Study Notes on Telemetry Rhythms

Telemetry rhythms are vital for heart function analysis and diagnosing conditions.
Arrhythmias exhibit distinct characteristics on telemetry.

Definition: Normal physiological heart rhythm, originating from the SA node.
Characteristics:
- P-R Interval: 0.12 - 0.20 seconds.
- QRS Duration: 0.04 - 0.12 seconds.
- Heart Rate: 60 - 100 beats/minute.
- Intervals: P to P and R to R are regular and equal.
- P Waves: Upright; one precedes each QRS; uniform in shape.
Application: Practice calculating PR interval, QRS interval, and heart rate for NSR confirmation.

Definition: Slower than normal heart rate from the SA node.
Characteristics:
- P-R Interval: Approx. 0.20 seconds.
- QRS Interval: Approx. 0.12 seconds.
- Heart Rate: <60 beats/minute (e.g., 48 bpm).
Diagnosis: Meets NSR criteria except for low heart rate.
Treatment:
- Stable: Monitor.
- Unstable: Atropine 0.5 mg IV push every 3-5 min (max 3 mg) or pacing.

Definition: Faster than normal heart rate from the SA node.
Characteristics:
- P-R Interval: Normal (0.12 seconds).
- QRS Interval: Normal (0.08 seconds).
- Heart Rate: >100 beats/minute (e.g., 136 bpm).
Diagnosis: Heart rate over 100 bpm; other criteria normal.
Treatment:
- Stable: No treatment.
- Unstable: Treat underlying cause.

Definition: Irregular, often rapid heart rate with potential complications.
Characteristics:
- Multiple irritable firing sites in atria cause quivering.
- No discernible P waves; telemetry shows a wavy line.
- Irregular ventricular rhythm.
Heart Rate Calculation: Measure narrowest and widest R to R intervals for a rate range.

Definition: Rapid reentrant tachycardia from abnormal atrial electrical activity.
Characteristics:
- SA node not origin; F waves (flutter waves) present.
- Variable conduction ratios to QRS complexes; no P waves.
- Sawtooth appearance on telemetry (e.g., 4:1 ratio).
Treatment:
- Generally conservative for asymptomatic patients.
- Medications for heart rate control.
- Anticoagulation before cardioversion if indicated, to prevent thromboembolic complications.

Definition: Early beats from atria that disrupt normal rhythm.
Characteristics:
- Full PQRST complex, but P wave appears early.
- Followed by a compensatory pause.
Causes: Hypoxia, stimulants (caffeine), infections, digoxin toxicity.
Treatment: Monitor; reduce stimulants if frequent/symptomatic.

Definition: Early beats from ventricles leading to irregular rhythms.
Characteristics:
- Wide, bizarre QRS complexes ( >0.12 seconds).
- No P wave.
- Followed by a compensatory pause.
Causes: Hypoxia, MI, electrolyte imbalances, caffeine.
Treatment: Based on frequency/symptoms; occasional PVCs require no intervention. Treat underlying cause for frequent PVCs.
Terminology:
- Couplet: Two PVCs in a row.
- Bigeminy: PVC every other beat.
- Trigeminy: PVC every third beat.
- V-Tach: 3+ PVCs in succession.
- Types:
- Unifocal: All PVCs resemble each other.
- Multifocal: PVCs have different morphologies.
- R-on-T Phenomenon: PVC on T-wave peak, potentially leading to VT.

Definition: Fast heart rate from ventricles, usually >150 beats/minute.
Characteristics:
- Absence of P waves; QRS complexes wide and bizarre (>0.12 seconds).
- Sustained VT: Lasts >30 seconds.
- Unsustained VT: Lasts <30 seconds.
Classification:
- Stable with Pulse: No significant BP/mental status changes.
- Unstable with Pulse: Changes indicating cardiac compromise.
- Pulseless: Requires immediate CPR.
Treatment:
- Stable: Monitoring; amiodarone (150 mg in 100 mL NS over 10-15 min).
- Unstable: Urgent cardioversion; monitor vitals.

Definition: Disorganized, ineffective ventricular contractions without effective blood flow.
Characteristics:
- Coarse V-Fib: More distinguishable waveforms.
- Fine V-Fib: Less distinguishable, more refined.
Treatment: Immediate defibrillation, epinephrine 1 mg every 3-5 minutes, continuous CPR.