Rhythms and Pacing

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rhythms, pacings, changes, treatments

Last updated 7:19 PM on 9/15/26
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61 Terms

1
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Asystole

flat line, no QRS present, no pulse, HR=0, no BP, lethal if not corrected in 3-5 minutes

<p><span>flat line, no QRS present, no pulse, HR=0, no BP, lethal if not corrected in 3-5 minutes</span></p>
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What is the treatment for asystole?

DO NOT SHOCK!!!!! CPR, check asystole in two leads, epinephrine, pacemaker, consider the causes.

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What is sinus tachycardia?

100-150bpm. rhythm is normal but too fast. workload of the heart is increased while the perfusion is decreased. this is a normal response to the body's increased demand for O2

<p><span>100-150bpm. rhythm is normal but too fast. workload of the heart is increased while the perfusion is decreased. this is a normal response to the body's increased demand for O2</span></p>
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What causes sinus tachycardia?

pain, hypovolemia, fever, exercise, anxiety, medications that stimulate sympathetic response, stimulants, illicit drugs

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What is sinus bradycardia?

sinus rhythm but the heart rate is below 60bpm. may be normal for athletes or during sleep, seen with inferior and posterior infarctions

<p><span>sinus rhythm but the heart rate is below 60bpm. may be normal for athletes or during sleep, seen with inferior and posterior infarctions</span></p>
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What is the treatment for sinus bradycardia?

ONLY TREAT IF PT IS SYMPTOMATIC. treat the cause. Give O2, atropine, pacemaker, dopamine or epinephrine infusion, assess for hypotension

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What is the treatment for a fib?

Controlled: anti thromb therapy, warfarin(coags), factor x inhibs, then elective cardiovet (will need 3wk antithromb therapy)

AMIOOOOOOOOO, ditiazem

uncontrolled: EMERGENT CARDIOVERT

<p>Controlled: anti thromb therapy, warfarin(coags), factor x inhibs, then elective cardiovet (will need 3wk antithromb therapy)</p><p>AMIOOOOOOOOO, ditiazem</p><p>uncontrolled: EMERGENT CARDIOVERT</p>
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What is atrial fibrillation?

Atria is quivering but not contracting, AV node acts as a filter to protect the ventricle

<p><span>Atria is quivering but not contracting, AV node acts as a filter to protect the ventricle</span></p>
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What is supraventricular Tachycardia?

cannot identify p wave and narrow QRS. rapid heartbeat that develops when the normal electrical impulses of the heart are disrupted.

<p><span>cannot identify p wave and narrow QRS. rapid heartbeat that develops when the normal electrical impulses of the heart are disrupted.</span></p>
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what is V tach?

BAD, ventricles are pumping too fast

<p><span>BAD, ventricles are pumping too fast</span></p>
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What is the treatment for v tach? WITH PULSE

-Pulse: amioderone or lidocaine, cardiovert(if unstable)

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What is the treatment for v tach? WITHOUT A PULSE


-Pulseless: CPR and defibrillation followed by vasopressors (epi, vasopressin) and antidysrhymics (amiodarone) if defib unsuccessful

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what is V fib?

you are dead, ventricles are quivering, clients have no pulse/BP/RR. fatal if not terminated in 3-5 minutes. Want Coarse v fib rather than fine because there is more of a rhythm to shock.

<p>you are dead, ventricles are quivering, clients have no pulse/BP/RR. fatal if not terminated in 3-5 minutes. Want Coarse v fib rather than fine because there is more of a rhythm to shock.</p>
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What is the treatment for v fib?

-CPR/DEFIB/EPI

-CPR, shock, med, shock, cpr, shock, med (epi, vasopressin), magnesium if low, bicarb (only in severe acidosis) antidysrythmics (amioderone, lidocaine, procinamide)

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what is PEA?

patient has a rhythm but NO PULSE, heart muscle loses its ability to contract even though the electrical activity is preserved. This is treated like asystole.

<p><span>patient has a rhythm but NO PULSE, heart muscle loses its ability to contract even though the electrical activity is preserved. This is treated like asystole.</span></p>
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What is the treatment for PEA?

Treat like asystole. CPR, epinephrine, rapid identification of the causes.

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What is the treatment for third degree heart block?

pacemaker

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What is fixed pacing?

generates paced beats regardless of what the heart's own intrinsic rate is doing. fire at a fixed rate constantly.

<p>generates paced beats regardless of what the heart's own intrinsic rate is doing. fire at a fixed rate constantly.</p>
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demand pacing

only paces the heart when needed. (i.e. the heart rate falls into a rate below the threshold of 60). ONLY KICKS IN WHEN THE HR DROPS.

<p>only paces the heart when needed. (i.e. the heart rate falls into a rate below the threshold of 60). ONLY KICKS IN WHEN THE HR DROPS.</p>
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ventricular pacing

Pacing is done within the ventricle. Firings are sent before the QRS.

<p><span>Pacing is done within the ventricle. Firings are sent before the QRS.</span></p>
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atrial pacing

Pacing is done within the atria. Firings are sent before the p wave.

<p>Pacing is done within the atria. Firings are sent before the p wave.</p>
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dual pacing

Combination of both atrial and ventricular pacing.

<p>Combination of both atrial and ventricular pacing. </p>
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What are some issues that can happen with a pacemaker?

failure to pace

failure to sense

failure to capture

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failure to pace

no pacemaker spikes. check connections and power to pacemaker.

<p><span>no pacemaker spikes. check connections and power to pacemaker.</span></p>
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Failure to sense

pacemaker spikes are not aligning with QRS and not pacing appropriately, ensure it is set to correct mode and does not need an increase in sensitivity.

<p><span>pacemaker spikes are not aligning with QRS and not pacing appropriately, ensure it is set to correct mode and does not need an increase in sensitivity.</span></p>
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failure to capture

pacemaker spike is being produced but not capturing a QRS

<p><span>pacemaker spike is being produced but not capturing a QRS</span></p>
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When is defibrillation indicated?

In a pulseless patient with a shockable rhythm (like V.fib and V tach)

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cardioversion

shocks are synched with the QRS

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what is important to do before cardioversion?

anticoagulant beforehand because it could dislodge a clot or embolism

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what rhythms require cardioversion?

atrial fibrillation, A flutter, SVT, V tach with a pulse.

SYMPTOMATIC PATIENTS

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automated external defibrillator (AED)

portable automatic device used to restore normal heart rhythm to patients in cardiac arrest

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What EKG changes might occur with hyperkalemia?

ST depression, peaked t waves, wide/flat QRS, prolonged PR interval.Seen with third degree AV block, asystole, v fib, and v tach.

<p><span>ST depression, peaked t waves, wide/flat QRS, prolonged PR interval.Seen with third degree AV block, asystole, v fib, and v tach.</span></p>
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What EKG changes might occur with hypokalemia?

wide t waves, st depression, possible U wave.seen with torsade's or v fib.

<p>wide t waves, st depression, possible U wave.seen with torsade's or v fib.</p>
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What EKG changes might occur with hypomagnesemia?

tall T waves, ST segment depression, long QT/PR interval .seen with torsade's v tach

<p><span>tall T waves, ST segment depression, long QT/PR interval .seen with torsade's v tach</span></p>
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What EKG changes might occur with hypermagnesemia?

slowing of cardiac conduction, bradycardia, prolonged PR and QT intervals, peak t waves, wide QRS, av block or asystole

<p><span>slowing of cardiac conduction, bradycardia, prolonged PR and QT intervals, peak t waves, wide QRS, av block or asystole</span></p>
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What EKG changes might occur with hypercalcemia?

short QT interval

<p>short QT interval</p>
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What EKG changes might be seen with hypocalcemia?

slowing of cardiac conduction, bradycardia, prolonged PR and QT intervals

<p><span>slowing of cardiac conduction, bradycardia, prolonged PR and QT intervals</span></p>
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What dysrhythmias are seen with the SA node?

sinus tachy and sinus Brady

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What dysrhythmias are seen with the AV node?

junctional rhythms, paroxysmal SVT

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What dysrhythmias are seen in the ventricles?

PVC, V tach, tosades, v fib, asystole

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what part of the heart is responsible for the P wave?

SA node

Atrial depolarization

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what part of the heart makes the QRS complex?

purkinjie fibers

ventricular depolarization

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what part of the heart makes the T wave?

ventricular repolarization

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pacemaker

stimulates depolarization

-can pace atrium, ventricle, or both

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5 indications of a temporary pacemaker

-heart attack (heart block)

-temporary support (post open heart surgery)

-awaiting a permanent pacemaker

-Arrhythmia (symptomatic bradycardia, AV blocks, complete heart block, overriding tachycardia, atrial or ventricular arrhythmia)

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epicardial pacemaker

pacing wires sutured into the myocardium and exposed through the skin on the patients chest

<p><span>pacing wires sutured into the myocardium and exposed through the skin on the patients chest</span></p>
48
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transvenous pacemaker

cardiac pacemaker using a pacing electrode or wire passed through a vein into the chambers of the heart that stimulates and maintains a normal heart rate; may be permanent or temporary

<p>cardiac pacemaker using a pacing electrode or wire passed through a vein into the chambers of the heart that stimulates and maintains a normal heart rate; may be permanent or temporary</p>
49
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transcutaneous pacemaker

external pacemaker used as a temporary emergency measure for maintaining adequate heart rate

<p><span>external pacemaker used as a temporary emergency measure for maintaining adequate heart rate</span></p>
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which type of pacemaker is inserted for open bypass patients?

epicardial

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dysrhythmias of the atria

PAC's, A flutter, A fib

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third degree heart block

PR interval is regular but does not match up to QRS.

<p><span>PR interval is regular but does not match up to QRS.</span></p>
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<p>hemodynamic changes of sinus brady</p>

hemodynamic changes of sinus brady

decreased cardiac output

decreased arterial pressure

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hemodynamic changes of atrial flutter

decreased cardiac output

decreased blood pressure

<p>decreased cardiac output</p><p>decreased blood pressure</p>
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<p>hemodynamic changes of ATRIAL fibrillation</p>

hemodynamic changes of ATRIAL fibrillation

decreased cardiac output

decreased blood pressure

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<p>hemodynamic changes in ventricular tachy</p>

hemodynamic changes in ventricular tachy

systemic arterial hypotension

decreased cardiac output

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<p>hemodynamic changes in ventricular fibrillation</p>

hemodynamic changes in ventricular fibrillation

decreased stroke volume

decreased cardiac output

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sinus tachycardia treatment

fix issue causing the dysrhythmia, if unstable sedate and cardiovert

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<p>SVT treatment</p>

SVT treatment

-vagal stimulation: Valsalva maneuver, carotid massage

-IV adenosine is drug of choice

-IV beta blockers, CCB, amiodarone also used

-if none of that works, cardioversion

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<p>torsades de pointes</p>

torsades de pointes

this is a form of v tach

-caused by low mag

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torsades de pointes treatment

Magnesium