Diagnosis
• ECG
• Laboratory testing
• Holter & event monitoring
• Loop recording
Key nursing actions
• Assess the patient for rhythm disturbances.
• Watch for hypoperfusion.
• When life-threatening arrhythmias develop, rapidly assess respirations, pulse rate, & consciousness
• Monitor for predisposing factors & signs of drug toxicity.
• If the patient has a permanent pacemaker, warn him about environmental hazards.
Type of cardiac arrhythmias
ECG characteristics:
Sinus tachycardia
• Atrial & ventricular rhythms regular
• Rate > 100beats/min.; rarely >160 beats/min.
• Normal P wave preceding each QRS complex
Sinus bradycardia
• Atrial & ventricular rhythms regular
• Rate <60 beats/min.
• Normal P waves preceding each QRS complex
Paroxysmal Supraventricular tachycardia
• Atrial & ventricular rhythms regular
• Rate >160 beats /min; rarely exceeds 250 beats/min.
• P waves regular but aberrant; difficult to differentiate from preceding T wave
• P wave preceding each QRS complex
• Sudden onset & termination of arrhythmia
Atrial Flutter
• Atrial Rhythm regular, rate 250 to 400 beats/minute
• Ventricular rate variable, depending on degree of AV block (usually 60 to 100 beats/minute)
• Sawtooth P-wave configuration possible (F-wave)
• QRS complexes uniform in shape but often irregularin rate
Atrial fibrilation
• Atrial rhythym grossly irregular; rate > 400beats/minute
• Venticular rhythm irregular
• QRS complexes of uniform configuration and duration
• PR interval indiscernible
• No P waves or P waves that appear as erratic, irregular, baseline fibrillatory waves
Junctional rhythm
• Atrial and ventricular rhythms regular; atrial rate 40 to 60 beats/minute; ventricular rate usually 40 to 60 beats/minute (60 to 100 beats/minute is accelerated junctional rhythm)
• P waves preceding, hidden within (absent), or after QRS complex; inverted if visible
• PR interval (when present) <0.12 second
• QRS complex configuration and duration normal, except aberrant conduction
First-degree AV block
• Atrial and ventricular rhythms regular
• PR interval >0.20 second
• P wave precedes QRS complex
• QRS complex normal
Second-degree AV lock (Mobitz I)
• Atrial rhythms regular
• Ventricular rhythm irregular
• Atrial rate exceeds ventricular rate
• PR interval progressively longer with each cycle until QRS complex disappear