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Basic Dysrhythmia Interpretation

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Basic Dysrhythmia Interpretation NURS 108 Spring 2008 Majuvy L. Sulse RN, MSN,CCRN Cardiac Cycle Systole-simultaneous contraction of ventricles, lasts 0.28 sec ... – PowerPoint PPT presentation

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Title: Basic Dysrhythmia Interpretation


1
Basic Dysrhythmia Interpretation
  • NURS 108
  • Spring 2008

Majuvy L. Sulse RN, MSN,CCRN
2
Cardiac Cycle
  • Systole-simultaneous contraction of ventricles,
    lasts 0.28 sec
  • Diastole- ventricular relaxation, lasts 0.52 sec
  • One cardiac cycle occurs every 0.8 sec

3
Cardiac Cycle
  • Stroke volume-volume of blood (70cc) pumped out
    of one ventricle of the heart in a single
    contraction
  • Heart rate- number of contractions per
    minute(60-100bpm
  • Cardiac output-amount of blood pumped by the left
    ventricle in 1 minute (4-8L/min)
  • CO SV XHR

4
Cardiac Cycle
  • Preload-degree of myocardial fiber stretch at the
    end of diastole
  • Afterload-resistance against which the heart must
    pump to eject blood through the semilunar valves
    and into peripheral vessels
  • STARLINGS Law-the more the muscle fibers are
    stretched up to a certain point, the more
    forceful the subsequent contraction will be.
  • Systemic vascular resistance (impedance)- amount
    of opposition to blood flow offered by the
    arterioles, pressure the heart must overcome to
    open the aortic valve

5
Autonomic Nervous System
  • Sympathetic-prepares for physical activity-fight
    or flight response-norepinephrine (Adrenergic
    nerve endings)
  • Alpha-vasoconstriction
  • Beta
  • Beta 1-increase HR contractility
  • Beta 2-bronchial dilation vasodilation
  • Parasympathetic-rest digest function
  • Acetylcholine (cholinergic nerve endings)

6
Electrophysiologic Properties
  • Automaticity-ability to generate an electrical
    impulse spontaneously repetitively
  • Excitability-ability to be electrically
    stimulated or respond to an electrical stimulus
  • Conductivity-ability to receive an electrical
    stimulus and transmit to other cardiac cells
  • Contractility-also rhythmicity is the ability to
    shorten and cause contraction in response to an
    electrical stimulus-coordination of contraction
    to produce a regular heartbeat

7
Major electrolytes that affect Cardiac Function
  • 3 major cations
  • K-performs a major function in cardiac
    depolarization and repolarization
  • Sodium plays a vital part in myocardial
    depolarization
  • Calcium is important in myocardial depolarization
    and contraction.
  • Magnesium-acts as transporter for Na K across
    cellular membranes. Also plays an important
    function in muscular contraction

8
Movement of Ions
  • Resting cardiac cells (Polarization) inside the
    cell is negatively charged. K is greater in the
    cell Na greater outside the cell (positively
    charged)-Resting membrane potential
  • Depolarization (action Potential)-sodium-potassium
    exchanged pump resulting in positive polarity
    inside the cell membrane. Myocardial contraction
    occurs.
  • Repolarization-recovery or resting phase
    positive charges are again on the outside and
    negative charges in the inside

9
Refractory Periods
  • Ensures that the muscle is totally relaxed before
    another action potential occurs
  • Atrial muscle-0.15 sec
  • Ventricular muscle-.25-.30 sec

10
Refractory Periods
Absolute refractory period-cardiac muscle cannot
be depolarized. Corresponds to beginning of QRS
to peak of T wave Relative refractory
period-cardiac muscles stimulated to contract
prematurely if stimulus is stronger than normal.
Corresponds with down slope of T wave
11
Cardiac Conduction System
12
Electrical Conduction Pathway
  • SA node (60-100bpm)
  • Internodal pathways
  • AV node ( 40-60bpm)
  • Bundle of His
  • Bundle Branches
  • Purkenje networks (20-40bpm)

13
EKG
  • ECG/EKG-a graphic representation of cardiac
    activity
  • 12 lead-shows electrical activity from 12
    different planes of the heart-used as a
    diagnostic tool rather than a monitoring device
  • Electrode-adhesive pad that contains conductive
    gel and designed to be attached to skin
  • Leads-wires generally color coded. For the EKG to
    receive a clear picture of electrical impulses,
    there must be a positive, a negative and a
    ground. The exact portion of the heart being
    visualized depends on lead placement

14
EKG Leads
  • Baseline-isoelectric line-no current flow in the
    heart consists of positive, negative deflections
    or biphasic complex
  • 3 or 5 lead- used for monitoring the current
    cardiac activity of patients at risk for cardiac
    abnormalities
  • Lead ll or MCL1-modified chest leads mostly used
    because of ability to visualize P waves. MCL
    provides a R sided view of the heart. MCL6-L
    sided view of the heart

15
EKG Leads
  • Limb leads
  • Bipolar leads-measures activity between 2 points
    (I, II, III)
  • Unipolar leads-positive electrodes only-aVR, aVL,
    aVF
  • Chest leads-6 precordial leads

16
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17
LIMB LEADS AUGMENTED LEADS
18
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19
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20
EKG Graph Paper
21
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22
Segments and Intervals
23
Segments and Intervals
  • P wave-deflection representing atrial
    depolarization
  • PR segment-isoelectric line from end of P wave to
    beginning of QRS-impulse is traveling through the
    AV node. PR interval-0.12-0.20(time for atrial
    depolarization-AV node-Purkenje fibers)
  • QRS complex-ventricular depolarization. QRS
    duration of 0.04-.10 sec from QRS to J-point
  • ST segment-early ventricular repolarization from
    J-point to beginning of T wave. Elevations not
    more than 1 mm or deflections o.5 mm from
    isoelectric line
  • T wave- ventricular repolarization, usually
    rounded, positive deflection
  • U wave-smaller polarity as T wave-slow
    repolarization- not normally seen except in
    hypokalemia
  • QT interval-total time for ventricular
    depolarization and repolarization

24
HR Determination
  • 6 second method
  • count QRS complexes in a 6 sec strip x 10 (30
    large boxes in 6 sec strip)
  • P-P or R-R interval method
  • count number of small blocks in a P- P or R-R
    interval and divide into 1500 (no. of small
    blocks in 1 min)
  • Count the number of large blocks in an interval
    and divide into 300 (number of large blocks in 1
    minute)
  • Memory method

25
ECG Rhythm Analysis
  • Analyze P waves- P wave is present. shape is
    consistent, must be before each QRS
  • Analyze QRS complex- QRS complex is present
    consistent
  • Determine atrial rhythm or regularity- check
    regularity by assessing P-P or R-R
  • Determine ventricular rhythm or regularity-check
    regularity by assessing R-R
  • Determine heart rate-use one of the methods
  • Measure the PR interval-measurement should be
    constant and should be between 0.12-0.20
  • Measure the QRS duration-measurement should be
    constant and should be between 0.04-0.10 sec
  • Interpret the rhythm

26
General Rules
  • First most important, LOOK at your PATIENT!
  • Read every strip from left to right
  • Apply the systematic approach
  • Avoid shortcuts and assumptions.
  • Ask and answer each question in the ECG analysis
    approach

27
Artifacts
  • Waveforms outside the heart-interference caused
    by
  • Patient movement wandering baseline
  • Loose or defective electrodes-lost contact with
    patients skin
  • Improper grounding-in touch with an outside
    source of electricity
  • Faulty EKG apparatus

Patient assessment is critical
28
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29
Normal Sinus Rhythm
SA node generated an impulse that followed a
normal pathway, the heart rate falls within the
range, atrial ventricular rhythms are regular,
P waves preceded every QRS and QRS is within
0.12sec
30
Sinus Bradycardia
SA node fires slower than normal heart rate-less
than 60bpm Rhythm is regular P wave upright and
same shape PR is constant .12-.20sec QRS-normal
lt.12sec
31
Sinus Bradycardia
  • Causes
  • Vagal stimulation, MI, hypoxia
  • Digitalis toxicity
  • Medication side effects
  • Normal to athletes
  • Adverse effects
  • Dizziness, weakness, syncope, diaphoresis,
    pallor, hypotension
  • Treatment
  • According to symptoms, atropine to speed up heart
    rate, pacemaker

32
Sinus Tachycardia
SA node fires at a rate faster than normal but
conduction pathway is normal. All criteria for
interpretation are the same except that the heart
rate is faster.
33
Sinus Tachycardia
  • Causes
  • Emotionally upset, pain, fever, thyrotoxicosis,
    hypoxia, hypovolemia, inhibition of vagus nerve,
  • Caffeine, norepinephrine, theophylline
  • Adverse effects
  • Angina, dizziness, hypotension, increased in
    cardiac workload
  • Treatment
  • Treat the cause
  • Medications may be given- betablockers

34
Sinus Arrhythmia
  • The only irregular rhythm from the sinus node and
    has a cyclic pattern that usually corresponds
    with breathing
  • Rate- varies with respiratory pattern
  • Regularity-irregular in a repetitive pattern
  • P waves-Upright in most leads, same shape and one
    to each QRS P-P interval is irregular
  • QRS-lt.12 sec
  • Cause-usually caused by breathing pattern but can
    also heart disease
  • Treatment- usually non required

35
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36
Atrial Dysrhythmias
  • SA node fails to generate an impulse
  • Atrial nodes or internodal pathways may initiate
    an impulse and follows the conduction pathway
  • Dysrhythmias of this type are not lethal
  • Accessory pathway-irregular muscle connection
    between atria and ventricles that bypasses the AV
    node

37
Premature Atrial Contractions
  • Causes- atria becomes hyper and fire early caused
    by medications, caffeine, tobacco, hypoxia or
    heart disease
  • Adverse effects-if frequent can be a sign of
    impending heart failure or atrial tachycardia or
    fibrillation
  • Treatment-O2, omit caffeine, tobacco or other
    stimulants. Give digitalis or quinidine, treat
    heart failure.

38
Premature Atrial Contractions
Rate normal Rhythm usually regular except for a
PAC P waves shaped differently from a normal P
wave or hidden in preceding T wave PR
interval .12 to .20sec QRS .12sec similar to
underlying rhythm
39
Supraventricular Tachycardia (SVT)
  • Tachycardia (gt150 bpm) originating above the
    ventricles-SA node, atria, AV nodes
  • P waves not discernible-hidden in T waves
  • Paroxysmal-starts ends abruptly
  • Causes-same as PAcs
  • Adverse effects- palpitations, light-headedness,
    dizziness, shortness of breath, chest pain,
    fainting decreased cardiac output
  • Treatment-vagal maneuvers (cough, bear down),
    carotid massage, or medications digitalis,
    calcium channel blockers, beta blockers, Adenosine

40
Supraventricular Tachycardia (SVT)
Rate 150-250bpm Rhythm regular P waves not
discernible PR not discernible QRS usually
less than .10sec
41
Atrial Flutter
  • Results when one irritable atrial foci fires out
    regular impulses at a rapid rate that P waves are
    in a sawtooth pattern
  • Av node (gatekeepers) cannot depolarize fast
    enough to keep up, many impulses never get
    through to ventricles. Conduction ratio is
    variable-21block, 31 block or 41 block. Slow
    ventricular response-VR of lt60pm rapid VR
    gt100-150bpm)
  • Causes-acute MI, CHF, digitalis toxicity,
    pulmonary embolism, SA node disease, septal
    defects
  • Adverse effects-decreased cardiac output
  • Treatment-digitalis, cardioversion, calcium
    channel blockers, ablation

42
Atrial Flutter
Rate atrial 250-300bpm, ventricles-variable Rhyth
m regular if conduction ratio is constant,
irregular if conduction rate varies P
waves replaced by fluttery waves PRnot
measurable QRS lt.12sec
43
Atrial Fibrillation
  • Most common atrial dysrhythmia in elderly
    patients
  • Multiple atrial impulses from different locations
    all at the same time (350-600bpm)
  • Ventricular response maybe rapid (100-150bpm) or
    slow (lt 60bpm)
  • Causes-maybe chronic MI CHF, valvular heart
    disease, hyperthyroidism
  • Adverse effects-decreased cardiac output, blood
    clots which can cause MI, stroke or clot in the
    lung
  • Treatment- Digitalis, quinidine, cardizem,
    anticoagulant as coumadin, cardioversion

44
Atrial Fibrillation
45
Junctional Rhythms
  • Arrhythmia originating in AV node
  • HR 40-60bpm accelerated 60-100bpm junctional
    100-140bpm
  • P wave-absent, inverted before or after a QRS
  • PR interval-lt.12if P precedes a QRS
  • QRS lt.12sec
  • Cause-vagal stimulation, hypoxia, ischemia of SA
    node, MI, digitalis toxicity
  • Treatment-varies according to type of arrhythmia.
    Atropine to increase HR, withhold or decrease
    medication that can slow heart rate

46
Junctional Rhythms
47
Ventricular Dysrhythmias
  • Ventricles serves as pacemaker
  • Heart rate significantly reduced (20-40 beats per
    min
  • Normal conduction system bypassed
  • QRS bizarre in appearance gt0.12 sec
  • P waves absent (buried or hidden in QRS)
  • Rhythms considered life threatening

48
Premature Ventricular Complexes (PVCs)
  • A single ectopic (out of place) complex from an
    irritable site
  • Indicates increased myocardial irritability
  • Precursors of more serious lethal rhythms
  • Cardiac output compromised
  • Causes
  • Myocardial ischemia, Emotional stress, increased
    physical exertion, CHF, electrolyte imbalance,
    digitalis toxicity or acid base imbalances
  • Treatment- based on symptoms and causative
    factors
  • O2 and antidysrhythmics

49
PVCs
  • Unifocal-arise from one single site
  • Multifocal- originate from different sites
  • Ventricular bigeminy- every other beat is a PVC
  • Ventricular trigeminy-every third beat is a PVC
  • Ventricular quadrigeminy- every 4th beat is a PVC
  • Interpolated- a PVC between two sinus beats
  • Couplet or repititive PVCs- two PVCs occurring
    together without a normal complex in between
  • Salvos-3 or more PVCs in a row (Vtach)

50
Premature Ventricular Contraction (PVC)
Unifocal PVCs
Multifocal PVCs
51
Premature Ventricular Contraction (PVC
Bigeminy
NSR with Couplets
52
Ventricular Tachycardia
  • 3 or more PVCs in a row overriding pacemaker
  • Sustained-lasts more than 30 sec
  • Unsustained- less than 30 sec
  • Can be tolerated for short bursts but can cause
    profound shock if unconscious or untreated
  • Causes- as with PVCs
  • Treatment
  • Pulseless Vtach-treated like Vfib
  • Stable-drug intervention
  • Lidocaine, procainamide, amiodarone
  • Unstable- defibrillation

53
Ventricular Tachycardia
Rate 100-25bpm Regularity usually regular P
waves none PR will vary if present QRS
wide bizarre gt0.12
54
Ventricular Fibrillation (VFib)
  • Fatal, most common initial rhythm in cardiac
    arrest
  • Myocardial cells quiver rather than depolarized
  • Usually coarse (amplitude gt 3mm) then becomes
    fine (amplitude less than 3mm)
  • No cardiac output- cardiovascular collapse
  • Causes- MI, drug toxicity or overdose, hypoxia,
    CAD
  • Treatment- immediate defibrillation must be done,
    CPR, epinephrine (medications make
    defibrillations more successful and prevent
    recurrence

Prompt intervention is vital to survival
55
Ventricular Fibrillation (VFib)
Rate cannot be counted Regularity rapid, not
detectable P waves none QRS none detectable
56
Asystole
  • Cardiac standstill
  • Absence of all ventricular activity-no waveforms
  • Check on 2 leads-? Very fine Vfib
  • Clinical death-absence of pulse and respirations
  • Causes- MI, cardiac trauma, ventricular aneurysm,
    CHB
  • Treatment-atropine to reverse vagal influences,
    epinephrine, CPR, pacemaker, dopamine, O2

57
Ventricular Asystole
Rate zero Regularity none P waves none QRS none
58
Atrioventricular Blocks
  • Impulses in the SA node are blocked or
    delayed-heart blocks- (PR gt.20, some Ps not
    followed by QRS some P-P with regular interval
  • Underlying rhythm is sinus
  • Rate normal or slow-symptomatic or asymptomatic
  • Site of block is either AV node or bundle
    branches
  • First dgree
  • Second degree
  • Type l-Mobitz l
  • Type ll- Mobitz 2
  • Third degree

59
First degree AV block
  • Prolonged PR interval that results from a delay
    in the AV nodes conduction of sinus impulse to
    ventricles
  • All parameters are normal except for prolonged PR
    interval (hallmark of 1st degree)
  • Usually asymptomatic
  • Causes-AV node ischemia, digitalis toxicity, use
    of betablockers or calcium blockers
  • Treatment- treat cause

60
First Degree AV Block
Rate based on underlying rhythm Regularity usuall
y regular P waves upright, one to each QRS PR
interval gt .20 sec QRS lt.0.12 sec looks alike
61
Second Degree Block (Mobitz l (Wenckebach
  • Progressive prolongation of the impulse
  • Cyclic pattern is produced PR interval continues
    to increase in length until an impulse is not
    conducted (QRS dropped)
  • Atrial rhythm is regular but ventricles ar
    irregular
  • Cause-MI, digitalis toxicity, n\medication
    effects
  • Treatment-atropine if heart rate is slow
    asymptomatic, pacemaker.

62
Second Degree Block (Mobitz l (Wenckebach)
Rate-Atrial rate normal ventricular rate less
than atria Regularity-maybe regular or
irregular P waves-normal P PR interval
progressive prolongation QRSlt0.12 if at AV node
gt if block is at bundle branch
63
Second Degree Block-Mobitz ll
  • Increased risk of progression to 3rd degree
  • Ratio of P waves to QRS complexes (21 block, 31
    block or 41 block)
  • PR interval is constant or regular for every
    conducted beat
  • Intermittent absence of QRS
  • Causes-same as type l
  • Treatment-02, atropine if patient is symptomatic,
    epinephrine, dopamine, pacemaker if block
    continues and symptoms are present

64
Second Degree Block-Mobitz ll
Rate atrial 60-100 ventricular half of atrial
rate Regularityregular P waves Normal PR
interval constant QRS lt.12 sec or gt.12 sec if
BBB present
65
Third Degree or Complete Heart Block (CHB)
  • SA node sends out impulses as usual but not one
    is conducted to the ventricles
  • Atria ventricles beat independently of each
    other-AV dissociation
  • Rate- atria-60-100, Ventricles-20-60
  • Regularity-Regular
  • P waves- no relationship with QRS
  • PR interval- no pattern, varies
  • QRS-based on site of pacemaker
  • Cause-MI, lesion on conduction system, hypoxia,
    medication side effects
  • Treatment-pacemaker insertion

66
Third Degree or Complete Heart Block (CHB)
67
PACEMAKERS
68
PACEMAKERS
  • Device that substitutes for the normal pacemaker
    of the hearts electrical conduction system
  • Generator-controls rate strength of each
    electrical impulse
  • Lead wires-electrode at the tip relay the
    electrical impulse from the generator to the
    myocardium
  • Types
  • Temporary-used to sustain HR in an emergency
    situation
  • Transcutaneous (TCP)-external cardiac pacing
  • Transvenous-lead wire threaded through the skin
    into a large vein
  • Permanent- implanted in patients chest

69
Indications for insertion of Pacemakers
  • Temporary
  • Suppression of ectopic atrial or ventricular
    rhythm
  • Acute MI with symptomatic bradycardia, 2nd 3rd
    degree AV block or bundle branch block
  • Maintenance of adequate HR during special
    procedures or as prophylaxis after an open heart
    surgery
  • Termination of AV nodal reentry
  • Permanent-
  • Chronic atrial fibrillation with slow ventricular
    response
  • Fibrotic or sclerotic changes in the cardiac
    conduction system
  • Sick sinus syndrome or Sinus node dysfunction
  • Tachyarrhythmias
  • Symptomatic bradycardia and Third degree AV block
    not responding to pharmacologic interventions

70
Permanent Pacemakers
  • Atrial- lead wire inserted into the Right
    atrium-stimulates the atrium then travels down
    the electrical conduction through the ventricles

71
Permanent Pacemakers
  • Ventricular- lead wire inserted into the Right
    ventricle. The electrical impulse from the
    pacemaker generator produces ventricular
    depolarization

72
Permanent Pacemakers
  • AV sequential- two electrodes on the lead wire
    one placed on the R atrium one on the R
    ventricle. Artificial impulses stimulate or pace
    first the atria, then the ventricles

73
Rules for interpretation of Pacemaker Rhythms
  • Same as for dysrhythmias
  • Remember Properly functioning pacemakers will
    produce rhythms with pacemaker spikes. Spikes
    indicates only that the pacemaker is firing. They
    do not reveal information relative to ventricular
    contraction. Assess your patient for presence of
    symptoms

74
Code System
  • 1st letter-chamber being paced
  • A-atrium
  • V-ventricle
  • D-dual (both)
  • 2nd letter- chamber sensed
  • A-atrium
  • V-ventricle
  • D-dual (both
  • O-off
  • 3rd letter- type of response by pacemaker to
    sensory
  • I-Inhibited (pacemaker will not function when the
    persons heart beats
  • O-none
  • T-triggered
  • D-dual

75
Code System
  • 4th letter- ability of generator to be programmed
  • O-none
  • P-Simple programmability
  • M-Multi programmability
  • C-Telemetry ability
  • P-ability of rate to change with activity
  • 5th letter-ability of generator to defibrillate
  • P-Antitachycardia
  • S-Shock
  • D-antitachycardia processing shock
  • O-none

76
Common Problems associated with Pacemakers
  • Battery failure
  • Decreased amplitude of pacemaker spike and a
    slowing pacemaker rate
  • Immediate transport to the hospital depending on
    the patients symptoms or underlying rhythm
  • Runaway Pacemakers
  • Rapid rate of electrical impulse discharge
    results
  • Immediate transport to a hospital

77
Failure to Sense
  • Failure to sense -pacemaker fails to sense the
    patient's own intrinsic rhythm and generates a
    pacer spike in the intrinsic rhythm's own QRS,
    absolute or relative refractory period of the T
    wave. The ventricular capture following the pacer
    spike may or may not occur. This can cause lethal
    arrhythmia. Failure to sense can be caused when
    the sensitivity setting is too low. 

78
Failure to Sense
  • EKG Characteristics Rate It may be regular or
    irregular. Rhythm It can be any intrinsic rhythm
    in which the pacemaker spike is in the QRS,
    absolute, or relative refractory period of the T
    wave. QRS complex It is within the normal limits
    of the intrinsic rhythm.
  • Nursing Intervention Obtain the blood pressure,
    pulse, respiratory rate, O2 saturation and notify
    the MD. Closely observe for ventricular
    tachycardia caused by failure to sense.

79
Failure to Capture
  • Failure to capture of a pacemaker happens when
    the output is too low, resulting in a failure to
    depolarize the ventricle, which causes an absence
    of a mechanical contraction of the ventricle, or
    no QRS. It can occasionally happen or be
    constantly happening which results in ventricular
    standstill and a pulse-less patient.
  • EKG Characteristics Rate It will be irregular
    due to the failure to produce QRS. Rhythm The
    pacemaker spike or spikes will not have a QRS
    following them. P Wave It may be absent or
    present. QRS Complex A loss of a QRS behind a
    pacer spike.

80
Failure to Capture
  • Nursing Intervention Should the loss to capture
    be occasional, one should get a blood pressure,
    pulse rate, respiration rate, and O2 saturation.
    This is to determine if the patient is tolerating
    the failure to capture. If the failure to capture
    is continuous, the patient will be pulse-less or
    have a symptomatic bradycardia. This can range
    from a situation in which medication may be
    needed, or a code situation in which one would
    follow hospital protocol. External pacing may be
    an option for this patient

81
Pre-procedure Post procedure care
  • Consent
  • VS
  • Skin prep
  • Pre-op checklist-NPO, dentures, pins
  • Position post op is important
  • Maintain hemodynamic stability
  • Prevent complications

82
Patient family Teaching Guides
  • Follow the instructions for pacemaker site skin
    care. Report any fever or redness, swelling, or
    drainage from incision site.
  • Keep your pacemaker identification card in your
    wallet and wear a medical alert bracelet
  • Take your pulse for 1 full minute at the same
    time each day and record the rate in your
    pacemaker diary. Take your pulse anytime you feel
    symptoms of a possible pacemaker failure and
    report them to your physician.

83
Patient family Teaching Guides
  • Know the rate at which your pacemaker is set and
    the basic functioning of your pacemaker, battery
    failure. Know what changes to report to your
    physician.
  • Report any of the following symptoms to your
    physician dizziness, difficulty of breathing,
    fainting, chest pain, weight gain, and prolong
    hiccupping. If you have any of these symptoms,
    check your pulse and call your physician.
  • Take all medications, follow prescribed diet,
    activity restrictions
  • Do not apply pressure over the generator. Avoid
    tight clothing or belts.

84
Patient family Teaching Guides
  • Do not operate electrical appliances over
    pacemaker as they may cause malfunction.
  • Be sure electrical appliances or motors are
    properly grounded.
  • Avoid all transmitter towers for radio, TV and
    radar. Radios, TV, other home appliance and
    antennas do not pose a hazard.
  • Inform airport personnel and show ID card before
    passing through the metal detector.

85
Automatic Implantable Cardioverter-Defibrillator
  • Lead placed via the subclavian into the
    endocardium
  • Generator is implanted subcutaneously over the
    pectoralis muscle
  • Monitors HR/rhythm and identifies ventricular
    tachycardia ventricular fibrillation
  • Delivers a shock (25 joules) to the heart muscle
    upon sensing a lethal arrhythmia
  • Some newer ICDs are equipped with antitachycardia
    and antibradycardia pacers- initiates
    ovrdrivepacing to prevent painful shocks

86
Patient Family teaching guide for AICD
  • Maintain close follow up with physician for
    testing ICD function inspection of site
  • Medic alert should be worn information about
    the ICD should be available
  • Watch for signs of infection
  • Avoid lifting operative side arm above shoulder
    for about a week
  • Avoid direct blows to ICD site

87
Patient Family teaching guide for AICD
  • When traveling, inform airport official about
    presence of AICD
  • When ICD fires
  • Routine checks with programmer device needed-2-3
    months
  • Family members should learn CPR
  • Avoid electromagnetic forces that may turn off
    device
  • Participate in ICD support groups
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