Arrhythmia

• Heart arrhythmia - an irregular heartbeat
• Heart rhythm problems (heart arrhythmias) occur when the electrical signals that coordinate the heart’s beats don’t work properly.
• Tachycardia – this is a fast heart beat. The resting heart rate is greater than 100 beats a minute.
• Bradycardia – this is a slow heart beat. The resting heart rate is less than 60 beats a minute.
• Atrial fibrillation (A-fib) – chaotic heart signaling causes a rapid, uncoordinated heart rate. This is associated with serious complications such as stroke.
• Atrial flutter – this is similar to A-fib, but heartbeats are more organized. This is also linked to stroke.
• Supraventricular tachycardia – this is a broad term that includes arrhythmias that start above the lower heart chambers (ventricles). This causes episodes of a pounding heartbeat (palpitations) that begin and end abruptly.
• Ventricular tachycardia – this rapid, regular heart rate starts with faulty electrical signals in the lower heart chambers (ventricles). The rapid heart rate doesn’t allow the ventricles to properly fill with blood.
• Ventricular tachycardia - As a result, the heart can’t pump enough blood to the body. This may not cause serious problems in people with an otherwise healthy heart. In those with heart disease, ventricular tachycardia can be a medical emergency that requires immediate medical treatment.
• Sick sinus syndrome – the sinus node is responsible for setting the pace of the heart. If it doesn’t work properly, the heart rate may alternate between too slow (bradycardia) and too fast (tachycardia).
• Sick sinus syndrome - Sick sinus syndrome can be caused by scarring near the sinus node that’s slowing, disrupting or blocking the travel of impulses. Sick sinus syndrome is most common among older adults.
• Conduction block – a block of the heart’s electrical pathways can cause the signals that trigger the heartbeats to slow down or stop. Some blocks may cause no signs or symptoms, and others may cause skipped beats or bradycardia.
• Symptoms of heart arrhythmia

  • A fluttering in the chest
  • A racing heartbeat (tachycardia)
  • A slow heartbeat (bradycardia)
  • Chest pain
  • Shortness of breath
  • Other symptoms may include:
  • Anxiety
  • Fatigue
  • Lightheadedness or dizziness
  • Sweating
  • Fainting (syncope) or near fainting
• ADENOSINE (injectable solution) – used to bring the heart back into a normal rhythm. This is under the class of antidysrhythmic drug.
• Infusion into a vein - how adenosine is given
• Adenocard, Adenoscan - ADENOSINE
• SIDE EFFECTS OF ADENOSINE

  • Facial flushing
  • DOB
  • Chest pain
  • Heart attack
  • Lightheadedness
  • Dizziness
  • Tingling in arms
  • Numbness
  • Nausea
  • Hypotension
  • Palpitations (irregular heartbeat)
  • Apprehension
  • Head pressure
  • Chest pain
  • Blurred vision
  • Burning sensation
  • Heaviness in arms, neck, and back pain
  • metallic taste
  • Tightness in throat
  • Pressure in groin
  • Sweating
  • hyperventilation
• Where is ADENOSINE contraindicated?

  1. Contraindicated to those with 2nd and 3rd degree atrioventricular block (AV block) except those on pacemakers.
  2. Contraindicated in broncho-constrictive or bronchospastic lung disease (asthma)
• ADENOSINE

  IV compatibilities with dextrose 5% in LR, D5W, LR, NS.
• ADENOSINE

  This is given as a rapid injection (1-3 sec) by peripheral IV route directly into vein or into IV line close (proximal) to patient and is followed by rapid NS flush after each injection (20 mL in adults, 5 mL or more for pediatrics.
• ADENOSINE

  Place patient in mild reverse Trendelenburg position before giving drug.
• ADENOSINE

  Place patient in mild reverse Trendelenburg position before giving drug.
• ADENOSINE

  Store at controlled room temperature of 15-30ᵒC; do not refrigerate; possible crystal formation; solution must be clear prior to administration.
• ADENOSINE

  Advise patient to avoid coffee, tea, cola, chocolate, energy drinks, or other sources of caffeine.
• ATROPINE – increases the heart rate and improves the atrioventricular conduction by blocking the parasympathetic influences on the heart.
• ATROPINE - used for symptomatic bradycardia in the absence of reversible causes.
• Atropen - ATROPINE
• CONTRAINDICATIONS OF ATROPINE

  angle closure glaucoma

  hypothermic bradycardias

  prostatic hypertrophy

  paralytic ileus

  GI bowel obstruction

  3rd degree AV blocks
• ATROPINE

  Monitor temperature in infants and children for “atropine fever”.
• ATROPINE

  Measures to relieve dry mouth: adequate fluid hydration, oral hygiene (don’t use alcohol based mouthwashes), ice chips, sugarless gum, or hard candies to suck on.
• ATROPINE

  Reduce lighting to decrease photophobia.
• ATROPINE

  Monitor GI motility (BMs and flatus) and urine output while patient is receiving atropine.
• ROUTES OF ATROPINE

  1. IM
  2. SC
• ROUTES OF ATROPINE

  1. IM
  2. SC
  3. PO
  4. IV
• POTASSIUM CHANNEL BLOCKERS (CLASS 3 ANTIARRHYTHMIC DRUGS) – these are a class of drugs used for treating arrhythmias (improper beating of the heart, whether irregular, too fast or too slow).
• POTASSIUM CHANNEL BLOCKERS (CLASS 3 ANTIARRHYTHMIC DRUGS) – used for emergency treatment of ventricular dysrhythmias.
• Amiodarone - potassium channel blockers
• SIDE EFFECTS OF POTASSIUM CHANNEL BLOCKERS

  1. Cough
  2. Dizziness, lightheadedness, or fainting
  3. Fever (slight)
  4. Numbness or tingling in the fingers or toes
  5. Painful breathing
  6. Photosensitivity
  7. Trembling or shaking of the hands
  8. Trouble with walking
  9. Unusual and uncontrolled movements of the body
  10. Weakness of the arms or legs
• Contraindications of POTASSIUM CHANNEL BLOCKERS

  • Angle closure glaucoma
  • Hypothermic bradycardias
  • prostatic hypertrophy
  • paralytic ileus
  • GI bowel obstruction
  • 3rd degree AV blocks
• Potassium channel blockers - The first dose of this drug is given in the hospital. The patient will be closely monitored to make sure there will be no side effects.