窦性心律失常的诊断和治疗课件

Sinus Rhythms: Dysrhythmia Recognition 0.12 - 0.20 seconds R-R interval: usually regular QRS complexes: usually normal appearing and 0.12 seconds, may be wide P to QRS Relationship: one P wave precedes each QRS complex Analyze the Rhythm Normal Sinus Rhythm lPathophysiology None specific to the ECG rhythm itself Normal and expected ECG rhythm lManagement Treat the patient! Sinus Bradycardia lCharacteristics Same as NSR with ONE exception Rate: 60 bpm Analyze the Rhythm Sinus Bradycardia lPathophysiology Generally a result of some other cause lExcessive parasympathetic tone on SA node lDecrease in sympathetic tone on SA node (blockade) lAdministration of calcium channel blockers lDigitalis toxicity lDisease of the SA node (sick sinus syndrome) lAcute inferior MI lHypothyroidism lHypothermia lHypoxia (later) lPhysical conditioning Sinus Bradycardia lSymptomatic Presentation Variable Severe presentation may result in lDizziness, lightheadedness, altered mental status, or syncope lSOB lCP lHypotension/Shock lPulmonary congestion lAcute MI Sinus Bradycardia lManagement First Steps after ABCDs lSymptomatic or Asymptomatic lIf symptomatic, then Stable or Unstable Altered mental status Severe respiratory difficulty Shock/Hypoperfusion Attempt to Identify the Cause lImplement Cause-Specific treatments, if applicable Asymptomatic Bradycardia lPrimary ABCD - Assess QRS may only result from ectopic complex Analyze the Rhythm Sinus Arrest lPathophysiology Depression in the automaticity of the SA node, or Block in the conduction pathways from SA node into atria Often precipitated by: lIncrease in vagal tone lHypoxia lHyperkalemia lExcessive drugs: digitalis, beta blockers, quinidine lSA Node ischemia or Sick Sinus Syndrome Sinus Arrest lPresentation Transient episodes may no clinical manifestation or significance Alternative pacemaker site should take over to prevent extreme bradycardia Symptoms most likely if episodes progr