Pediatric Dysrhythmia Review

The goal of this presentation is to review

basic principles of pediatric rhythm interpretation

Module 1: Basic Cardiac Anatomy

 Module 1: Basic Cardiac Anatomy
At the completion of this presentation,
you will be able to:
• Describe the basic cardiac anatomy and it’s
relationship to cardiac output and cardiac
function.

Directions:
Complete each module including the practice strips, then check
your answers.
There are handouts to accompany this presentation. Please
print them from the Education Services website where you
accessed this module.They will be very helpful to you.
 Cardiac Anatomy:
The Atria and Ventricles
„ The Atria are the
thin walled upper
chambers of the
heart

„ The Ventricles are

the thick walled
lower chambers
of the heart
 Cardiac Anatomy:
The Septum

„ The Septum
divides the heart
into right and left
sides and
contains
structural
elements of the
conduction
system
 Cardiac Anatomy:
The Valves
„ Valves promote the
forward flow and
prevent the backward
flow of blood through
the heart. The four
valves are classified
into 2 groups:
• Atrioventricular
„ Tricuspid
„ Mitral
• Semilunar
„ Pulmonic
„ Aortic
 Cardiac Anatomy:
The Atrioventricular Valves
„ The
Atrioventricular
valves are located
between atria and
ventricles. They
consist of the
Tricuspid, located
on the right side
of the heart, and
the Mitral, located
on the left side of
the heart.
 Cardiac Anatomy:
The Semilunar Valves
„ The Semilunar
valves are located
between the
ventricles and the
large blood vessels.
They consist of the
pulmonic, located
on the right side of
the heart, and the
Aortic, located on
the left side of the
heart.
 Cardiac Anatomy:
The Coronary Arteries
„ The very first
arteries after the
aortic valve.
„ Due to the location
of these arteries,
the heart is able to
provide oxygen
rich blood to itself
first.
The Cardiac Cycle consists of:

Diastole – Rest Stage

&
Systole – Contraction Stage
 Diastole…
„ The passive filling phase of the
cardiac cycle, where the heart is in a
relaxed state.
„ It represents two-thirds of the total
cardiac cycle time.
 The Two Phases of Diastole
„ Early Diastole
• the ventricles fill passively
„ Late Diastole
• as the atria get the message to
contract, the ventricles are “topped off”
with blood to provide maximum stretch
within the ventricles. This is also known
as the atrial kick.
 Diastole
„ Key Point
• If the filling time is shortened, that is to say
there is a fast heart rate, less blood fills the
ventricle and there is a smaller volume of
blood to be pumped out with the next
contraction.
• This also means as the heart rate increases
there is less filling time for the coronary
arteries to fill and thus to perfuse the cardiac
tissue.
 Systole
„ The active contractile phase of the
cardiac cycle.
„ Blood is being pumped from the right
ventricle into the pulmonary artery
to the lungs and from the left
ventricle to the aorta and the
systemic circulation.
 The Two Phases of Systole
„ Early systole
• Cardiac muscle contracts using large
amounts of the oxygen that was
delivered in diastole
„ Late systole
• Contractile response to the electrical
signal pushes blood into the aorta.
Cardiac Output =

Stroke Volume
X
Heart Rate
 Stroke Volume

„ The quantity of blood that is ejected

from the heart with each beat
 Heart Rate = The number of
cardiac cycles per minute
Normal Heart Rates in children*

Age Awake Heart Rate Sleeping Heart Rate

Neonate 100-180 80-160

Infant (6 mo) 100-160 75-160
Toddler 80-110 60-90
Preschooler 70-110 60-90
School-aged child 65-110 60-90
Adolescent 60-90 50-90
__________________________________
From Gilette PC and others: Dysrhythmias. In Adams FH and Emmanoulides GC, editors:
Moss’ heart disease in infants, children, and adolescents, ed 4, Baltimore, 1989, Williams
& Wilkins.
*Always consider the patient’s normal range and clinical condition. Heart rate will normally
increase with fever or stress” in children.
 Cardiac Output

„ Total volume of blood ejected from

the heart each minute
 Cardiac Output =
Heart Rate x Stroke Volume

„ Consider the effects of the following

equations:

• 60bpm x 100ml = 6 liters

• 120bpm x 50ml = 6 liters
• 60bpm x 50ml = 3 liters

so if the stroke volume or the heart rate changes it directly

affects cardiac output.
 Signs and Symptoms of
Decreased CO
„ Dizziness
„ Decreased LOC, Confusion,
Restlessness
„ Decreased BP
„ Decreased UO
„ Decreased or absent peripheral
pulses
„ Cool, clammy skin
This Completes Module 1