Abnormal Cardiac Electrophysiology

Paramedic Class 108

 Normal
Electrophysiology
Sinoatrial

Atrioventricular

His-Purkinje System (Bundle of His- Bundle Branches –Purkinje Fibers)

 Normal
Electrophysiology
Causes Abnormal Electrophysiology
1. SA Node Fires Faster or Slower than
inherent rate.
2. Cells outside SA Node create ectopic &
escape beats or rhythms.
3. AV loss of ability to conduct impulse to
ventricle.
4. Reentry or accessory pathway present.
Faulty or obstructed.
 Sinus Rhythms

Sinus Bradycardia

Sinus Tachycardia
 Sympathetic Stimulation
Airway
Shock
Drugs
AMI
Hypercapnea
Electrolyte Imbalances
Acid Base Balance
Fear, Anger, Anxiety
 Sympathetic Stimulation
What is this rhythm?
 Parasympathetic Stimulation
Decrease Automaticity SA Node

Decrease Conduction AV Node

May lead to heart blocks

Sinus Bradycardia normal?

May Lead to Ectopic Beats

 Parasympathetic Stimulation
What is the underlying
rhythm?

What is the escape

ectopic origin?
 Parasympathetic Stimulation
Heart Blocks 2nd
Degree

Type 1 Variable

Type 2 Fixed
 Escape – Ectopic Rhythms

Escape Mechanism

Backup Pace Maker Cells

AV Node
Ventricles

Atria Irritability – Reentry – Accessory Pathways

Escape – Ectopic Rhythms
Ectopic Premature Irritability
Causes

Catecholamine's – Epinephrine
Drugs Hypoxia
Shock Hypercapnea
AMI CHF
Electrolyte Imbalances
Acid Base Imbalances
 Premature Complexes

Atrial
 Premature Complexes

Junctional
 Premature Complexes

Ventricular
Atrioventricular Node
Dysfunction
Causes

AMI

Drugs

Age
 Atrioventricular Node
Dysfunction
Pathophysiology
Delayed from SA Node

Totally Blocked from the Ventricles

(More P’s Than QRS)

Delayed or Blocked at AV Node

(Heart Block)
 Atrioventricular Node
Dysfunction

Sinus Bradycardia

Sinus Arrhythmia
 Atrioventricular Node Dysfunction

1st Degree Heart Block

Is the least fatal of the three. It is characterized by a longer PR
interval, greater then 0.20 seconds. The rate is not affected and
can vary from bradycardia to tachycardia.
 Atrioventricular Node Dysfunction
Second Degree A/V Block, Type I
This rhythm is characterized by a increasing PR interval with a
non-conducted, or dropped, p-wave and then a repeat of the
cycle. Each p-wave is followed by a QRS except the dropped
one and the interval between each QRS tends to get shorter.
 Atrioventricular Dysfunction
Second Degree A/V Block, Type II
This form of A/V Block is noted for the consistent PR interval
and may have a widened QRS complex, depending on the
level of the conduction tract where the block occurs. There
may be shortening of the PR interval after the dropped p-wave.
 Atrioventricular Dysfunction
Third Degree Heart Block
The most dangerous of the
blocks, the third degree block
occurs when the communication
between the top and bottom
conduction tracts is broken. The
QRS can be narrow or wide,
depending on the origin of its
impulse. If the QRS is narrow,
the impulse is starting above the
ventricles but below the level of
the block. A wide QRS means
the impulse started in the
ventricles themselves. The p-
wave and the QRS will likely be
regular but not coordinated with
each other, occurring regularly
but at different rates.
Pathway Problems

Reentry Causes

Coronary Artery Disease

Myocardial Ischemia

Electrolyte Imbalances
 Pathway Problems
Definition

Reactivation of fibers for a second

time or repeatedly by the same
wave front or impulse.
 PREMATURE BEATS

Arial

Junctional
 PREMATURE BEATS

Ventricular
 PREMATURE BEATS

Arial Tachycardia – PSVT

Junctional Tachycardia -
PSVT
PREMATURE BEATS

VENTRICULAR TACHYCARDIA
 Accessory Pathway
Preexcitation
Remember:

Accessory Pathways are extra

pathways located OUTSIDE the
normal conduction system of the
atria and ventricles!
Shortened PR Interval.
 Accessory Pathway
Preexcitation
RISKS
Loss of Arial Kick
Loss Ventricular Filling
Tachyarrhymias
Shock – Ventricular Arrhymias
Death
 Wolf-Parkinson-White (WPW)
Remember Bundle of Kent: Accessory
Pathway.
Bypasses normal conduction Pathway.
Genetic – Men
Seem symptom Free until Adult hood.
May cause Ventricular Fibrillation in PSVT
rhythms.
 Wolf-Parkinson-White (WPW)
Characteristics

2. Wide QRS
3. Delta Wave – Found as an
upstroke or slur at the
beginning of the QRS.
4. PR Interval less than .12
seconds.
 Wolf-Parkinson-White (WPW)
The short PR and the subtle 'delta' wave at the beginning of the
QRS complexes. The delta wave represents early activation of
the ventricles in the region where the AV bypass tract inserts.
The rest of the QRS is derived from the normal activation
sequence using the bundle branches.
 Wolf-Parkinson-White (WPW)
TREATMENT

Call Medical Control ASAP when patients are

Tachycardic and in PSVT.

ACLS Protocols requires Synchronized Cardioversion

for unstable patients.

What is an Unstable Patient?

 The Ventricles
Delayed Conduction-

Ventricles depolarize in less than .12 seconds

So… Common sense will tell us a delay is

anything greater than a QRS complex of .12
seconds.
 Aber rant Con duction
Remember: Not an Arrhythmia
Means wandering from usual or expected
course.
Blocked or damage to bundle branches

QRS Complex greater than .12 seconds

Wide Complex Characteristics
 THE END

QUESTIONS ?