KINE 639 - Dr. Green Section 3 Terminology and Definitions of Arrhythmias Rhythm Reading in Conover: pages 45-52, 55

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KINE 639 - Dr. Green Section 3 Terminology and Definitions of Arrhythmias Rhythm Reading in Conover: pages 45-52, 55-170

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Rhythms from the Sinus Node Normal Sinus Rhythm (NSR) Sinus Tachycardia: HR > 100 b/m Causes: Withdrawal of vagul tone & Sympathetic incitement ( practice , battle or flight) Fever & irritation Heart Failure or Cardiogenic Shock (both speak to hypoperfusion states) Heart Attack (myocardial dead tissue or expansion of localized necrosis) Drugs (liquor, nicotine, caffeine) Sinus Bradycardia: HR < 60 b/m Causes: Increased vagul tone, diminished thoughtful yield, ( perseverance preparing ) Hypothyroidism Heart Attack (regular in substandard divider localized necrosis) Vasovagul syncope (individuals going out when they get their blood drawn) Depression

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Rhythms from the Sinus Node Sinus Arrhythmia: Variation in HR by over .16 seconds Mechanism: Most frequently: changes in vagul tone connected with respiratory reflexes Benign variation Causes Most regularly: youth and continuance preparing Sick Sinus Syndrome: Failure of the heart's pacemaking capacities Causes: Idiopathic (no cause can be discovered) Cardiomyopathy (infection and deformity of the cardiovascular muscle) Implications and Associations Associated with Tachycardia/Bradycardia arrhythmias Is regularly trailed by an ectopic "escape beat" or an ectopic "musicality"

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Recognizing and Naming Beats & Rhythms QRS is marginally unique yet slender, demonstrating that conduction through the ventricle is moderately ordinary Atrial Escape Beat typical ("sinus") thumps sinus hub doesn't fire prompting to a time of asystole (wiped out sinus disorder) p-wave has diverse shape showing it didn't start in the sinus hub, however some place in the atria. It is along these lines called a "atrial" beat

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Recognizing and Naming Beats & Rhythms Junctional Escape Beat QRS is marginally extraordinary yet at the same time contract, showing that conduction through the ventricle is generally typical there is no p wave, demonstrating that it didn't start anyplace in the atria, yet since the QRS complex is still thin and ordinary looking, we can reason that the beat began some place close to the AV intersection. The beat is accordingly called a "junctional" or a "nodal" beat

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Recognizing and Naming Beats & Rhythms QRS is wide and very different ("bizarre") looking than the ordinary beats. This demonstrates the beat began some place in the ventricles and thus, conduction through the ventricles did not happen through typical pathways. It is thusly called a "ventricular" beat Ventricular Escape Beat there is no p wave, demonstrating that the beat did not begin anyplace in the atria really a "retrograde p-wave may some of the time be seen on the right hand side of thumps that start in the ventricles, showing that depolarization has spread go down through the atria from the ventricles

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Recognizing and Naming Beats & Rhythms Ectopic Beats or Rhythms pulsates or rhythms that begin in spots other than the SA hub the ectopic center may bring about single thumps or assume control and pace the heart, directing its whole cadence they might possibly be risky relying upon how they influence the cardiovascular yield Causes of Ectopic Beats or Rhythms hypoxic myocardium - perpetual pneumonic malady, aspiratory embolus ischemic myocardium - intense MI, extending MI, angina thoughtful incitement - apprehension, work out, CHF, hyperthyroidism drugs & electrolyte awkward nature - antiarrhythmic drugs, hypokalemia, imbalances of calcium and magnesium bradycardia - an ease back HR inclines one to arrhythmias augmentation of the atria or ventricles delivering stretch in pacemaker cells

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The "Reentry" Mechanism of Ectopic Beats & Rhythms Electrical Impulse Cardiac Conduction Tissue Fast Conduction Path Slow Recovery Slow Conduction Path Fast Recovery Tissues with these sort of circuits may exist: in infinitesimal size in the SA hub, AV hub, or any kind of heart tissue in a "plainly visible" structure, for example, an adornment pathway in WPW

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The "Reentry" Mechanism of Ectopic Beats & Rhythms Premature Beat Impulse Cardiac Conduction Tissue Repolarizing Tissue (long hard-headed period) Fast Conduction Path Slow Recovery Slow Conduction Path Fast Recovery 1. An arrhythmia is activated by an untimely beat 2. The beat can't pick up passage into the quick directing pathway as a result of its long obstinate period and therefore goes down the moderate leading pathway just

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The "Reentry" Mechanism of Ectopic Beats & Rhythms Cardiac Conduction Tissue Fast Conduction Path Slow Recovery Slow Conduction Path Fast Recovery 3. The rush of excitation from the untimely beat lands at the distal end of the quick leading pathway, which has now recuperated and in this way ventures retrogradely (in reverse) up the quick pathway

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The "Reentry" Mechanism of Ectopic Beats & Rhythms Cardiac Conduction Tissue Fast Conduction Path Slow Recovery Slow Conduction Path Fast Recovery 4. On touching base at the highest point of the quick pathway it finds the moderate pathway has recouped and in this manner the rush of excitation 're-enters' the pathway and proceeds in a "roundabout" development. This makes the reentry circuit

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Re-section Circuits as Ectopic Foci and Arrhythmia Generators Atrio-Ventricular Nodal Re-passage supraventricular tachycardia Ventricular Re-passage ventricular tachycardia Atrial Re-section atrial tachycardia atrial fibrillation atrial vacillate Atrio-Ventricular Re-section Wolf Parkinson White supraventricular tachycardia

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Recognizing and Naming Beats & Rhythms Clinical Manifestations of Arrhythmias numerous go unnoticed and deliver no side effects palpitations – going from "seeing" or "staying alert" of ones heart beat to a vibe of the heart "pulsating out of the mid-section" if Q is influenced (HR > 300) – discombobulation and syncope, swooning medications & electrolyte uneven characters - antiarrhythmic drugs, hypokalemia, imbalances of calcium and magnesium extremely quick arrhythmias u myocardial oxygen request r ischemia and angina sudden demise – particularly on account of an intense MI

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Recognizing and Naming Beats & Rhythms Premature Ventricular Contractions (PVC's, VPB's, extrasystoles) : A ventricular ectopic center releases bringing about an early beat Ectopic beat has no P-wave (perhaps retrograde), and QRS complex is "wide and bizarre" QRS is wide in light of the fact that the spread of depolarization through the ventricles is unusual (variant) In many cases, the heart courses no blood (no heartbeat in light of a sporadic pressing movement PVC's are here and there portrayed by laypeople as "skipped heart beats"

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Recognizing and Naming Beats & Rhythms Characteristics of's PVC's don't have P-waves unless they are retrograde (might be covered in T-Wave) T-waves for PVC's are generally vast and inverse in extremity to terminal QRS Wide (> .16 sec) scored PVC's may show a widened hypokinetic left ventricle Every other beat being a PVC (bigeminy) may demonstrate coronary vein illness Some PVC's separated 2 ordinary sinus thumps and are called "interjected" PVC's The exemplary PVC – take note of the compensatory stop Interpolated PVC – take note of the sinus musicality is undisturbed

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Recognizing and Naming Beats & Rhythms PVC's are Dangerous When : They are visit (> 30% of edifices) or are expanding in recurrence The approach or on top of a previous T-wave (R on T) at least three PVC's in succession (keep running of V-tach) Any PVC in the setting of an intense MI PVC's originated from various foci ("multifocal" or "multiformed") These hazardous marvel may block the event of destructive arrhythmias: Ventricular Tachycardia Ventricular Fibrillation The sooner defibrillation happens, the improved probability of survival "R on T wonder" time Unconverted V-tach r V-lie sinus pulsates V-tach

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Recognizing and Naming Beats & Rhythms Notes on V-tach : Causes of V-tach Prior MI, CAD, enlarged cardiomyopathy, or it might be idiopathic (no known cause) Typical V-tach persistent MI with confusions & broad corruption, EF<40%, d divider movement, v-aneurysm) V-tach buildings are probably going to be comparative and the cadence standard Irregular V-Tach rhythms might be expected to: leap forward of atrial conduction atria may "catch" the whole beat an atrial beat may "converge" with an ectopic ventricular beat (combination beat) Capture beat - take note of that the complex is sufficiently restricted to propose ordinary ventricular conduction. This demonstrates an atrial motivation has endured and conduction through the ventricles is moderately typical. Combination beat - note p-wave before PVC and the PVC is smaller than the other PVC's – this shows the beat is a result of both the sinus hub and an ectopic ventricular center

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Recognizing and Naming Beats & Rhythms Premature Atrial Contractions (PAC's) : An ectopic center in the atria releases bringing on an early beat The P-wave of the PAC won't resemble a typical sinus P-wave (diverse morphology) QRS is limited and ordinary looking in light of the fact that ventricular depolarization is normal PAC's may not enact the myocardium on the off chance that it is still hard-headed (non-led PAC's) PAC's might be generous: brought about by stretch, liquor, caffeine, and tobacco PAC's may likewise be created by ischemia, intense MI's, d electrolytes, atrial hypertrophy PAC's may likewise go before PSVT Non directed PAC Non led PAC bending a T-wave PAC

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Recognizing and Naming Beats & Rhythms Premature Junctional Contractions (PJC's) : An ectopic core interest

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