Heart Rhythm characteristics Flashcards
(25 cards)
Sinus Rhythm
Regular R to R interval
P, QRS, & T wave present
Rate 60-100
Normal PR, QRS, & QT intervals
Sinus Tachycardia
regular R to R interval
P, QRS, & T-wave present
rate: above 100
normal PR, QRS, & QT intervals
causes: Fever, Pain, Anxiety, hypovolemia
Tx: treat underlying cause
Sinus Bradycardia
Regular R to R intervals
P, QRS, T-wave present
Rate: below 60
regular PR, QRS, QT intervals
causes: Could be normal, drugs, damage to SA Node
Tx: Assess for symptoms
SYMPTOMATIC: Atropine, EPI, Dopamine and pacing
ASYMPTOMATIC: May not get treated, adjust meds that affect HR
sinus arrhythmia
Irregular R to R interval
P, QRS, T-wave
regular PR, QRS, QT interval
gradual HR increases, than gradual HR decrease.
Tx:
None unless pauses or slow HR causes symptoms
A-Fib
Irregular R to R interval
No P-wave
Fibrillary waves
Tx:
Rate Control–> CCB, BB, Dig , Amiodarone
Rhythm Control–> cardioversion, amiodarone
Radiofrequency Ablation–> Could achieve rate or rhythm control
Anticoagulation –> Heparin, LMWH, Warfarin
high stroke risk
A-flutter
Regular Flutter Waves ( saw tooth)
Rate of atrial activity usually > 250 bpm
Ventricular response regular or irregular (QRS)
P to P regular
No P waves
Tx:
Rate Control–> CCB, BB, Dig , Amiodarone
Rhythm Control–> cardioversion, amiodarone
Radio-frequency Ablation–> Could achieve rate or rhythm control
Anticoagulation –> Heparin, LMWH, Warfarin
Less of a stroke risk
A-Tach
regular atrial activity 150-250 bpm
Usually regular ventricular response
often sudden onset & termination (think of it as a run of PACs
P-wave could be hidden
QRS normal or narrow
R to R may have slight irregularity
Tx:
Rate Control–> CCB, BB, Dig , Amiodarone
Rhythm Control–> cardioversion, amiodarone
Radiofrequency Ablation–> Could achieve rate or rhythm control
no Anticoagulation therapy
PSVT
Rate 150-250
Regular R to R intervals
P-waves frequently not identified, merged with T-wave
PR often not measurable
QRS narrow
vagal, adenosine, BB, Dig ablation
If you see a P- wave it A-tach
Premature Atrial Contraction (PACs)
an earlier than expected normal P-wave or much different. Compensatory
pause often follows.
Tx:
assess for symptoms
Treat underlying causes:
excessive Caffene, stress, smoking, dehydration, excessive exercsie.
Premature Ventricular Contractions (PVCs)
Wide, Bizarre QRS
Premature Complex
Not associated with P-waves.
PVC every other beat = Bigeminy
PVC every third beat= Trigeminy
2 in a row = Couplet
3 in a row= Triplet
4 in a row= Vtach
Tx:
watch frequency
assess for cause: caffine, stress, electrolytes imbalance, smoking, ETH, treat it
do not routinely give drugs to suppress, if reoccurence happens then we give beta-blockers, CCB are given.
*check electrolytes
Premature Junctional contractions (PJCs)
P-wave is like junctional p-wave ( before, hidden or after QRS)
QRS looks like sinus QRS
Often confused with PACs- can list either one
List underlying- SR, SB, ST
Tx;
assess for symptoms
Treat the underlying cause: caffine, CAD, alcohol, hypoxemia, smoking and heart failure.
Idioventricular rhythm
Regular R to R interval
Rate 20-40 bpm
wide, bizarre QRS
premature complex
Not associated with P-waves
Last rhythm before asytole
TX:
pace ( have a pulse now, but not for long Massive MI)
Tips: often confused with Junctional– normal QRS (HR 40-60)
Ventricular Tachycardia
Rate> 100 bpm
Wide QRS
A-V dissociation
May or may not have a pulse
No P-waves
Often waveforms same height
Tx:
pulseless ( code, CPR, Defibrillation, Epi or vasopressin or amio )
Pulse ( Vitals, 12- lead, Vagal Manoeuvres, Drug therapy, correct electrolytes
cardioversion)
Ventricular Fibrillation
Chaotic, quivering of ventricles
Grossly irregular electrical activity
unable to recognized any waveforms
WILL NOT HAVE A PULSE = Defibrillation
Tx:
Call code, CPR
Defib
EPI or vassopressin
Amiodarone
Torsades de Pointes (TDP)
Twisting of VT around Baseline ( looks like a tornado. funnels)
Rate: 250 bpm
Nothing round
TX:
CPR
CODE
Amiodarone
EPI
MAG
Overdrive pacing
Junctional (escape) rhythm
Rate 40-60
p-wave before, during or after QRS
Always regular R to R intervals
Mixed up with Idioventricular and junctional
Normal or narrow QRS
P-waves Always inverted
Tx:
Assess for symptoms
Adjustment meds that affect SA node
Atropine
Pacing
Junctional Tachycardia
Same as junctional rhythm, except rate > 100 bpm
Assess for symptoms, cause
Hold dig
Correct electrolytes
if rapid HR is causing symptoms- CCB, BB
Accelerated Junctional Rhythm
Same as Junctional Rhythm
60-100 bpm
Tx;
Assess for cause, check dig level
Hold dig if indicated
correct electrolytes
1st degree AV block
PR interval > 2.0 on all beats
All impulses able to get through AV Node, just take longer then normal
Regular P to P and R to R
SR, SB, ST
tx: Assess for Length for PR ( often medication is to blame)
If the R is far from the P then its’ must be First Degree.
2nd Degree AV Block
Type 1 Wenckenbach
PR progessively Lengthens until QRS is droped cycle repeats itself
After QRS dropped, next PR shorter
P to P regular; R to R irregular
SR, SB, ST-based on p waves
Tx:
Asymptomatic: Observe and indentify underlier.
Symptomatic:
Atropine, pacing, dopamine
If PR gets longer then a QRS drop then it must be a Wenckebach
2nd degree AV block- Mobitz II
QRS is droped and the cycle repeats itself
After QRS dropped, PR intervals constant with dropped QRS’s.
tx:
May progress to 3rd degree without warning
Tx:
Pacing
If PR stays normal and QRS quits then its must be TYPE II Mobitz
2:1 Av block (2nd Degree Type 2)
2 p-waves for every QRS
every other QRS is dropped
PR intervals are all the same
P to P regular; R to R regular
SR, SB, ST
can have more then on dropped QRS in a row
more P-waves the QRS waves.
Tx:
Assess for symptoms
Prepare to pace if needed
continue to monitor for determining which type of block is present and if it progressess to 3rd degree.
3rd Degree AV Block
P-waves regular
QRS regular
But Ps & QRSs not related to each other
Can have narrow or wide QRS (wider QRS=outcome)
P to P regular; R to R regular
Hidden P-waves can happen.
Tx:
Narrow QRS
atropine
TCP
Dopamine
EPI
Wide QRS
TCP
Prepare for transvenous pacing
Idioventricular Conduction Delays (IVCD) ( bundle branch-Bunny ears)
QRS > 0.11 seconds on each beat
Can be present in variety of rhythms, (SR, SB,ST, AFIB, AFlutter, AV Node Blocks) that normally have narrow QRS.
