Cardiology Self Learning Package Mod ule 3: Cardiac Arrhythmias: Mechanisms of Arrhythmias, Atrial, Ventricular, Conduction Module 3: Cardiac Arrhythmias: Mechanisums of Arrhythmias – Atrial, Ventricular, Conduction and ST Changes Developed by Tony Curran (Clinicaal Nnursde Ed uScatoTr) an dC Gill Shhepaparnd (Cgliniecal Nsur.se Specialist) Cardiology, June 2011 Page 1 CONTENT Introduction…………………………………………………………………………………………………………………Page 3 How to use the ECG Self Learning Package…………………………………………………………………..Page 4 Journal Articles…………………………………………………………………………………………………………….Page 5 Overview of Arrhythmias……………………………………………………………………………………………Page 18 Etiology………………………………………………………………………………………………………………………Page 21 Electrolyte Imbalance…………………………………………………………………………………………………Page 22 Pathophysiology: Clinical Manifestation…………………………………………………………………….Page 23 Mechanisms of Arrhythmias………………………………………………………………………………………Page 24 Normal Automaticity……………………………………………………..………………………………………….Page 25 Abnormal Impulse Initiation………………………………………………………………………………………Page 25 Triggered Rhythms…………………………………………………………………………………………………….Page 27 Abnormal Impulse Conduction…………………………………………………………………………………..Page 28 Arrhythmias: Sinus Rhythm……………………………………………………………………………………………………..Page 29 Sinus Dysrhythmia……………….……………………………………………………………………………...Page30 Atrial Arrhythmias………………………………………………………………………………………………Page 31 Conduction Disturbance…………………………………………………….……………………………….Page 43 Ventricular Arrhythmias……………………………………………………………………….…………….Page 48 ST Changes…………………………………………………………………………………………………………Page 52 References…………………………………………………………………………………………………………………Page 55 Module 3 Question ………………………………………..…………….…………………………………………..Page 56 Module 3 Rhythm Interpretation……………………………………………………………………………….Page 59 Module 3 Evaluation Form…………………………………………………………………………………………Page 73 Module 3: Cardiac Arrhythmias: Mechanisums of Arrhythmias – Atrial, Ventricular, Conduction and ST Changes Developed by Tony Curran (Clinical Nurse Educator) and Gill Sheppard (Clinical Nurse Specialist) Cardiology, June 2011 Page 2 INTRODUCTION Welcome to the ECG self learning package module 3. Patients presenting with the symptom of palpitation form a large proportion of admissions into the departments of cardiology. In the great majority of cases the correct diagnosis can be determined at the initial consultation after careful analysis of the history, findings at clinical examination, and 12- lead ECG. This package will provide an overview of most cardiac arrhythmias and the mechanism that causes them. This package will provide information on in regards to the different arrhythmias and the abnormalities that causes them such as electrical instability in the myocardial cell membrane, the ability of cardiac cells contract twice, although they only have been activated once and the propagation through issues rather than abnormalities in physiology of individual cells. The goal of this module is to review: Arrhythmia etiology Arrhythmia pathophysiology The different mechanisms of Arrhythmias Defining the different types of arrhythmias. Learning outcomes for this module are: To identify the different clinical manifestations of arrhythmias. To state what is define as arrhythmia mechanisms. To state what is define as normal automaticity To state what is define as abnormal impulse imitation. To state what is define as triggered rhythms. To state what is define as abnormal impulse conduction To identify the arrhythmias in relation to each mechanisms. To diagnose arrhythmias. Module 3: Cardiac Arrhythmias: Mechanisums of Arrhythmias – Atrial, Ventricular, Conduction and ST Changes Developed by Tony Curran (Clinical Nurse Educator) and Gill Sheppard (Clinical Nurse Specialist) Cardiology, June 2011 Page 3 HOW TO USE THIS SELF LEARNING PACKAGE Follow the step outline to complete the Self Learning Package. 1) Read the two journal articles provided. 2) Read the information provided in the Self Leaning Package regarding arrhythmias. 3) Complete Question at the end of the package. 4) Diagnosing rhythms Strip provided at the end of the package. 5) Complete the Evaluation form 6) Once the above are completed return to your Clinical Nurse Educator or Clinical Nurse Specialist for marking. Following the completion of this module, you will receive 10 hours professional development hours, which will be credited to you education data base (CDHB). Module 3: Cardiac Arrhythmias: Mechanisums of Arrhythmias – Atrial, Ventricular, Conduction and ST Changes Developed by Tony Curran (Clinical Nurse Educator) and Gill Sheppard (Clinical Nurse Specialist) Cardiology, June 2011 Page 4 Module 3: Cardiac Arrhythmias: Mechanisums of Arrhythmias – Atrial, Ventricular, Conduction and ST Changes Developed by Tony Curran (Clinical Nurse Educator) and Gill Sheppard (Clinical Nurse Specialist) Cardiology, June 2011 Page 5 Module 3: Cardiac Arrhythmias: Mechanisums of Arrhythmias – Atrial, Ventricular, Conduction and ST Changes Developed by Tony Curran (Clinical Nurse Educator) and Gill Sheppard (Clinical Nurse Specialist) Cardiology, June 2011 Page 6 Module 3: Cardiac Arrhythmias: Mechanisums of Arrhythmias – Atrial, Ventricular, Conduction and ST Changes Developed by Tony Curran (Clinical Nurse Educator) and Gill Sheppard (Clinical Nurse Specialist) Cardiology, June 2011 Page 7 Module 3: Cardiac Arrhythmias: Mechanisums of Arrhythmias – Atrial, Ventricular, Conduction and ST Changes Developed by Tony Curran (Clinical Nurse Educator) and Gill Sheppard (Clinical Nurse Specialist) Cardiology, June 2011 Page 8 Module 3: Cardiac Arrhythmias: Mechanisums of Arrhythmias – Atrial, Ventricular, Conduction and ST Changes Developed by Tony Curran (Clinical Nurse Educator) and Gill Sheppard (Clinical Nurse Specialist) Cardiology, June 2011 Page 9 Module 3: Cardiac Arrhythmias: Mechanisums of Arrhythmias – Atrial, Ventricular, Conduction and ST Changes Developed by Tony Curran (Clinical Nurse Educator) and Gill Sheppard (Clinical Nurse Specialist) Cardiology, June 2011 Page 10