ch8 ekg extra - atrial rhythms

Deflections of atrial rhythm QRS

QRS deflection depends on lead being monitored

Wandering atrial pacemaker criteria

Average HR <100, Irregular, at least 3 different P wave shapes, variable PR interval with narrow <0.12 sec QRS

Multifocal atrial tachycardia criteria

Average HR >100, irregular, at least 3 different P wave shapes, variable PR interval with narrow <0.12 sec QRS

Premature atrial complex criteria

May occur at any HR, regular interrupted by premature beat, different P wave shape than sinus ones with P waves possibly hiding inside T waves, normal PR and QRS ints

Paroxysmal atrial tachycardia criteria

HR 160-250, interrupted rhythm has different heartrate, atrial tach is regular but causes strip to appear regular but interrupted, uniform P waves different from sinus, normal PR and QRS ints

Atrial flutter criteria

Atrial rate 250-350 varies with conduction ratio, regularity depends on conduction ratio, P waves absent and replaced with zigzag flutter waves, absent PR but present and normal QRS int

Atrial fibrillation criteria

Atrial rate 350-700 HR varies, irregular, P waves absent and replaced with fibrillatory waves with undulatory baseline, PR intervals absent but present and normal QRS int

Supraventricular tachycardia criteria

HR 130 or more, regular, P waves not visible, no visible PR, but present and normal QRS int

Causes of wandering atrial pacemaker

caused by drug side effects, MI, vagal stimulus

Causes of multifocal atrial tachycardia

usually caused by COPD

Causes of premature atrial complexes, paroxysmal atrial tachycardia, and supraventricular tachycardia

usually caused by stimulant use, medications, hypoxia, heart disease

Causes of atrial flutter

heart disease, pulmonary embolus, lung disease, heart valve disease

Causes of atrial fibrillation

MI, lung disease, heart valve disease, hyperthyroidism

Adverse effects of wandering atrial pacemaker

usually no adverse effects

Adverse effects of multifocal atrial tachycardia

potential decreased CO

Adverse effects of premature atrial complexes

usually no adverse effects

Adverse effects of paroxysmal atrial tachycardia

can result in decreased heart rate

Adverse effects of atrial flutter

decreased CO if heartrate too fast or too slow

Adverse effects of atrial fibrillation

decreased CO, blood clots which may cause strokes, pulmonary emboli, or MI

Adverse effects of supraventricular tachycardia

decreased CO

Treatment for wandering atrial pacemaker

usually no treatment needed

Treatment for multifocal atrial tachycardia

beta blockers and calcium channel blockers used

Treatment for premature atrial complexes

O2, calcium channel blockers, beta blockers, avoid stimulants, treat CHF if present

Treatment for paroxysmal atrial tachycardia

digitalis, calcium channel blockers, beta blockers, adenosine, oxygen, electrical cardioversion

Treatment for atrial flutter

oxygen, calcium channel blockers, beta blockers, adenosine, digitalis

Treatment for atrial fibrillation if duration less than 48 hr

digitalis, calcium channel blockers, amiodarone, or electrical cardioversion

Treatment for atrial fibrillation if duration more than 48 hr

anticoagulants for 2-3 weeks, then cardioversion

Treatment for atrial fibrillation in emergency

start on heparin, conduct TEE to check for atrial blood clots, and then perform cardioversion

Treatment for supraventricular tachycardia

adenosine, digitalis, ibutilide, calcium channel blockers, beta blockers, o2, electrical cardioversion