EKG Part 2

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8 Terms

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Normal Heart Function

SA node: 60-100 bpm

controls heart rate

atrial rate=ventricular rate

loudest+fastest foci in heart

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Foci of Automaticity

SA node: 60-100
-sinus brady: under 60
-sinus tachy: over 100

atrial: 60-80

junctional: 40-60
near AV node

ventricular: 20-40
bundle of his/purkinje fibers

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Conduction System

SA node→AV node→bundle of his→L+R bundle branches→purkinje fibers

bachmann’s bundle: only way for SA node to send pulses to L atrium

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3 Types of P Waves

normal: SA node
round P node

abnormal: SA node
angled P node
e.g.: COPD

ectopic: non SA node
retrograde depolarization
e.g.: premature atrial contraction (PAC)

lead II: inverted p wave

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Sinus Arrhythmia

PP: inspiration→lung stretch receptors activate sympathetic SA stimulation
expiration→parasympathetic SA stimulation

E: kids
prognostic post MI

CM:
inspiration→increased HR
expiration→decreased HR

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Wandering Atrial Pacemaker

PP: Blocking the breathing-related influence of the vagus nerve on the heart's natural pacemaker and signal pathway

rate: normal

rhythm: irregular

pacer site: shifts back&forth from SA to ectopic (1 or more) atrial pacer sites

morphology: p’ (abnormal P wave) in any lead

interval:
PR→varies
QRS→normal

E: young
old
athletes
digitalis

TX: none

<p>PP: Blocking the breathing-related influence of the vagus nerve on the heart's natural pacemaker and signal pathway</p><p>rate: normal</p><p>rhythm: irregular</p><p>pacer site: shifts back&forth from SA to ectopic (1 or more) atrial pacer sites</p><p>morphology: p’ (abnormal P wave) in any lead</p><p>interval:<br>PR→varies<br>QRS→normal</p><p>E: young<br>old<br>athletes<br>digitalis</p><p>TX: none</p>

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Multifocal Atrial Tachycardia

PP:
rate: 100-150 bpm

rhythm: irregular

pacer site: shifts back&forth from from SA to ectopic (2+) atrial pacer sites

morphology: 3 abnormal p waves

interval:
PR: varies
QRS: normal

E: COPD
elderly
CAD
valvular disease
HTN
cor pulmonale
digoxin toxicity
hypokalemia
hypomagnesemia

TX:
tx underlying condition
abx x PRN
nebulizers
IVF
electrolyte replacement

<p>PP:<br>rate: 100-150 bpm</p><p>rhythm: irregular</p><p>pacer site: shifts back&forth from from SA to ectopic (2+) atrial pacer sites</p><p>morphology: 3 abnormal p waves</p><p>interval:<br>PR: varies<br>QRS: normal</p><p>E: <strong>COPD</strong><br>elderly<br>CAD<br>valvular disease<br>HTN<br>cor pulmonale<br><strong>digoxin toxicity</strong><br>hypokalemia<br>hypomagnesemia</p><p>TX:<br>tx underlying condition<br>abx x PRN<br>nebulizers<br>IVF<br>electrolyte replacement</p>

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Atrial Fibrillation

PP:
rate: slow
fast→bad

rhythm: irregular

pacer site: multiple ectopic sites
rape reentry atrial circuits

morphology: f waves (350-600 bpm in II/III/AVF/V1)
chaotic atrial spikes
no P wave
no single atrial impulse→depolarizes both atria

interval: RR varies
QRS normal

ventricular response: irregular (slow or fast)
controlled→60-80 bpm
uncontrolled→160-180 bpm

<p>PP:<br>rate: slow<br>fast→bad</p><p>rhythm: irregular</p><p>pacer site: multiple ectopic sites<br>rape reentry atrial circuits</p><p>morphology: f waves (350-600 bpm in II/III/AVF/V1)<br>chaotic atrial spikes<br>no P wave<br>no single atrial impulse→depolarizes both atria</p><p>interval: RR varies<br>QRS normal</p><p>ventricular response: irregular (slow or fast)<br>controlled→60-80 bpm<br>uncontrolled→160-180 bpm</p>