EKG Interpretation

normal sinus

sinus brady

Treat ONLY if symptomatic:

d/c meds that cause it, Atropine if symptomatic

Pacer if chronic tx needed

sinus tachy

If sx: TAKE BP!

treat underlying cause (usually compensation)

meds to slow HR: BB, Ca Channel Blocker

Dehydrated? IVF

pain meds

cut back on smoking/caffeine

sinus arrythmia

NSR but regular, SA node fires irregularly

no clinical significance, no tx

sinus block

Tx if symptomatic:
stop meds that cause, IV atropine if too slow, pacer if chronic

sinus arrest

tx if symptomatic

stop meds that cause it

IV atropine if too slow

pacer if chronic

NSR with PACs

treat underlying cause if sx

BBs, Ca Channel Blockers, anti-anxiety meds

monitor someone with LOTS of PACs, could turn into atrial dysrhythmia

SVT (paroxysmal/multifocal)

O2, IV access

Vagal maneuvers (things to slow HR down - ice around face, bear down, breathe thru a straw)

Anti-arrhythmic (adenosine) (given QUICKLY over SECONDS, stop caulk and flush immediately - stuns heart asystole into sinus), can give twice 6 mg to 12 mg

Ca Channel Blockers, Amiodarone, BBs

Cardioversion (synchronized shock to sync heartbeat) - avoid R on T phenomenon (Torsades), Sometimes use conscious sedation; TEE done before to look for clots prior to shock, heparin drip as well

Ablation for chronic (surgery to burn off abnormal pathways)

Atrial flutter

cardioversion for sx and unstable pts

Digoxin, Ca Channel blockers, amiodarone, BBs

A fib

if sustained with rapid ventricular response: control ventilation rate and return to sinus, pacer

Ca Channel Blocker (Cardizem), Digoxin, amiodarone, BBs

cardioversion (if meds not working/pt is unstable)
Coumadin (anti coag)

NSR with PJCs

treat the underlying cause (stimulants, heart disease, electrolyte imbalance, fatigue)

junctional escape

rate 40-59

slow rates lead to decreased CO (change in LOC, SOB, chest pain, decreased BP)

atropine, temporary pacer

treat underlying cause (RHD, valve disease, post-CABG, hypoxia, Ca Channel Blockers, BBs, increased vagal tone)

accelerated junctional

rate 61-100

no tx (NSR rate)

can be caused by MI, post-cardiac surgery, RHD, COPD, hypokalemia, dig toxicity

junctional tachycardia

rate 101-180

stop meds if they’re the cause

treat as SVT - slow HR w adenosine

amiodarone, Ca Channel blockers, BBs

unifocal PVCs (w NSR)

assess BP, change in LOC, breathing, chest pain

Asx - monitor, treat underlying cause (hypoxia, electrolytes, HF, MI, post CABG, reperfusions, catheters in RV, anxiety, caffeine/stimulants)

DO NOT COUNT PVCs IN HR COUNT

multifocal PVCs (sinus tach)

assess BP, change in LOC, breathing, chest pain

Asx - monitor, treat underlying cause (hypoxia, electrolytes, HF, MI, post CABG, reperfusions, catheters in RV, anxiety, caffeine/stimulants)

DO NOT COUNT PVCs IN HR COUNT

V tach

follow algorithm:

pulse and stable: 02, IV access, anti-arrhythmics

pulse and unstable: O2, cardiovert (sedate prn), antiarrhythmics

no pulse: treat as vfib

chronic: PO meds, ICD, ablation

torsades de pointes

treat cause (low Mg++/K+), amiodarone can cause

Mg++ bolus to slow HR

cardioversion

coarse V fib

above 3 mm - more recent

Follow algorithm sequence:

CPR (no pulse)

Defibrillate* (120 to 150-200 joules) + CPR after

Epinephrine, amiodarone, O2/ventilation

fine v vib

under 3 mm, present for longer, harder to get person back

Follow algorithm sequence:

CPR (no pulse)

Defibrillate* (120 to 150-200 joules) + CPR after

Epinephrine, amiodarone, O2/ventilation

asystole

CPR, epi

Hs and Ts: hypovolemia, hypoxia, hydrogen ions, hypothermia, hyper/hypokalemia, hypoglycemia, toxins (drug overdose), tachycardia, tamponade, tension pneumo, thrombosis (MI/PE), trauma

no CO, no perfusion

PEA

regular electrical rhythm with no pulse, no actual perfusion is getting through

Hemorrhage, Tamponade

CPR, epi

Hs and Ts: hypovolemia, hypoxia, hydrogen ions (acidosis), hypothermia, hyper/hypokalemia, hypoglycemia, toxins (drug overdose), tachycardia, tamponade, tension pneumo, thrombosis (MI/PE), trauma

shockable cardiac arrest rhythms

pulseless v tach, v fib

unshockable cardiac rhythms

asystole, PEA

1st degree AV heart block

delay within underlying rhythm, slowing down (not an actual block)

regular rhythm, just > 0.20 PR interval

occurs within underlying rhythm 

hold meds if over 0.26 seconds

check with pcp with digoxin or antiarrhythmics

post MI: monitor for more serious block

2nd degree type 1 AV heart block (Wenkebach)

happens with inferior MI (RCA is what is blocked)

monitor for worse block

hold meds if the cause

atropine/pacing for slow rate

(atropine increase SA node firing (increases P waves, increasing impulses)

2nd degree type 2 AV block

anterior MI

monitor for worse block, especially MI (3rd degree or asystole)

temporary/perm pacer

hold anti-arrhythmic

NO ATROPINE - atropine increases SA node firing = P waves… we don’t need those

3rd degree complete heart block

pace maker

monitor EKG post-MI

limit activity, 02

(inferior/anterior MI)

AV dissociation, Ps and QRS have no association

atrial pacer

ventricular pacer

atrial/ventricular pacer

AV blocks

delay/block that occurs within AV node

PR interval key to determine type of block

junctional dysrhythmias

retrograde depolarization of atria: SA to AV almost ‘going backwards”

Inverted P Wave (before, after, or hidden in QRS)

HR distinguishes junctional type (<60, 60-100, >100

atrial dysrhythmias characteristics

hallmark feature= shape of atrial P wave (different from sinus)

can be pointed, inverted, sawtooth, or wavy