Cardiac Arrhythmias and Their Electrocardiographic Interpretation

Some of the most distressing types of heart malfunction occur not as a result of abnormal heart muscle but because of abnormal rhythm of the heart. For instance, sometimes the beat of the atria is not coordinated with the beat of the ventricles, so that the atria no longer function as primer pumps for the ventricles.

The purpose of this chapter is to discuss the physiology of common cardiac arrhythmias and their effects on heart pumping, as well as their diagnosis by electrocardiography.The causes of the cardiac arrhythmias are usually one or a combination of the following abnormalities in the rhythmicity-conduction system of the heart:

1. Abnormal rhythmicity of the pacemaker

2. Shift of the pacemaker from the sinus node to another place in the heart

3. Blocks at different points in the spread of the impulse through the heart

4. Abnormal pathways of impulse transmission through the heart

5. Spontaneous generation of spurious impulses in almost any part of the heart

Abnormal Sinus Rhythms

Tachycardia

The term "tachycardia" means fast heart rate, usually defined in an adult person as faster than 100 beats per minute. An electrocardiogram recorded from a patient with tachycardia is shown in Figure 13-1. This electrocardiogram is normal except that the heart rate, as determined from the time intervals between QRS complexes, is about 150 per minute instead of the normal 72 per minute.

The general causes of tachycardia include increased body temperature, stimulation of the heart by the sympathetic nerves, or toxic conditions of the heart.

The heart rate increases about 10 beats per minute for each degree Fahrenheit (18 beats per degree Celsius) increase in body temperature, up to a body temperature of about 105°F (40.5°C); beyond this, the heart rate may decrease because of progressive debility of the heart muscle as a result of the fever. Fever causes tachycardia because increased temperature increases the rate of metabolism of the sinus node, which in turn directly increases its excitability and rate of rhythm.

Many factors can cause the sympathetic nervous system to excite the heart, as we discuss at multiple points in this text. For instance, when a patient loses blood and passes into a state of shock or semishock, sympathetic reflex stimulation of the heart often increases the heart rate to 150 to 180 beats per minute.

Simple weakening of the myocardium usually increases the heart rate because the weakened heart does not pump blood into the arterial tree to a normal extent, and this elicits sympathetic reflexes to increase the heart rate.

Bradycardia

The term "bradycardia" means a slow heart rate, usually defined as fewer than 60 beats per minute. Bradycardia is shown by the electrocardiogram in Figure 13-2.

Bradycardia in Athletes. The athlete's heart is larger and considerably stronger than that of a normal person, which allows the athlete's heart to pump a large stroke volume output per beat even during periods of rest. When the athlete is at rest, excessive quantities of blood pumped into the arterial tree with each beat initiate feedback circulatory reflexes or other effects to cause bradycardia.

Figure 13-1

Figure 13-1

Sinus tachycardia (lead I).

Figure 13-2

Figure 13-2

Sinus bradycardia (lead III).

Figure 13-3

Sinus arrhythmia as recorded by a cardiotachometer. To the left is the record when the subject was breathing normally; to the right, when breathing deeply.

Vagal Stimulation as a Cause of Bradycardia. Any circulatory reflex that stimulates the vagus nerves causes release of acetylcholine at the vagal endings in the heart, thus giving a parasympathetic effect. Perhaps the most striking example of this occurs in patients with carotid sinus syndrome. In these patients, the pressure receptors (baroreceptors) in the carotid sinus region of the carotid artery walls are excessively sensitive. Therefore, even mild external pressure on the neck elicits a strong baroreceptor reflex, causing intense vagal-acetylcholine effects on the heart, including extreme bradycardia. Indeed, sometimes this reflex is so powerful that it actually stops the heart for 5 to 10 seconds.

Sinus Arrhythmia

Figure 13-3 shows a cardiotachometer recording of the heart rate, at first during normal and then (in the second half of the record) during deep respiration. A cardiota-chometer is an instrument that records by the height of successive spikes the duration of the interval between the successive QRS complexes in the electrocardiogram. Note from this record that the heart rate increased and decreased no more than 5 per cent during

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Essentials of Human Physiology

Essentials of Human Physiology

This ebook provides an introductory explanation of the workings of the human body, with an effort to draw connections between the body systems and explain their interdependencies. A framework for the book is homeostasis and how the body maintains balance within each system. This is intended as a first introduction to physiology for a college-level course.

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  • anton
    When a patient loses blood and passes into a state of shock or semishock?
    3 years ago

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