ICP Myocardial infarction
- 17. Cont… ECG Characteristics Ventricular and atrial rate less than 60. Rhythm: Normal P wave: Normal and Consistent P:QRS ratio-1:1 Treatment Inj.Atropine 0.5-1.0 mg/iv IV catecholamine Transcutaneous Pacing
- 18. Cont… Sinus Tachycardia It occures when the sinus node creates an impulse at a faster than normal rate. Causes Acute blood loss CCF Pain Hyper metabolic State Fever Anxiety
- 19. Cont… ECG Characteristics Ventricular and Atrial rate more than 100. Rhythm: Normal P Wave: Normal and consistent P:QRS ratio-1:1
- 20. Cont…. Sinus Arrhythmias It occures when the sinus node create an impulse at a irregular rhythm, rate usually increases with inspiration and decrease with expiration ECG Characteristics Ventricular and atrial rate :60-100 Rhythm Irregular QRS Wave Abnormal P Wave; Normal P:QRS ratio-1:1
- 21. Atrial Dysarrythmias 1. Pre Mature Atrial Complex It occurs when an electrical impulse starts in the atrium before the normal impulse of the sinus node. Causes Intake of Caffeine Alcohol Nicotine Anxiety Infarction Note: Treatment is not usually required
- 22. Cont…. 2.Atrial flutter It occur when the atrium creates an impulse at a rate of 250- 400/min. Atrial rate is faster than AV node can conduct not all atrial impulse enter ventricle causing a therapeutic AV block. Causes Hypotension Cardiomyopathy Heavy alcoholism Open Heart surgery Management Cardio version Ad.B-blocker and Digitalis
- 23. Cont… 3.Atrial Fibrillation It causes a rapid,disorganised and uncontrolled twitching of the atrial musculature. Causes Same as Atrial Flutter Treatment Cardio version Medication: Amiodarone Calcium Channel Blockers Warfarin Digoxin to improve cardiac function Pacemaker
- 24. Junctional Dysarrythmias 1.Premature Junctional Complexes It is an impulse that starts in the AV nodal area before the next normal sinus impulse reaches AV node. 2.Junctional Rhythm It occurs when the AV node instead of the SA node becomes the pacemaker of the Heart Treatment: Emergency Pacing 3.Atrioventricular Nodal reentry tachycardia It occurs when an impulse is conducted to an area in the AV node that causes the impulse to be re routed back into the same area over and over again at a faster rate.
- 25. Ventricular Dysarrhythmias Premature Ventricular Complex It is an impulse that start in the ventricle and is conducted through the ventricle before the next normal sinus impulse Ventricular Tachycardia It is defined as more than 3 PVC in a row. It is treated with immediate defibrillation Ventricular Fibrillation It is rapid but disorganized ventricular rhythm that causes ineffective waves from ventricle. No atrial activity seen in ECG.
- 26. Cont… Treatment CPR and emergency services Transcutaneous pacing