4. Location? Supraventricular? Could be SA node
• SA node is not coordinated……
• atrial contraction not effective
http://lysine.pharm.utah.edu/netpharm/netpharm_00/gifs/arrhythmia_gifs/atrial_fib.gif
5. Atrial Arrhythmias
• Atrial fibrillation
– >400bpm
– Not immediately fatal
– But… embolisation highly likely
• Premature atrial contraction (PAC)
– “Skips”
– Caffeine, stress
• SVT
– Can be genetic, short spurts of rapid beats
6. Possible causes of AF
• MI – 90% of pt with MI experience arrhythmia
• Idiopathic?
• Drugs
– e.g. caffeine, nicotine, alcohol, pseudoephedrine
• lots of other reasons, too!
7. Atrial Fibrillation Treatment Goals
• Restore normal sinus rhythm
– Drugs – antiarrhythmics
– Cardioversion?
• Control ventricular rate during AF
– Drugs – antiarrhythmics
• Prevention of blood clot formation.
– Drugs – anticoagulants
8. Cardioversion vs defibrillation
• Cardioversion refers to elective procedure to
restore normal SA node control…common in
AF not responsive to drugs
• Defibrillation…….. Refers to emergent shock
applied
• Both will stop all electrical activity
• Several YouTube videos available to see the
procedure…..
9. Nodal? AV node
• If the p wave is not always transmitted to the
ventricles
• “blocked” at the AV node
• In third degree block: Ventricles have a
separate pacemaker, 2 different rhythms going
on…an atrial rhythm and a ventricular (slower)
rhythm……
• Must implant a mechanical pacemaker
12. VF
• Fibrillation is an uncontrolled twitching or
quivering of muscle fibers (fibrils).
• During ventricular fibrillation, blood is not
pumped.
• Sudden cardiac death results.
• The most common cause of VF is MI.
• However, VF can occur whenever the heart does
not get enough oxygen or if a person has other
heart disorders…
• electrocution!
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0004467/
26. Definitions
Rheumatic Fever:
• is a complication following Group A
Streptococcus infection (sore throat)
• damages collagen fibrils & ground substance
of connective tissue
• affects mostly heart, joints, CNS, skin.
• Outcomes include Rheumatic Heart Disease,
Rheumatoid arthritis, and mental illness.
(Franks, 2002; McCance & Huether, 2002).
27. Streptococcus Infection
• Reservoirs of infection
– Group A Streptococcus pyogenes – endogenous in oral cavity
(5% of ATSI)
– Group A Streptococcus pyoderma – endogenous in skin (70% of
ATSI)
– dried (months) in dust & mucus
• Portal of Entry
– Pharyngeal mucous membranes
– Skin damage
• Scratched pimples or scabies (esp. low socioeconomic
communities, living with animals, rural)
(Currie & Brewster, 2001; Franks, 2002; McCance & Huether, 2002).
28. Rheumatic Fever
• Streptococcus antibodies
• Once the immune system has removed the
bacteria, antibodies may attack normal “self”
tissue
– Collagen fibrils
– Connective tissues
– Basement substances (under endothelium)
34. What is Heart Failure?
• Heart cannot circulate enough blood to supply
organs with sufficient oxygen, nutrients to
support cells
• Common end-point for many cardiac diseases
• Long-term, slow decline of Cardiac Output
• Compensatory mechanisms
• Eventual failure
35. What Causes Heart Failure?
Any health condition that either damages the
heart or makes it work too hard
Coronary artery disease > ischemia
Myocardial infarction
Hypertension (↑ peripheral resistance)
Abnormal heart valves
Cardiomyopathy
Heart inflammation (myocarditis &
pericarditis)
3/28/2012 35
37. Stages in the Evolution of Heart
Hypertension
Diabetes,
Failure
Hypercholesterolemia A
Heart disease
(any) B
Asymptomatic
LV dysfunction
Systolic / Diastolic
C
Dyspnea, Fatigue
Reduced exercise
tolerance
D
Marked symptoms
at rest despite
max. therapy
AHA guidelines 2001
38. Left heart failure
Forward failure Backward failure
Ischemia,
Myocarditis,
↓ cardiac output Residual blood in left ventricle
Valvular heart diseases
et cetera!
Tissue anoxia Left atrial pressure and volume
Pressure in pulmonary venous circulation
↓ renal perfusion
Pulmonary arterial hypertension
Activation of RAAS
Right heart failure
Right ventricular pressure
Na+, H2O retention
SYSTEMIC VENOUS
CONGESTION and
PULMONARY PERIPHERAL OEDEMA
CONGESTION and
OEDEMA
41. Lt. VENTRICULAR FAILURE Rt. VENTRICULAR FAILURE
• Ischemia, Myocarditis, Valvular • Pulmonary HTN, Valvular heart
heart disease disease
COMPENSATORY MECHANISMS
Activation of
Sympathetic NS Activation of RAAS Activation of Sym NS >
mechanism Myocardial contractility
Tachycardia cardiac workload
Na+ and water
retention
Cell stretching
Further stress on myocardium
COMPENSATORY
CONGESTIVE HYPERTROPHY and
HEART FAILURE DILATATION
42. Treatment Options
The more common forms of heart
failure cannot be cured, but can be
treated/managed
Lifestyle changes
Medications
Surgery
Heart transplant
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