heart rhythm 101.. what you really need to know in a nutshell…
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Heart rhythm 101.. what You really NEED to know in a nutshell…. Tara Cypher , RN MSN. Why is this something to worry about???. According to the NHI, approx 1 in 18 or 14.4 million people in USA have a diagnosis of an irregular heart rhythm - PowerPoint PPT PresentationTRANSCRIPT
HEART RHYTHM 101..WHAT YOU REALLY NEED TO KNOW IN A NUTSHELL…
Tara Cypher, RN MSN
WHY IS THIS SOMETHING TO WORRY ABOUT??? According to the NHI, approx 1 in 18 or 14.4
million people in USA have a diagnosis of an irregular heart rhythm
In order to understand when something is wrong, we need to know how the heart works
We have hands on time and the opportunity to recognize changes in our patients condition.
We need to recognize what is “normal” and what is a potential problem
THE ANATOMY OF THE HEART
PHYSIOLOGY OF THE HEART…HOW DOES THE MAGIC HAPPEN??? TWO important concepts:
1. Electrical activity in the heart
2. Mechanical contraction of the heart
BLOOD FLOW THROUGH THE HEART Deoxygenated blood from the Superior and
Inferior Vena cava enter the RIGHT ATRIUM Blood Flows from the Right Atrium through
the TRICUSPID valve into the Right Ventricle Blood is pumped from the RIGHT VENTRICLE
through the PULMONARY VALVE to the Pulmonary Arteries
The Pulmonary Arteries bring blood to the lungs to be oxygenated
BLOOD FLOW THROUGH THE HEART Oxygenated blood comes back to the heart
from the PULMONARY VEINS The Pulmonary Veins enter the LEFT ATRIUM The oxygenated blood passes through the
MITRAL (BICUSPID) Valve to the Left Ventricle The LEFT VENTRICLE pumps blood through
the AORTIC valve into the AORTA The Aorta is our largest artery, branching off
to deliver oxygenated blood to our body Capillaries serve as small exchange vessels
between arteries and veins where nutrients and gasses diffuse
The heart consists of two parallel pumps.
• The right ventricle pumps blood through the lungs.
• The left ventricle pumps blood through the systemic circulation– the body
THE HEART AS A PUMP The RIGHT and LEFT side are pumping at the
SAME time… The right pumps to the lungs The left pumps to the body When we listen to the heart, TWO sounds
should be heard 1. S1: LUB: Tricuspid and Mitral Valve closing
2. S2: DUB: Pulmonary and Aortic Valve closingo Any extra heart sounds are called a MURMER
HOW DOES THE HEART PUMP???The heart needs “electricity’ to start the pump
The heart is made of specialized muscle tissue to conduct electricity
The heart as special nodes, branches and fibers so the signals can pass quickly through the heart
THIS IS WHERE THE ION CHANNELS COME IN…. Like all muscle cells in the body, the heart
depends K, Na, and Ca channels for contraction…
The pacemakers of the heart (the SA node, AV node, Bundle of HIS and Purkinge Fibers) have specialized cells to make heart muscle contraction more efficient
All have specific “refractory” periods when they will not get “excited” or depolarize and cause contraction of heart muscle
IONS AND THE HEART
NORMAL SINUS RHYTHM
THE HEART WORKS BEST WHEN THE SINUS NODE RUNS THE SHOW All cells in the heart are capable of electrical
activity…but the heart works much better when the SINUS NODE (the fastest internal pacemaker) takes the lead and the heart contracts in an organized fashion
Normal Sinus Rhythm is meant to depolarize the atria uniformly, gives the AV valves time to close, then depolarize the ventricles evenly to the lungs and the body…but this is not a perfect world
Arrythmias are common
EXAMPLES OF PROBLEMS WHEN THE ELECTRICAL ACTIVITY IS OUT OF WHACK… Premature beats…we all have them! Atrial Fibrillation….the most common Atrial Tachycardia Junctional Rhythm SVT Heart blocks Ventricular Tachycardia Ventricular Fibrillation
PREMATURE BEATS Premature Atrial Contractions
PREMATURE BEAT Premature Ventricular Contraction
ATRIAL FIBRILLATION Nothing regular about it…
ATRIAL TACHYCARDIA The atria are contracting 1, 2, 3, 4, etc times
for each ventricular contraction
SUPRAVENTRICULAR TACHYCARDIA Its just too fast…
JUNCTIONAL RHYTHM
FIRST DEGREE HEART BLOCK
SECOND DEGREE HEART BLOCK: II Mobitz Type 2
SECOND DEGREE HEART BLOCK: I Mobitz Type 1: Wenckebach
THIRD DEGREE HEART BLOCK Complete Heart Block.....BAD NEWS
VENTRICULAR TACHYCARDIA Get ready to shock ladies and gentleman…
VENTRICULAR FIBRILLATION The heart is just quivering…ouch
ASYSTOLE Nothing good…but always check your leads!
WHAT ARE THE BIG THINGS I NEED TO LOOK OUT FOR??? 1. Heart rate and pulse
2. Common medications that slow down or speed up the heart
3. Common problems with abnormal heart rhythms…like clots!
4. Many medications or conditions that increase or decrease K, Na or Ca COULD AFFECT THE HEART
MEDICATIONS THAT SPEED UP THE HEART Keep in mind, pacemakers are usually placed for
slow heart rhythms
In an emergency, IV medications are given to speed up heart rate
Many medications may speed up heart rate as a side effect…when in doubt, look it up!
Cold medications, Caffiene, Allergy Medications, Diet medications, some cough medications, thyroid medications, some blood pressure medications
MEDICATIONS THAT BLOCK IMPULSES
Na Channels: Procainamide, Quinidine, Lidocaine, Flecainide
Beta nerve impulses: Atenolol, Metoprolol, Carvedilol, Nadolol, Esmolol, etc
Potassium: Amiodarone (Cordarone®), Dofetilide (Tikosyn®), Ibutilide (Corvert®), Sotalol (Betapace®), Tedisamil
Calcium: Diltiazim (Cardizem®), Verapamil
HEART RATE VS PULSE The heart rate is the electrical impulses, the
pulse is the mechanical output
Need to listen/feel how that beat is pumping blood
Not all beats are created equally
TAKE HOME MESSAGE: Electrical activity does not always mean good mechanical contraction of the heart
WHAT DOES THIS MEAN TO ME? Check the HR and pulse BEFORE giving any drug for
the heart
Check with the patient…how is the mental status, how are their other vital signs??
Double check the orders…when to hold the medication, etc.
Anything fast or slow NEEDS TO BE ADDRESSED. Document and tell someone.
When in doubt, ASK. ALWAYS. Medications are hard to take back.
POP QUIZ! You enter Mrs. X’s room at your rehab facility to
pass evening medications. She is 81 yrs old, recovering from hip surgery. She has had a fever and a “cold” for the last 2 days. She is ordered to receive Sudafed to relieve nasal congestion.
Mrs. X states she is feeling very weak. She sounds short of breath with minimal exertion.
As a diligent LPN, you check her pulse and her blood pressure
Her BP is 88/60, her pulse is 160 and feels thready. Her temperature is 99.9, her oxygen saturation is 91% but it is difficult to get a good reading.
WHAT DO YOU DO FOR MRS. X??? A. Give her the cold medicine and a glass of
water. She could be dehydrated.
B. Ask her if she would like Tylenol for her fever, as she has a standing order for this medication
C. Notify the charge nurse/MD that Mrs. X needs immediate attention.
D. Write down the vital signs and come back to Mrs. X when you are finished with your other patients?
C. NOTIFY THE CHARGE NURSE/MD ON CALL
Mrs. X needs immediate intervention, as she potentially unstable in a fast arrythmia!!
Upon returning from lunch, you receive report that one of your patients has been “confused” and “agitated”
The Nursing Assistant reports that Mr. Q’s blood pressure is 180/109 and his heart rate is 55 on the cardiac monitor
You enter the room of Mr. Q, and find him trying to get out of bed. He does not recognize you.
He is sweating and appears pale. He is grimacing and rubbing his left shoulder and chest
You can feel a pulse but it is weak.
WHAT DO YOU DO FOR MR. Q A. Try to get an order for restraints. He is at
high risk for falls
B. Bring in his daughter to see if he recognizes her. He has a history of dementia.
C. Give him is scheduled blood pressure medication
D. Call the physician and ask for help
D. CALL THE PHYSICIAN AND GET HELP
Mr. Q is unstable, with a symptomatic bradycardia– Possible heart attack!
BONUS ROUND!!
NAME THAT RHYTHM!!!
THE GOOD
THE BAD
AND THE UGLY!!!
THANK YOU FOR YOUR TIME!