Ventricular Arrhythmia

Ventricular Arrhythmia

1. Pathophysiology

   • Associated with Coronary Artery Disease (Goyal, 2014)
   • Intracellular calcium accumulation (Goyal, 2014).
   • Metabolic alterations (Goyal, 2014)
   • As the heart loses ability to pump, ischemia sets in (Goyal, 2014)
   • Premature complex establish reentrant patterns that cause depolarization (Goyal, 2014)
   • Chaotic and irregular ECG pattern (Goyal, 2014)

2. Clinical Manifestations

   • Long QT Syndrome (Compton, 2015)
   • Short QT Syndrome (Compton, 2015)
   • Brugada Syndrome (Compton, 2015)
   • Previous Myocardial Infarction (Compton, 2015).
   • Lightheadedness (Compton, 2015)
   • Syncope (Compton, 2015)
   • Chest Pain (Compton, 2015)
   • Anxiety (Compton, 2015)
   • Sense of “neck fullness” related to increased pressure (Compton, 2015)
   • Dyspnea (Compton, 2015)
   • Sometimes asymptomatic (Compton, 2015)

3. Risk Factors

   • A previous episode of ventricular fibrillation (Down & Graboys, 2007)
   • A previous heart attack (Down & Graboys, 2007)
   • A heart defect you're born with (Down & Graboys, 2007)
     • Congenital heart disease ( Down& Graboys, 2007)
   • Heart muscle disease (Down & Graboys, 2007
     • Cardiomyopathy (Down & Graboys, 2007)
   • Injuries that cause damage to the heart muscle (Down & Graboys, 2007)
   • Use of illegal drugs (Down & Graboys, 2007)
   • Significant electrolyte abnormalities (Down & Graboys, 2007)

4. Types

   • Ventricular Tachycardia
     • Rapid Heart rate of 150bpm-250bpm (O’Riordan, n.d)
     • May prevent heart from pumping blood to the rest of the body; resulting in lack of blood to vital organs (O’Riordan, n.d).
     • Occurs when an ectopic focus/foci fire reptetively and ventricle takes control as pacemaker (O'Riordan, n.d.)
     • Different contraction types (O'Riordan, n.d)
       • Multifocal PVS
       • Ventricular trigemini
       • Couplet
       • Ventricular bigeminy
     • Patient can be stable or unstable
     • Can result in hypotension, pulmonary deem, decreased cerebral flow, or cardiopulmonary arrest
     • Must be treated immediately
     • Severe decrease of cardiac output
   • Premature Ventricular Beats
     • Extra abnormal heartbeats from the ventricles (O’Riordan, n.d).
     • Extra beats disrupt the normal heart rhythm (O’Riordan, n.d).
   • Ventricular Fibrillation
     • Rapid heart rate, over 300bpm (O’Riordan, n.d).
     • Electrical activation of the ventricles does not show a specific or repetitive pattern (O’Riordan, n.d). .
     • Severe derangement of heart rhythm
     • Characterized on ECG by irregular indications of varying shapes and amplitudes
     • Firing of multiple ectopic foci in ventricle
     • No cardiac output. No pulse.
     • Immediate initiation of CPR required

5. Potential Issue

   • Decreased Electrical Factors
     • Nursing Interventions
       • Assess neurological state for changes from baseline assessment
       • Conduct continuous cardiac monitoring
       • Document rhythm strip as changes in rhythm occur.
       • Assess Vital Signs
       • Notify doctor
   • Insufficient oxygen
     • Nursing interventions

6. Risk Factors

   • Heart Attack
   • Heart Failure
   • Thick heart tissue
   • Leaking or narrowed heart valves
   • Congenitial heart defects
   • High blood pressure
   • Diabetes
   • Sleep apnea
   • Thyroid gland issues
   • Infections that effect the heart

7. Living with Arrhythmia

   • Ongoing
     • Take medications as prescribed (Bytesnik, 2003)
     • Notify doctor of any side effects (Bytesnik, 2003)
   • Lifestyle
     • Healthy diet
     • Physical activity
     • Smoking cessation
     • Stress control
     • Maintain healthy weight

8. Treatment

   • Pharmaceutical (Bytesník, 2003)
     • Antidysrhythmics, Ib (Goyal, 2014)
     • Antidysrhythmics, III (Goyal, 2014)
     • Antidysrhythmics, V (Goyal, 2014)
     • Vasopressors (Goyal, 2014)
   • Non-Pharmaceuticals (Bytesnik, 2003)
     • Cardiac Catheterization (Bytesník, 2003)
     • Surgical Ablation of the arrhythmogenic substrate (Bytesník, 2003)
     • Cardioverter-defibrillator (Bytesník, 2003)
     • Large number do not survive ventricular fibrillation (Bytesník, 2003)
   • Combination of pharmaceutical and non-pharmaceutical interventions (Bytesník, 2003)
   • Emergency (Bytesník, 2003)
     • CPR (Bytesník, 2003)
     • Defibrillation (Bytesník, 2003)
   • Treatment to Prevent Future Episodes
     • Medications (Bytesník, 2003)
       • anti-arrhythmic (Bytesník, 2003)
     • Implantable cardioverter-defibrillator (Bytesník, 2003)
     • Coronary angioplasty and stent placement (Bytesník, 2003)
     • Coronary bypass surgery (Bytesnik, 2003)

9. Diagnoses

   • History
     • Palpitation
     • Lightheadedness
     • Syncopse
     • Chest pain
     • Dyspnea
     • Prior myocardial infarction
     • Known structural heart disease
     • Family history of premature sudden death
   • Physical exam
   • Electrocardiogram
   • Holter monitor
   • Blood test
   • Chest x-ray
   • Echocardiography
   • Stress test
   • Electrophysiology study
   • Tilt table testing
   • Coronary angiography
   • Implantable loop recorder
   • Physical Exam
     • Vital signs
       • Tachycardia
       • Hypotension
       • Tachypnea
     • Diminished perfusion
       • Pallor
       • Loss of consciousness
       • Diaphoresis
     • Increased jugular venous pressure
     • Heart rhythm
       • Murmur
       • S3 gallop
       • Rales

10. What lifestyle changes can help

    • Smoking cessation (Goyal, 2014)
    • Limit alcohol intake (Goyal, 2014)
    • Limit caffeine (Goyal, 2014)
    • Stay away from stimulants used in cough and cold medications (Goyal, 2014)

11. Etiology

    • Coronary disease(National Heart Blood and Lung Institute, 2011)
      • Coronary artery disease
      • Cardiomypathy
    • Electrolyte imbalances in your blood (National Heart Blood and Lung Institute, 2011)
      • Potassium (National Heart, Blood, and Lung Institute, 2011)
      • Calcium (National Heart, Blood, and Lung Institute, 2011)
    • Structural heart disease (National Heart Blood and Lung Institute, 2011)
    • Injury from a heart attack (National Heart Blood and Lung Institute, 2011)
    • Cardiomypathy (National Heart Blood and Lung Institute, 2011)
    • Can occur in "normal, healthy" hearts (National Heart Blood and Lung Institute, 2011)
    • Ischemic heart disease (National Heart Blood and Lung Institute, 2011)
    • Heart failure (National Heart Blood and Lung Institute, 2011)
    • Inherited (National Heart Blood and Lung Institute, 2011)
    • Rare cases (National Heart Blood and Lung Institute, 2011)
      • Medications (National Heart Blood and Lung Institute, 2011)
      • Excessive caffeine (National Heart Blood and Lung Institute, 2011)
      • Excessive alcohol consumption (National Heart Blood and Lung Institute, 2011)
      • Intense exercise (National Heart Blood and Lung Institute, 2011)
    • Acute MI
    • May occur during insertion of cardiac pace/catheter
    • Mitral valve prolapse

12. Complications