362 final cardiac arrhythmias + EKG

intrinsic rate of sinus node

60 - 100 bpm

intrinsic rate of AV node

40 - 60 bpm

intrinsic rate of purkinje fibers

20 - 40 bpm

ways to assess rate of ventricular contractions

1. number of large squares between 2 R waves / 300 

2. number of small squares between 2 R waves / 1500

3. number of Rs in a 6 sec period x 10

compensatory pause

pause in the beat occurring after a premature beat

description of normal sinus rhythm

60 - 100 bpm

normal R to R

p wave present

normal PR interval

description of sinus bradycardia

<60 bpm

normal R to R

p wave present

normal PR interval

interventions for sinus bradycardia

pacemaker

atropine

description for sinus tachycardia

100+ bpm

normal R to R

p wave present

normal PR interval

interventions for sinus tachycardia

treat underlying cause!

description of sinus arrhythmia

rate 60 - 100

irregular R to R

p wave present

normal PR interval

is sinus arrhythmia dangerous?

no, usually common in younger pt and benign

occurs when BPM increase with inhalation and decrease with exhalation

description of supraventricular tachycardia (SVT)

rate 150 - 200

cannot see P wave

interventions for SVT

vagal maneuvers

adenosine

ablation

lifestyle changes (caffeine, nicotine, etc.)

description of premature atrial contractions (PACs)

abnormal P wave that comes early + has a pause

causes of PACs

atrial muscle irritation

usually benign but can precede more significant arrhythmias

caffeine, nicotine, stress, ischemia

description of junctional rhythm

SA node is not initiating or conducting properly, so initiation occurs above the ventricle at the AV node or bundle of his

rate 40 - 60 bpm

R to R regular

no P wave or inverted P wave

treatment of junctional rhythm

treat underlying cause (pacemaker malfunction, drug toxicity, etc.)

description of atrial fibrillation

atrial rate = 400 - 600 bpm

may have ventricular rate response, may not

R to R irregular

no pwave

QRS normal

atrial fibrillation with rapid ventricular response (AFib with RVR)

atrial fibrillation with ventricular rate as high as 110 - 160

patient will be tachy + hypotensive

primary complications of AFib

atrial kick is lost => CHF

thromboembolic events like stroke

tx for AFib

meds = cardizem, digoxin, Verapamil, beta blockers, ASA/anticoagulants, heparin drip

cardioversion or pacemaker if unstable

description of atrial flutter

atrial rate 200 - 300 with sawtooth pattern

R to R regular

mural thrombi

clot attached to a wall of the heart or blood vessel

associated with A Flutter

tx of AFlutter

meds = cardizem, digoxin, Verapamil, beta blockers, ASA/anticoagulants, heparin drip

cardioversion or pacemaker if unstable

description of preventricular contraction

irregular, wide/bizarre QRS complexes that come early + have a pause after

can be unifocal, bifocal, or multifocal

causes of PVCs

1. hypoxia

2. myocardial ischemia

3. hypokalemia

4. acidosis

5. exercise

6. increased digoxin levels

serious medical problems that can cause PVCs

1. MI

2. digoxin toxicity

3. hypoxia

4. electrolyte imbalances

PVCs are likely dangerous if:

they occur more than 6 per min

they are near a T wave

they occur in couplets, triplets, or more in a row

bigeminy

trigeminy

bigeminy = every other beat

trigeminy = every third beat

tx for PVCs

acute attack = IV lidocaine

treat cause

meds for long term control

• amiodarone

• beta blockers

• calcium channel blockers

• antiarrhythmics

if PVCs are related to ischemic problems

• nitrates

• oxygen

catheter ablation

catheter ablation

destroying part of the heart causing the PVC to stop them

description of ventricular tachycardia

ventricular rate 150 - 200+

wide/bizarre QRS

regular R to R

no P wave

sustained V tach

lasting longer than 30 sec

nonsustained V tach

lasting less than 30 sec

tx for Vtach

1. IV lidocaine

2. IV amiodarone

3. cardioversion

4. treat underlying cause 

   1. MI

   2. potassium imbalance

5. chronic = may need implantable defibrillator

description of ventricular fibrillation

no QRS or P wave

rhythm is irregular / chaotic

rate is rapid + ineffective

tx for ventricular fibrillation

immediate defibrillation

CPR

ACLS protocol

antiarrhythmic drugs

tx for asystole

epi, atropine

pacemaker (external or temporary internal)

CPR

cardioversion

electrical shock synchronized with heart rhythm

less risk of putting someone in an even more lethal rhythm

turn synchronizer ON

defibrillation

shock that is not synchronized with heart rhythm

turn synchronizer OFF

uses for a pacemaker

1. sick sinus syndrome

2. heart blocks

3. post op cardiac surgery

4. post MI with heart block

use of an implantable defibrillator (ICD)

senses + converts vtach / vfib

complications of pacemaker or defibrillator use

1. infection

2. bleeding/hematoma 

3. dislocation of lead

4. skeletal muscle / phrenic nerve stimulation

5. cardiac tamponade

6. malfunction of pacemaker / defibrillator

normal sinus rhythm

sinus bradycardia

sinus tachycardia

sinus arrhythmia

supraventricular tachycardia

premature atrial contraction (PAC)

junctional rhythm

atrial fibrillation

atrial fibrillation with RVR

atrial flutter

preventricular contraction

bigeminy

trigeminy

multifocal PVC

ventricular tachycardia

ventricular fibrillation

asystole