CHART 388

Dysrhythmia Junctional escape rhythm

Junctional Dysrhythmias: Etiology, Physical Assessment, and Treatment

Etiology SA node disease Myocardial infarction Hypoxia and ischemia Heart failure Increased vagal tone Certain cardiac drugs: such as digoxin, beta adrenergic blockers, and calcium channel blockers Sinus bradycardia Digoxin toxicity Hyperkalemia Valve disease Irritability of the AV junctional tissue caused by: SA node disease Myocardial infarction Sinus bradycardia Mitral stenosis Mitral valve prolapse Cor pulmonale Hypoxia Ischemia Infectious diseases Increased vagal tone Increased sympathetic tone Electrolyte imbalances Digoxin Stimulants Stress Anxiety May precede AV block May occur at any age with no prior history of underlying heart disease. Digoxin toxicity (most common cause) Inferior wall myocardial infarction Myocarditis Ischemia Untoward response to open heart surgery Frequent ingestion of stimulants Anxiety Increased catecholamine secretion Physical Assessment Pulse: rhythm is regular with a usual rate of 40 60 bpm unless it is an accelerated rhythm of > 100 bpm If cardiac output is decreased the following clinical manifestations may occur: Angina Syncope Generalized weakness Dizziness Shortness of breath Altered mental state may be present, although rare. Pulse: Irregular BP: Normal unless PJCs occur frequently enough to decrease cardiac output. Treatment Observe for other dysrhythmias if a slow rate is present. Generally this condition is asymptomatic; however, if symptomatic, typical treatment includes: Oxygen Drug therapy: (atropine, dopamine) Pacemaker Cardioversion

Premature junctional contraction (PJC)

Rarely causes symptoms, thus typically not treated. Find and treat the underlying cause, if possible. If it initiates a more serious dysrhythmia, such as tachycardia, therapy becomes more aggressive, contingent on the type of dysrhythmia. If occurring frequently, more than 5 times per minute, they can drop cardiac output, and predispose the patient to other dysrhythmias. Oxygen Drugs such as stimulants, sympathomimetics, and digitalis may be discontinued.

Paroxysmal junctional tachycardia (PJT)

Pulse: Rapid, with patient experiencing a fluttering sensation. BP: Lower than usual due to decreased cardiac output. If cardiac output is decreased the following clinical manifestations may occur: Angina Syncope Generalized weakness Dizziness Shortness of breath Altered mental state may be present, although rare.

Find and treat the cause as PJTs may be a predisposition to lethal dysrhythmias, heart failure, and shock. Vagal maneuvers may be applied. Oxygen Drug therapy initiated: includes: amiodarone or beta-adrenergic blockers. Cardioversion may be initiated if necessary.