Atrial Dysrhythmias for Progressive Care Certified Nurse (PCCN)

Atrial Dysrhythmias

Definition/Etiology:

• PCCN Focus: Identification, Cause & Treatment
• Definition
  • Rhythm whose impulse is generated by the Atrial, instead of the Sinus Node
  • Analogy – Stone in Pond
    • If you drop a stone into one corner of a pond a neat ripple moves across the pond. In the same way, during a normal rhythm, electricity spreads smoothly from the pacemaker across the atria to the ventricles. If you drop stones randomly all over a pond you get choppy, messy waves moving in all
      directions.
• Types & Etiology/Cause
  • Hypoxia
  • Electrolyte Disturbances
  • Medications
  • Injury to Myocardium
  • Injury to Electrical System
  • CAD/ACS

Pathophysiology:

• Cardiac Conduction Pathway
  • SA node (sinoatrial node)
  • INTERNODAL PATHWAYS (Atria Contract)
  • AV node (Delay)
  • His-Purkinje Network (Ventricles COntract)
  • The SA node fires another impulse and the cycle begins again.
    • Stones don’t Skip Smoothly = Makes waves
• Atrial Dysrhythmia = Conducted by Internodal Pathways
  • Starts in Atria

Noticing: Assessment & Recognizing Cues:

• Decreased Cardiac Output
• Subjective
  • Chest Pain
  • Weak/Fatigued/Dizzy
  • SOB/dyspnea
  • “Cold & Clammy”
• Objective
  • Vitals
    • Change in Hemodynamics
      • ↓BP, ↑HR, ↓pulses
  • Heart Sounds
    • Possible Irregular S1S2 (Afib)
    • S3 = Heart Failure
  • Lung Sounds
    • WET
  • Other Signs/Symptoms
    • ↓Mentation
    • ↓ Urine Output

Interpreting: Analyzing & Planning:

• Labs
  • ABGs – Hypoxemia
  • Electrolytes – Decreased KCL/MAG
  • Troponin – Infarcts
  • BUN/Creatinine – Renal Function
• Diagnostics – Atrial TachyCardias
  • ECG: Identify (Narrow QRS = above Ventricles)
    • Afib = Irregular R – R with fibrillation waves
    • Aflutter = Regular R – R with sawtooth flutter waves
    • SVT = Tachycardia (↑140) + Narrow QRS

Responding: Patient Interventions & Taking Action:

• ABCs First
  • Airway, O2, Heart monitor and IV
• Stable vs Unstable
  • Stable
    • Control Rate = Ventricular Filling
      • BB, ACE/ARBs, CCB, Digoxin, Antiarrhythmics
    • Convert Rhythm – Sedation/Cardioversion Depolarizes all cells. Resets environment so SN takes over again
      • Provider selects Joules
      • Stable = Sedation
      • Unstable = No Sedation
    • AFIB/AFLUTTER =Provide Anticoagulation
      • Avoid Embolic Stroke
  • Unstable
    • Cardioversion FIRST
    • Meds come second

Reflecting: Evaluating Patient Outcomes:

• Patient Stable?
  • Control Rate
  • Convert Rhythm
  • Monitor for signs of ↑ Cardiac Output
    • Chest Pain resolved
    • Vital Stable
    • Good Mentation
    • Heart/Lung Sounds Normal

Linchpins (Key Points):

• Notice
  • Assessing signs of ↓ Cardiac Output
• Interpret
  • ECG -AFIB, AFLUTTER, SVT
• Respond
  • Treating underlying cause
  • Pharm & Convert Rhythm
• Reflect
  • Symptom free. Remain in Stable Rhythm