Rhythms Flashcards
(58 cards)
what are the 3 irregularly irregular rhythms
Afib, wandering atrial pacemaker, multifocal atrial tachycardia
what is normal sinus rhythm
rate 60-100 BPM, regular rhythm, p wave present and upright in lead II, p/QRS ratio: 1:1, QRS width is normal
what is sinus arrhythmia
normal respiratory variation; rhythm gets faster on inhalation and slower on exhale; rate is still 60-100 BPM; p waves normal; P/QRS 1:1; and PR interval normal
what is sinus bradycardia
rate < 60 BPM; otherwise NSR
regular; p waves present; P/QRS ratio 1:1; PR interval- WNL to slightly prolonged; QRS width- WNL to slightly prolonged
May be caused by medication, vagal stimulation, sick sinus syndrome, inferior ischemia/infarct; also seen in athletes
what is sinus tachycardia
rate > 100 BPM; otherwise NSR
regular with p waves present; P/QRS 1:1; PR interval-slightly shortened; QRS width- slightly shortened
Found in high cardiac output states: exercise, fever, hyperthyroidism, hypovolemia
what is sinus pause/ arrest
rate varies; rhythm is irregular; p wave is present except in the pause area; P/QRS 1:1; PR interval is normal; QRS width is normal; grouping none; dropped beats YES!!
-time interval is NOT a multiple of the normal P-P interval
what is sinoatrial block
a dropped complex that is a multiple of the P-P interval
rate varies; rhythm is irregular; P wave present except in area of dropped beat; P/QRS 1:1; PR interval is normal; QRS width normal; dropped beat YES!!
- occurs in some multiple of the P-P interval; after the dropped beat the cycle continues on time
- the pathology is a non conducted beat from the normal pacemaker
what is atrial premature contraction (PAC)
PACs occur when another region of the atria depolarizes before the SA node and thus triggers a premature heartbeat
the pause after the PAC is non compensatory; meaning the underlying rhythm is disturbed and does not proceed at the same pace= PAC resets the SA node
rate varies; p waves PRESENT and UPRIGHT except in the PAC may be a diff shape; irregular rhythm; PR interval varies in the PAC otherwise normal; QRS width normal; P/QRS 1:1; grouping sometimes; dropped beats no
what is ectopic atrial tachycardia
a run of PACs
ectopic atrial focus fires quicker than the SA node; the p waves and PR intervals within the ectopic rhythmm are different; episodes are not sustained for a long period of time;
rate: 100-180 BPM
rhythm is regular
p wave: morphology of ectopic focus is diff;P/QRS 1:1; PR interval: diff in ectopic focus; QRS width narrow
what is wandering atrial pacemaker
irregularly irregular rhythm caused by multiple ectopic pacemakers in the atria
-atleast 3 different p wave morphologies**
-rate < 100 BPM
-P/QRS: 1:1
QRS width: narrow
What is multifocal atrial tachycardia
a tachycardic WAP: three or more different ectopic foci in the atria that fire at different rates
- atleast 3 different p wave morphologies**
- rate >100 BPM
P/QRS 1:1; QRS width is narrow
found in patients with severe lung disease**
what is atrial flutter
atrial rate 250-350 BPM ventricular rate 125-175 BPM usually regular P wave: saw toothed P/QRS 2:1, variable PR interval variable QRS width normal; grouping none; dropped beats none
what is atrial fibrillation
chaotic firing of numerous pacemaker cells in the atria; no discernible p waves and QRS complexes are in irregular pattern
rate: variable irregularly irregular p wave: NONE; chaotic atrial actibitiy P/QRS: none 0;1 PR interval: none QRS width normal; no grouping or dropped beats
if a p wave is upright what is it’s origin
high atria or SA node
if a p wave is inverted what is it’s origin
low atria or AV node
if a p wave is absent…
and the QRS is narrow?
or the if the QRS is wide?
what is it it’s origin
absent= AV node or ventricle
narrow QRS= AV node ( Junctional)
wide QRS= ventricular origin
what indicates sinus rhythm
an upright p wave in lead II
p waves in junctional rhythms: if the retrograde impulse is the same speed as the antegrade impulse then how should the p wave look?
there won’t be one
p waves in junctional rhythms: if the retrograde is faster than the ante grade impulse then how will the p wave look?
inverted and before QRS
p waves in junctional rhythms: if the retrograde is slower than the ante grade impulse then how will the p wave look?
inverted and after the QRS
if you see a narrow QRS with no p wave what should you be thinking….
JUNCTIONAL rhythm!
why do we want to see if the p wave and the QRS wave are married
it tells you the atria depolarized before the ventricles; if they aren’t married then it could be AV block
if the QRS is narrow what is the origin of the impulse
supraventricular
- sinus
- atrial
- junctional
if the QRS is wide what is the origin of the impulse
ventricular OR abnormal conduction (BBB)
