BOOK
Cardiac Arrhythmias, An Issue of Critical Care Nursing Clinics of North America, E-Book
(2016)
Additional Information
Book Details
Abstract
A cardiac dysrhythmia is a disturbance in the cardiac rhythm which can be normal (e.g., sinus arrhythmia) or instantly lethal (e.g., sustained ventricular tachycardia). This issue of Critical Care Nursing Clinics of North America will provide state of the art diagnostic and treatment information for cardiac dysrhythmias as well as addressing how to achieve the most accurate diagnostic approach to interpreting an electrocardiogram, which is omnipresent in critical care and of critical importance in diagnosing arrhythmias. Articles in this issue are devoted to: The Normal Cardiac Conduction System; The Normal Electrocardiogram: Resting 12-lead and Continuous Cardiac Rhythm Strips; Premature Beats; Paroxysmal Supraventricular Tachycardia, Including the Special Type Called Wolff-Parkinson-White; Atrial Fibrillation, The Most Common Type of Supraventricular Arrhythmia; Ventricular Tachycardia and Its Disorganized Counterpart, Ventricular Fibrillation; Brady-Dysrhythmias, When Heart Rate Slows Myocardial Ischemia & Infarction and their Relationship to Dysrhythmias; Pharmacologically Induced Dysrhythmias; and Implantable Cardiac Devices and their Role in Dysrhythmias Management.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| Cardiac Arrhythmias\r | i | ||
| Copyright\r | ii | ||
| Contributors | iii | ||
| CONSULTING EDITOR | iii | ||
| EDITOR | iii | ||
| AUTHORS | iii | ||
| Contents | v | ||
| Preface: Cardiac Arrhythmias\r | v | ||
| The Cardiac Conduction System: Generation and Conduction of the Cardiac Impulse\r | v | ||
| The Normal Electrocardiogram: Resting 12-Lead and Electrocardiogram Monitoring in the Hospital\r | v | ||
| Bradyarrhythmias: Clinical Presentation, Diagnosis, and Management\r | v | ||
| Paroxysmal Supraventricular Tachycardia: Pathophysiology, Diagnosis, and Management\r | vi | ||
| Ventricular Tachycardias: Characteristics and Management\r | vi | ||
| Cardiac Monitoring in the Emergency Department\r | vi | ||
| Acute Coronary Syndrome and ST Segment Monitoring\r | vi | ||
| Basic Cardiac Electrophysiology and Common Drug-induced Arrhythmias\r | vii | ||
| Arrhythmias and Cardiac Bedside Monitoring in the Neonatal Intensive Care Unit\r | vii | ||
| In-Hospital Cardiac Arrest: An Update on Pulseless Electrical Activity and Asystole\r | vii | ||
| CRITICAL CARE NURSING\rCLINICS OF NORTH AMERICA\r | viii | ||
| FORTHCOMING ISSUES | viii | ||
| December 2016 | viii | ||
| March 2017 | viii | ||
| June 2017 | viii | ||
| RECENT ISSUES | viii | ||
| June 2016 | viii | ||
| March 2016 | viii | ||
| December 2015 | viii | ||
| Preface: Cardiac Arrhythmias\r | ix | ||
| DEDICATION | x | ||
| The Cardiac Conduction System | 269 | ||
| Key points | 269 | ||
| INTRODUCTION | 269 | ||
| THE UNDERLYING PRINCIPLES BEHIND THE HEARTBEAT | 270 | ||
| Electrolytes and Concentration Gradients | 270 | ||
| Depolarization and Repolarization | 271 | ||
| Action Potential of a Cardiac Myocyte | 271 | ||
| Action Potential of a Pacemaker Cell | 272 | ||
| THE CONDUCTION SYSTEM OF THE HEART | 273 | ||
| Atrial Activation | 273 | ||
| The Sinoatrial Node | 273 | ||
| Internodal Pathways | 273 | ||
| VENTRICULAR ACTIVATION | 274 | ||
| The Atrioventricular Node | 274 | ||
| The Bundle of His, Bundle Branches, and the Purkinje Network | 275 | ||
| FACTORS THAT INFLUENCE THE CARDIAC CONDUCTION SYSTEM | 275 | ||
| Autonomic Regulation | 275 | ||
| Abnormalities of the Conduction System | 275 | ||
| THE CARDIAC CONDUCTION SYSTEM AND THE ELECTROCARDIOGRAM | 276 | ||
| SUMMARY | 278 | ||
| REFERENCES | 278 | ||
| The Normal Electrocardiogram | 281 | ||
| Key points | 281 | ||
| INTRODUCTION OF THE ELECTROCARDIOGRAPH | 281 | ||
| Historical Highlights | 282 | ||
| Ubiquitous Use in Modern Intensive Care | 282 | ||
| THE NORMAL RESTING 12-LEAD ELECTROCARDIOGRAM | 282 | ||
| Orientation to the Resting 12-lead Electrocardiogram | 282 | ||
| ELECTRODES AND LEADS | 283 | ||
| Standard Electrode Placement | 283 | ||
| Patient and Skin Preparation | 285 | ||
| Spatial Orientation | 285 | ||
| Polarity | 285 | ||
| Standard Leads | 285 | ||
| Augmented Leads | 286 | ||
| Chest Leads | 286 | ||
| Mason-Likar Lead Placement | 286 | ||
| Electrocardiogram Waves and Time Intervals | 287 | ||
| Sinus Rhythm | 287 | ||
| Waveform Deflection | 290 | ||
| QRS Axis | 290 | ||
| Electrocardiogram Case Study | 290 | ||
| CONTINUOUS ELECTROCARDIOGRAM MONITORING IN THE HOSPITAL | 290 | ||
| Overview of Electrocardiogram Monitoring in Intensive Care | 290 | ||
| Lead Configuration for Continuous Monitoring | 292 | ||
| Indications for Monitoring | 292 | ||
| Skills and Responsibilities for Monitoring | 293 | ||
| FUTURE DIRECTIONS | 294 | ||
| SUMMARY | 294 | ||
| REFERENCES | 294 | ||
| Bradyarrhythmias | 297 | ||
| Key points | 297 | ||
| INTRODUCTION | 297 | ||
| DEFINITION OF BRADYCARDIA | 297 | ||
| BRIEF OVERVIEW OF THE SINOATRIAL NODAL CONDUCTION SYSTEM | 298 | ||
| TYPES OF BRADYARRHYTHMIAS | 298 | ||
| CAUSES OF BRADYARRHYTHMIAS | 299 | ||
| Athletes | 299 | ||
| Aging | 300 | ||
| Medications | 301 | ||
| Genetics | 301 | ||
| Acute Myocardial Ischemia of Infarction | 302 | ||
| Seizures | 302 | ||
| Gender | 302 | ||
| Other Conditions | 302 | ||
| CLINICAL PRESENTATION | 302 | ||
| EVALUATION AND DIAGNOSIS OF BRADYARRHYTHMIAS | 302 | ||
| Diagnostic Testing | 303 | ||
| MANAGEMENT | 303 | ||
| Pharmacologic Therapy | 304 | ||
| Atropine sulfate | 304 | ||
| Alternative medications | 304 | ||
| Cardiac Pacing | 305 | ||
| Temporary pacing | 305 | ||
| Permanent pacing | 305 | ||
| SUMMARY | 306 | ||
| REFERENCES | 306 | ||
| Paroxysmal Supraventricular Tachycardia | 309 | ||
| Key points | 309 | ||
| INTRODUCTION | 309 | ||
| DEFINITION AND PREVALENCE | 310 | ||
| MECHANISM AND PATHOPHYSIOLOGY | 310 | ||
| Case history | 310 | ||
| CAUSE AND CLINICAL SIGNIFICANCE | 312 | ||
| ELECTROCARDIOGRAPHIC CHARACTERISTICS | 313 | ||
| DIAGNOSTIC TESTING AND MANAGEMENT | 313 | ||
| PROGNOSIS | 315 | ||
| SUMMARY | 315 | ||
| Case study discussion | 315 | ||
| REFERENCES | 316 | ||
| Ventricular Tachycardias | 317 | ||
| Key points | 317 | ||
| INTRODUCTION | 317 | ||
| NONSUSTAINED VENTRICULAR TACHYCARDIA | 318 | ||
| Management | 319 | ||
| Sequence of Actions | 319 | ||
| SUSTAINED VENTRICULAR TACHYCARDIA | 319 | ||
| Electrocardiogram Characteristics | 321 | ||
| Management | 321 | ||
| Sequence of Actions | 321 | ||
| VENTRICULAR FIBRILLATION | 323 | ||
| Electrocardiogram Characteristics | 324 | ||
| Management | 324 | ||
| Sequence of Actions | 324 | ||
| Torsades de Pointes | 325 | ||
| Electrocardiogram Characteristics | 325 | ||
| Management | 325 | ||
| Sequence of Actions | 326 | ||
| SUMMARY | 326 | ||
| REFERENCES | 327 | ||
| Cardiac Monitoring in the Emergency Department | 331 | ||
| Key points | 331 | ||
| INTRODUCTION | 331 | ||
| ARRHYTHMIA MONITORING IN THE EMERGENCY DEPARTMENT | 332 | ||
| Cardiac Arrest | 332 | ||
| Acute Coronary Syndrome | 332 | ||
| Heart Failure and/or Pulmonary Edema | 334 | ||
| Atrioventricular Block | 334 | ||
| After Cardiac Surgery | 334 | ||
| Syncope | 334 | ||
| ISCHEMIA MONITORING IN THE EMERGENCY DEPARTMENT | 334 | ||
| The 12-Lead Electrocardiogram | 335 | ||
| Electrocardiographic Signs of Ischemia | 335 | ||
| Serial Electrocardiographic Monitoring | 336 | ||
| Continuous ST-Segment Monitoring in the Emergency Department | 337 | ||
| Reduced Lead Sets | 338 | ||
| QT INTERVAL MONITORING | 338 | ||
| SUMMARY | 342 | ||
| REFERENCES | 342 | ||
| Acute Coronary Syndrome and ST Segment Monitoring | 347 | ||
| Key points | 347 | ||
| INTRODUCTION | 347 | ||
| MYOCARDIAL INFARCTION | 348 | ||
| ST Elevation Myocardial Infarction | 348 | ||
| Electrocardiographic Patterns | 349 | ||
| Regional, Not Global | 349 | ||
| Non–ST Elevation Myocardial Infarction | 351 | ||
| UNSTABLE ANGINA | 351 | ||
| Electrocardiographic Patterns | 351 | ||
| ST SEGMENT MONITORING | 352 | ||
| Asymptomatic Myocardial Ischemia and Infarction | 352 | ||
| Indications | 352 | ||
| Reducing False-Positive Alarms | 353 | ||
| SUMMARY | 353 | ||
| REFERENCES | 353 | ||
| Basic Cardiac Electrophysiology and Common Drug-induced Arrhythmias | 357 | ||
| Key points | 357 | ||
| INTRODUCTION | 357 | ||
| CARDIAC ACTION POTENTIAL | 358 | ||
| INTRINSIC MECHANISMS OF ARRHYTHMIA | 359 | ||
| Abnormal Automaticity | 360 | ||
| Triggered Activity | 360 | ||
| Re-entry | 360 | ||
| EXTRINSIC MECHANISMS OF ARRHYTHMIA | 361 | ||
| Acquired Long QT Syndrome | 363 | ||
| Clinical features | 363 | ||
| Treatment | 363 | ||
| Acquired Short QT Syndrome | 364 | ||
| Clinical features | 364 | ||
| Treatment | 364 | ||
| ANTIARRHYTHMICS AND PROARRHYTHMIA | 365 | ||
| Class I, Sodium Channel Blockade Arrhythmias | 365 | ||
| Clinical features | 366 | ||
| Treatment | 366 | ||
| Class IV, Calcium Channel Blockade Arrhythmias | 366 | ||
| Clinical features | 367 | ||
| Treatment | 367 | ||
| Class V, Other and Unknown Mechanisms of Action | 368 | ||
| Class II, Antisympathetic Agents | 368 | ||
| SUMMARY | 368 | ||
| ACKNOWLEDGMENTS | 369 | ||
| REFERENCES | 369 | ||
| Arrhythmias and Cardiac Bedside Monitoring in the Neonatal Intensive Care Unit | 373 | ||
| Key points | 373 | ||
| INTRODUCTION | 373 | ||
| THE PHYSIOLOGY OF A NEONATE: THE FIRST 28 DAYS OF LIFE | 374 | ||
| THE NORMAL ELECTROCARDIOGRAM OF THE NEONATE HEART | 374 | ||
| Electrocardiogram Leads | 375 | ||
| CARDIAC ARRHYTHMIAS IN THE NEONATE HEART | 375 | ||
| CLASSIFICATION OF ARRHYTHMIAS | 376 | ||
| Benign Arrhythmias | 377 | ||
| Sinus bradycardia | 377 | ||
| Sinus tachycardia | 377 | ||
| Premature atrial contractions | 378 | ||
| Premature ventricular contractions | 378 | ||
| Nodal or junctional rhythm | 378 | ||
| Nonbenign Arrhythmias | 378 | ||
| Supraventricular tachycardia | 378 | ||
| Wolff-Parkinson-White | 378 | ||
| Atrial flutter | 380 | ||
| Heart block | 380 | ||
| Ventricular tachycardia | 380 | ||
| Ventricular fibrillation | 380 | ||
| Long QT syndrome | 381 | ||
| Sudden infant death syndrome | 381 | ||
| MECHANISMS OF ARRHYTHMIAS | 381 | ||
| Intrinsic Cardiac Arrhythmias | 381 | ||
| Accessory pathways | 381 | ||
| Sinoatrial node dysfunction | 381 | ||
| Acquired Cardiac Arrhythmias | 382 | ||
| Electrolyte imbalance | 382 | ||
| Medications | 383 | ||
| TREATMENT OF NEONATAL ARRHYTHMIAS | 383 | ||
| NONCARDIAC APPLICATIONS FOR BEDSIDE CARDIAC MONITORING | 383 | ||
| Early Detection of Sepsis | 383 | ||
| FUTURE RESEARCH | 384 | ||
| SUMMARY | 384 | ||
| REFERENCES | 385 | ||
| In-Hospital Cardiac Arrest | 387 | ||
| Key points | 387 | ||
| INTRODUCTION | 387 | ||
| DEFINITIONS | 388 | ||
| Pseudo-Pulseless Electrical Activity and True Pulseless Electrical Activity | 388 | ||
| Asystole | 388 | ||
| In-Hospital Cardiac Arrest | 389 | ||
| PROFESSIONAL ORGANIZATIONS COMMIT TO IMPROVE SURVIVAL RATES IN CARDIAC ARRESTS | 389 | ||
| EPIDEMIOLOGY OF PULSELESS ELECTRICAL ACTIVITY AND ASYSTOLE | 390 | ||
| Incidence | 390 | ||
| Trends of Cardiac Arrhythmias | 390 | ||
| Survival Rates | 390 | ||
| Locations | 391 | ||
| Short-Term and Long-Term Outcomes | 391 | ||
| NONSHOCKABLE RHYTHMS IN CARDIAC AND NONCARDIAC DISEASES | 391 | ||
| NURSING PERSPECTIVE | 392 | ||
| Work Environment and Nursing Staffing | 392 | ||
| Resources | 393 | ||
| Training | 393 | ||
| SUMMARY | 394 | ||
| ACKNOWLEDGMENTS | 394 | ||
| REFERENCES | 394 |