Common ECG rhythms in PT practice and associated decision making

what are the ways to count HR on an ECG

six-second strip, count off, divide into 300, divide into 1500

if you feel a regular pulse there could be

sinus rhythm or first degree heart block

if there is a fast regular pulse there could be

sinus tachycardia, atrial flutter, or SVT

if there is slow regular pulse there could be

junctional, sinus bradycardia, or third degree heart block

if there is a regularly irregular pulse there could be

bigeminy, trigeminy, or second degree heart block type 1

if there if irregularly irregular pulse there could be

sinus pause / dysrhythmia, atrial fibrillation, PVCs, second degree heart block type 2, paroxysmal SVT or NSVT

artifacts could be due to

patient movement, poor contact, electrical interference, or cable issues

what does sinus tachycardia show on an ECG

the "M" with the fast HR 100+ bpm

HR affects myocardial

oxygen supply and demand

what is the major issue with sinus brady

insufficient CO and whether the cause is meds or SA node problem.

what helps you determine if you should mobilize someone with bradycardia

how low of HR, presence of symptoms, and whether the cause is identified

Sinus Dysrhythmia is due to

increase and decrease in intrathroacic pressure which impacts venous return and HR. Inhalation increase pressure which increase HR.

when is sinus dysrhythmia normal

in children and the elderly

what is a sinus pause

when the SA node fails to depolarize and the pause is too long so the AV node may depolarize and drive rate / rhythm. No p-wave will be present.

what are premature atrial complexes due to

an irritable focus within the atria which results in a different shape

frequent PACs result in

an irregularly irregular rhythm that looks like a-fib but has a p-wave

when are PACs frequently seen

post cardiothoracic procedures

what are the major issues with a-fib

rate control, rhythm control, stroke risk

what impacts your decision to report / consult on a-fib

new onset, recurrence post-conversion, RVR, symptomatic, hemodynamic changes

the onset of a-fib may be due to

a cardiothoracic procedure, age, obesity, HF, OSA, vascular disease, endocrine disease, ETOH abuse

what are some ways to control the rhythym with a-fib

DC cardioversion, pharmacologic, and surgical

what are some ways to reduce stroke risk in patients with a-fib

warfarin or DOACS, left atrial appendage closure, implanted loop monitoring

a fib burdern associated with increased CVA risk is

6 minutes

what outcome measure can look at stroke risk in people with a fib

CHADSVAS

what is atrial flutter

where there is a single irritable focus in the atrial that is going off

why is there a concern with atrial flutter

much more likely to lead to RVR

possible atrial flutter treatments are

catheter ablation or pharmacological control

first degree heart blocks

long P-R intervals with a slower regular rate.

second degree type one heart blocks

the P-R interval gets longer until a complex drops then it restarts. Resolves when the problem is correected.

second degree type two heart blocks

there are several p-waves before a QRS complex and some dropped complexes. They are more serious and may require a pacer.

what is a third degree heart block

SA node fires regularly but the QRS doesn't always take / is coordinated. This is a significant hemodynamic problem that requires a pacer.

junctional rhythms are associated with

slow rates. They occur because the AV node is not receiving any signals from the SA node.

junctional rhythms are due to

SA dysfunction from drugs or ischemia / injury

junctional rhythms on ECG

very slow without p-waves

when should you be worried about bradycardia

where there are signs and symptoms of poor perfusion such as acute altered mental status, ongoing chest pain, hypotension, or signs of shock

what is supraventricular tachycardia

when there is a narrow QRS complex and a HR of 150+. The p-wave is buried and there is no "M".

what is the risk of supraventricular tachycardia

it is urgent due to the risk of myocardia ischemia and hemodynamic compromise think about starting CPR

what do premature ventricular complexes look like

inverted QRS complexes or irregular amplitude

what is the concern with PVCs

underlying myocardia irritation where the irritable foci are due to serious pathology which is a risk of decompensation or V TACH

what is the level of concern for PVCs associated with

Frequency (6+ per minute), multifocal, worsening with exertion or stress, progression to paring or runs

VTACH PVS couples

two PVCs in a row

VTACH VT

greater than 3 PVCs in a row

NSVT is

not sustained 3 PVCs which are short in duration and spontaneously convert

sustained VT eventually results in

pulseless cardiac arrest

if someone has VTACh due to myocardial ischemia can you work with them

best to wait if CABG or L heart cath is pending

if someone has VTACH and a history of cardiomyopathy with an ICD placement can you work with them

best to wait

if someone has VTACH with cardiomyopathy and is otherwise stable with no other options can you work with them

yes but be very cautious

is someone has VTACH with an LVAD in place what should you do

stop exercise and alert staff

V fib

looks fuzzy on the ECG with no defined features. It is a shockable rhythm and there is no perfusion occurring so start CPR.

Asystole

a complete stop of electrical activity.

is asystole shockable

nope since there is no electrical activity to start. Do CPR.

depression and T wave inversion reprresent

ischemia

a prominent Q wave and ST elevation represent

injury and infarction with a greater amount of wall thickness involved. Should measure troponin.

why are ventricular based QRS complexes wide

because the signal falls outside the normal system