SPECIFIC

CARDIOVASCULAR
DISORDERS

LEILA C. BONDOC, MD
1. DYSRHYTHMIA AND CONDUCTION PROBLEMS
A. ATRIAL ARRHYTHMIA
Dysrhythmia and arrhythmia both mean the same
thing: an unusual heart rhythm. The only difference is
that the word dysrhythmia literally means “bad rhythm”
while arrhythmia means “without rhythm.” Dysrhythmia
and arrhythmia refer to when the heart does not beat
at a regular rhythm or speed.
• Atrial arrhythmias are irregular heartbeats that cause
poor circulation. They occur when the upper
chambers of your heart are out of rhythm with the
lower chambers. This can cause your heart to beat
either too fast or slow.
• These arrhythmias may result from too much
caffeine, alcohol or stress. They can also result from
a serious health condition or heart problem. Atrial
arrhythmias can range from harmless to life-
threatening.
• The types of atrial arrhythmias include:
1. Atrial fibrillation (Afib), which is a very common type
of arrhythmia. It causes a fast, disorganized, irregular
heartbeat. Untreated, it can lead to stroke and other
health problems.
2. Atrial flutter, which happens when electrical signals
fire quickly in the atria, causing the atria to beat too
fast. It can occur along with heart failure, heart attack
and structural problems with the heart.
3. Accessory pathway tachycardia (bypass tract
tachycardia), a fast heartbeat that results from an
extra pathway between the atria and the ventricles. If
electrical signals travel more quickly through the
pathway than they do through the AV node, the heart
beats faster than it should. Wolff-Parkinson-White
syndrome is an example of this type of arrhythmia.
4. Atrial tachycardia (AT), a fast heart rate
(tachycardia) that happens when an electrical signal
comes from the wrong place in the atria.
5. AV nodal re-entrant tachycardia (AVNRT), which
happens when there is more than one pathway
through the AV node. AVRNT is a type of paroxysmal
supraventricular tachycardia (PSVT), a fast heart rate
that has a regular rhythm. AVRNT can come and go
suddenly.
6. Premature atrial contractions (PACs), a type of
ectopic heartbeat that causes the heart to beat too
soon. PACs are usually harmless and may not require
treatment.
• Heart arrhythmias are common.Afib is the most
common kind of arrhythmia
CAUSES OF ATRIAL ARRYTHMIA:
• Atrial arrhythmias result from abnormal electrical
signals. These signals, or impulses, start in the atria.
The abnormal impulses can be inherited (passed
down through families) or result from several health
problems or heart conditions, including:
1. Anemia (low red blood cell count).
2. Cardiomyopathy -a disease of the heart muscle.
3. Diabetes.
4. Heart attack or damage from a previous heart attack.
5. Heart disease, coronary artery disease (CAD) and heart
failure.
6. High blood pressure (hypertension).
7. Lung conditions such as chronic obstructive pulmonary
disease (COPD).
8. Structural heart problems, including valve disease.
9. Thyroid problems, including hyperthyroidism.
• Atrial arrhythmias can also develop as a result of lifestyle
factors:
1. Dehydration.
2. Drinks and foods that contain caffeine. Foods that are high
in fat, sugar or carbohydrates can cause heart palpitations
after eating.
3. Drug use, including nasal decongestants that contain
pseudoephedrine.
4. Excessive alcohol.
5. Having extra weight and obesity.
• FEMALE 5FEET = 100LBS
• EVERY INCH INC. PLUS 5
• 5’1 = 105 LBS
• LBS TO KGS
• 105/2.2 = 47KGS
• OVERWEIGHT (10% INC FROM NORMAL)- 47PLUS
4.7 = 52.4
• OBESE -(20% INC. FROM NORMAL ) 9.4 =56.4 OR
HIGHER
• MALE 5FEET = 105 LBS
• EVERY INCH INCREASE 6 LBS
• 5’4 = 129LBS/58.6KGS
• OVERWEIGHT 58.6PLUS 5.86/64.4KGS
• OBESE 20 = 11.2 PLUS 58.6= 70.32KGS
6. High levels of anxiety and stress.
7. Hormonal changes, including those that happen
during menopause or pregnancy. Heart palpitations
during pregnancy are very common and usually
harmless.
8. Smoking and using tobacco products.
• Symptoms of atrial arrhythmia include:
1. A heartbeat that’s fast and regular. It may feel like
your heart is racing.
2. An irregular heartbeat. You may feel like it skipped a
beat, stopped for a minute, speed up or slowed down.
3. Chest pain, discomfort or tightness in the chest.
4. Difficulty breathing or shortness of breath.
5. Dizziness or confusion.
6. Fainting (syncope) or loss of consciousness.
7. Fatigue or feeling sluggish.
8. Fluttering or pounding in your chest, throat or neck
(heart palpitations).
9. Swelling (edema) in your limbs, especially your legs,
ankles and feet.
HOW TO DIAGNOSE ATRIAL ARRHYTHMIA
1. History and Physical Examination
2. A blood test looks for anemia(Complete blood count-
CBC), vitamin deficiencies or a problem with your
thyroid.(T3T4,TSH)
3. ECG/EKG
4. If the EKG doesn’t detect an irregular heartbeat, your
provider may recommend an ambulatory monitor such as
a Holter monitor. This device is portable and you wear it
for about a week. It records your heart rate and any
irregular heartbeats.
MANAGEMENT AND TREATMENT OF ATRIAL
ARRYTHMIA
Consult a Cardiologist will recommend treatment
based on your overall health and the type of
arrhythmia. Many arrhythmias get better with lifestyle
and dietary changes, such as:
1. Avoiding alcohol, caffeine and some types of
medications, such as cold medications and nasal
decongestants that include pseudoephedrine.
2. Drinking plenty of water to avoid dehydration.
3. Getting help for anxiety and doing relaxation
exercises and deep breathing to lower stress levels.
4. Losing weight and maintaining a healthy weight if
you are obese.
5. Quitting smoking and using tobacco products.
Atrial arrhythmia treatments include:
1. Catheter ablation, a minimally invasive procedure
that destroys a bit of the tissue on the inside of the
heart that is sending irregular electrical signals and
causing arrhythmia.
2. Devices, such as an implantable cardioverter-
defibrillator (ICD), subcutaneous ICD or pacemaker.
3. Electrical Cardioversion - a procedure that delivers
safe jolts of energy to your heart and disrupts the
abnormal rhythm back to a normal rhythm.
• Medications, including arrhythmia medications to
make your heart rhythm regular or prevent heartbeat
irregularities. Other drugs, such as blood thinners,
reduce your risk of stroke from Afib.
• Amiodarone(Cordarone), with its multiple extra-
cardiac side effects, remains the most efficient anti-
arrhythmic drug.
• To treat all acute tachyarrhythmias in adults,
amiodarone can be given IV 150 mg over 10
minutes, followed by a 1 mg/min infusion for 6 hours,
followed by an infusion at 0.5 mg/min. The
recommended total dose over 24 hours should not
exceed 2.4 grams.
• The standard recommended dose is 5mg/kg
bodyweight given by intravenous infusion over a
period of 20 minutes to 2 hours. This should be
administered as a dilute solution in 250 ml 5%
dextrose.
• 50mg/ml, 3 ml ampule
• Brand name : Cordarone
NURSING INTERVENTIONS:
1. Amiodarone can cause pulmonary toxicity and
ARDS, so monitor your patient's respiratory status
carefully.
2. Patients taking amiodarone long-term should get
regular chest x-rays and pulmonary function tests.
3. Palpate pulses (radial, carotid, femoral, dorsalis
pedis), noting rate, regularity, amplitude (full or
thready), and symmetry. Document the presence of
pulsus alternans, bigeminal pulse, or pulse deficit.
4. Auscultate heart sounds, noting rate, rhythm,
presence of extra heartbeats, and dropped beats.
5. Monitor vital signs. Assess the adequacy of cardiac
output and tissue perfusion, noting significant
variations in BP/pulse rate equality, respirations,
changes in skin color, temperature, level of
consciousness, sensorium, and urine output during
episodes of dysrhythmias.
6. Investigate reports of chest pain, documenting the
location, duration, intensity (0–10 scale), and relieving or
aggravating factors. Note nonverbal pain cues: facial
grimacing, crying, changes in BP/heart rate.
7. Be prepared to initiate cardiopulmonary resuscitation
(CPR) as indicated.
The development of life-threatening dysrhythmias
requires prompt intervention to prevent ischemic
damage/death.
8. Insert and maintain IV access.
JUNCTIONAL ARRHYTHMIA
• A junctional rhythm is a type of arrhythmia (irregular
heartbeat). If you have a junctional rhythm, your heart’s
natural pacemaker, known as your sinoatrial (SA) node,
isn’t working as it should.
• Your SA node sends electrical signals that control your
heartbeat. When you have a junctional rhythm, your SA
node stops working or sends signals that are too slow or
weak. Your heart responds by using one of your backup
pacemakers instead. Your heart’s backup pacemakers
keep your heart beating, but they might make your
heartbeat slower or faster than normal.
1. SA node: This group of cells usually serves as your first-line
pacemaker. Your SA node is in your heart’s upper right chamber
(right atrium).
2. AV node: These cells often take over if your SA node isn’t
working correctly. Your AV node is in the junction, or center, of
your heart, between your atria and ventricles. Most junctional
rhythms happen in the AV node.
3. His-Purkinje system: This group of string-like fibers is also near
the middle of your heart. The His-Purkinje system includes the
bundle of His and the Purkinje cells. These thin fibers conduct
electricity in the heart and serve as a backup pacemaker.
• All types of junctional rhythms occur when the SA
node isn’t working correctly. But there are different
ways your heartbeat may change when this happens.
• A normal adult heartbeat is 60 to 100 beats per
minute (BPM). Junctional rhythm can cause your
heartbeat to be slower than normal (bradycardia), or
faster than normal (tachycardia).
• Types of junctional rhythm include:
1. Junctional bradycardia: Less than 40 BPM.
2. Junctional escape rhythm: 40 to 60 BPM.
3. Accelerated junctional rhythm: 60 to 100 BPM.
4. Junctional tachycardia: Over 100 BPM.
• A junctional rhythm is less common than other
arrhythmias like atrial fibrillation. It is often found in
children or adults who have:
1. Had a recent heart transplant or heart surgery.
2. Sinus node dysfunction, also known as sick sinus
syndrome.
Causes of a junctional rhythm include:
1. Inflammation of the heart: If your heart muscle is
inflamed, the SA node may become damaged or stop
working. Heart surgery and myocarditis are common
causes of heart inflammation. It can also occur from sepsis
or certain infections like Lyme disease or rheumatic fever.
2. Low oxygen levels: Certain heart problems like
myocardial ischemia can lead to low oxygen levels and
reduced blood flow in your heart. With lower blood flow in
your heart, your SA node may stop working.
3. Medications: Certain medicines that treat heart
problems or high blood pressure can slow your heart
rate and cause a junctional rhythm. However, don’t
stop taking any of your medications without talking to
your provider first
SYMPTOMS OF JUNCTIONAL RHYTHM
• Anxiety.
• Chest pain.
• Dizziness.
• Fainting.
• Feeling fatigued or weak.
• Heart palpitations (feeling a fast, fluttering or pounding
heartbeat in your chest).
• Shortness of breath.
• Slow heart rate.
HOW TO DIAGNOSE JUNCTIONAL RHYTHM
1. History and Physical Examination
2. Vital signs, which include your blood pressure,
heart rate and breathing rate. During your exam, tell
your provider about your:
• Health history.
• Lifestyle, including whether you consume caffeine or
use tobacco products or alcohol.
• Medications, supplements and vitamins you take.
TEST TO DIAGNOSE JUNCTIONAL RHYTHM
1. ECG/EKG- a small wave called a “P wave” is either
inverted (upside down) or missing on your EKG.

2. Echocardiogram: This ultrasound of the heart can

show how well blood is pumping through your heart.
.
3. Stress test: This test can find arrhythmias that start
or get worse when you exercise. Stress tests can also
help diagnose some types of heart disease or
coronary artery disease.
4. Tilt table test: During this test, you lie on a table.
Your provider measures your heart rhythm and blood
pressure as the table tilts your body at different angles.
MANAGEMENT OF JUNCTIONAL RHYTHM
1. If you don’t have other heart problems and you don’t have
symptoms, you may not need treatment for a junctional rhythm.
2. Regular checkups and EKGs to monitor your heart health.
3. Treatment if your blood oxygen levels are too low or your
symptoms bother you.Treatment may include:
a. Medication changes: - change the dose or type of
medications you take if your current medications are causing
the junctional rhythm. Medications that speed up or slow down
your heart rate may also be an option, depending on your
needs.
• Permanent pacemaker: Your provider implants this
device in your heart. Pacemakers send electrical
impulses and can correct many kinds of arrhythmias.
A pacemaker can take the place of your SA node to
help your heart beat.
NURSING INTERVENTIONS
1. Advised for follow-ups
2. Maintain on medications
3. Lifestyle habits
VENTRICULAR ARRYTHMIA
A ventricular arrhythmia is an abnormal heart rhythm
that affects just the lower chambers of your heart.
Those lower chambers are what drive the heart’s
ability to pump blood throughout the body. While some
of them are harmless and don’t usually cause
symptoms, some of these rhythm problems can have
serious — or even deadly — effects on your body.
• Heart is a pump that has four chambers. The upper
chambers are the left atrium and right atrium (you
can say “atria” to refer to both of them). The lower
chambers are the left ventricle and right ventricle.
• The right ventricle pumps blood out of your heart and
into your lungs, which add oxygen and remove
carbon dioxide before the blood reenters your heart.
The left ventricle is the last chamber blood flows
through before being pumped out to your entire body.
• Because the ventricles are so key to the heart’s ability to
pump blood, any disruption in their normal rhythm can
have major consequences. These include:
1. Cardiogenic shock. This is where the heart can't pump
enough blood to supply oxygen to your body.
2. Sudden cardiac arrest. This is when your heart stops
beating suddenly and unexpectedly.
• Without CPR or the use of an automated external
defibrillator, both of these conditions are deadly within
minutes.
TYPES OF VENTRICULAR ARRYTHMIA
1. Preventricular contractions
• Also known as PVCs, these feel like extra heartbeats and are
usually harmless. A key exception is when you have a
condition that has changed the shape of your heart or when
PVCs happen frequently or for longer periods.
2. Ventricular tachycardia
• Ventricular tachycardia (VTach) happens when the lower
chambers of the heart beat unusually fast. This can happen
because of a malfunction in the heart's electrical system. In
some cases, VTach can turn into ventricular fibrillation, which
is a more dangerous condition.
3. Ventricular fibrillation
Ventricular fibrillation — often shortened to “v-fib” —
happens when the lower chambers of the heart quiver
or twitch rather than expand and contract. Because the
ventricles don’t fully expand and contract, blood
doesn’t get pumped through them. This causes your
heart to stop, sending you into sudden cardiac arrest,
and lack of blood flow to your brain causes you to
pass out within seconds. If blood flow isn’t restarted
within a few minutes, this condition is deadly.
• Ventricular tachycardia causes include:
1. Cardiomyopathy.
2. Cardiovascular disease (especially when it changes
the shape of your heart).
3. Congenital heart conditions (heart problems you’re
born with).
4. Electrolyte imbalances.
5. Heart attack.
6. Heart failure.
7. Heart inflammation.
8. Heart surgery.
9. Heart valve diseases.
10. Lack of oxygen.
11. Medications.
Ventricular fibrillation causes include:
1. Blunt impacts to the chest (especially from small, fast-moving
objects like a baseball).
2. Cardiomyopathy.
3. Congenital heart conditions.
4. Electrocution.
5. Heart attack.
6. Heart surgery.
7. Medications.
8. Ventricular tachycardia.
• Ventricular arrhythmias are most common in people
who have heart-related conditions and diseases. As
a result, the likelihood of developing these
arrhythmias naturally increases as you get older. In
addition, diseases that change the heart's structure
have a much higher risk of causing ventricular
arrhythmias.
• The symptoms of ventricular arrhythmia depend on the
type of arrhythmia. Some have no symptoms
(especially non-sustained and benign arrhythmias).
• Ventricular tachycardia usually has the following
symptoms:
1. Chest pain (angina).
2. Dizziness, feeling lightheaded or fainting.
3. Shortness of breath or trouble breathing.
4. Heart palpitations.
• Ventricular fibrillation typically causes a person to collapse
or pass out. Sometimes, there are no warning signs before
this takes place. If symptoms happen, they tend to appear
just minutes before a person passes out. Symptoms often
include:
1. Chest pain (angina).
2. Dizziness, feeling lightheaded and fainting.
3. Nausea.
4. Heart palpitations or an irregular or racing pulse.
5. Shortness of breath or trouble breathing.
DIAGNOSIS
1. History and Physical Examination
2. Vital signs
3. ECG/EKG
4. Other devices
a. Holter monitor- These are about the size of a cell
phone and connect to electrodes stuck to the skin of
your chest. These record for one to two days.
b. Ambulatory monitor- These are similar to Holter
monitors, but you can wear them for longer periods
(sometimes up to 30 days). These devices come in
several different types. Some only record when you
press a button because you feel possible symptoms of
an arrhythmia. Others “listen” to your heart rhythm and
record automatically when they detect an arrhythmia.
• Depending on what causes a ventricular arrhythmia, it may
be possible to cure it. However, if the cause is an underlying
chronic condition or disease — especially a condition you’re
born with — it’s usually not possible to cure it. When an
arrhythmia isn’t curable, the goal becomes treating and
managing it so it affects your life as little as possible.
• The treatment for a ventricular arrhythmia depends on the
type. Benign arrhythmias like PVCs don’t need treatment
(unless they happen frequently and for longer periods).
Other arrhythmias are treated long-term. Some are more
dangerous and need emergency care.
• Emergency treatments for ventricular arrhythmias
include:
• 1. CPR: Short for cardiopulmonary resuscitation, this
technique uses chest compressions to force blood
throughout your body. CPR should be started
immediately for anyone who doesn’t have a pulse
and shouldn’t be stopped until they start breathing
normally on their own, an automated external
defibrillator can be used or emergency medical
personnel arrive.
2. Automated External Defibrillator (AED): An
automated external defibrillator is a device that can
analyze a person’s heart rhythm. If needed, it can then
deliver an electric shock to restore their heart rhythm
to normal. Both ventricular tachycardia and ventricular
fibrillation are “shockable” rhythms.
3. Medication: For both ventricular tachycardia and
fibrillation, certain medications can help maintain a
normal heart rhythm.
• The following methods can treat ventricular arrhythmia in
non-emergency situations:
1. Ablation: This technique uses intense heat or cold to
intentionally damage small areas of your heart, preventing an
arrhythmia from happening. This is most often done using
catheter-based devices inserted into a major blood vessel
(usually near your groin) and then passed up and into your
heart.
2. Implantable cardioverter defibrillator (ICD): These can
detect abnormal heart rhythms and deliver an electric shock
that can return your heart to a normal rhythm.
3. Medication: Some types of anti-arrhythmia
medication may help, depending on the type of
arrhythmia. However, medications may not be as
effective or may cause unwanted side effects.
NURSING INTERVENTIONS
1. Avoid or quit using tobacco (including vaping products
and smokeless tobacco).
2. Eat a balanced diet as recommended by your primary
healthcare provider.
3. Stay physically active.
4. Maintain a healthy weight.
5. Use alcohol in moderation. This means limiting your
alcohol intake to one drink per day (seven per week) for
women and no more than two drinks per day (no more than
14 per week) for men.