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Normal Sinus Rhythm โ Rate : 60 - 100 beats per minute โ Rhythm : Atrial and Ventricular Regular โ P Wave : Uniform in appearance, upright, normal shape, one preceding each QRS complex โ PR Interval : 0.12- 0.2 seconds โ QRS : 0.12 second or less. (If larger than 0.12- QRS is wide and there may be a bundle branch block) Sinus Bradycardia โ Rate: Less than 60 beats per minute โ Rhythm: Atrial and Ventricular Regular โ P Waves: Uniform in appearance, upright, normal shape, one preceding each QRS complex โ PR Interval: 0.12-0.2 seconds โ QRS: Usually 0.12 seconds or less โ Etiology : athletic training, MI, hypothyroidism, hypothermia, sick sinus syndrome, medications, increased ICP โ Treatment : None may be indicated โ Treat underlying cause โ Atropine #1 medication to treat bradycardia!!!!! โ Pacemaker for patients with chronic bradycardia, takes over SA node; puts intrinsic rate into heart Sinus Tachycardia
Cardiac EKG RHYRTHMS Test Questions and Answers
โ Rate: Usually 100-140 beats per minute โ Rhythm: Atrial and ventricular regular โ P Waves: Uniform in appearance, upright, normal shape, one preceding each QRS โ PR Interval: 0.12-0.2 second โ QRS: Usually 0.12 second or less โ Etiology : stress or fear, anemia, fever, hypoxia, shock, hyperthyroidism, drugs, heart failure, pain, hypoglycemia โ Treatment : โ Treat underlying cause โ ฮฒ Blocker โ Calcium Channel Blocker (Diltiazem aka Cardizem) โ Valsalva Maneuvers โ series of motions that stimulates nerve, running by the heart, which slows it down; ex: bearing down Sinus Arrhythmia โ Rate: Usually 60-100 beats per minute โ Rhythm: Atrial and ventricular occasionally have an irregular beat โ P Waves: Uniform in appearance, upright, normal shape, one preceding each QRS โ PR Interval: 0.12-0.2 second โ QRS: Usually 0.12 second or less โ Etiology : idiopathic (unknown cause), stress, electrolyte imbalance โ first sign โ Treatment : likely no treatment unless symptomatic -- treat underlying condition!
โ Ablation โ procedure where part of heart causing afib is zapped (damage so source of afib can no longer fire) โ Maze Procedure โ noninvasive or during another cardiac surgery โ laser on atria in maze design so atria cannot fire/twitch irregularly (fancy ablation) Atrial Flutter โ Rate: Atrial rate 250 - 350 bpm. Ventricular rate variable. โ Rhythm: Atrial regular, ventricular may be regular or irregular โ No discernable P waves โ โSawtoothโ waves โ Loss of atrial kick โ Risk of Atrial Fib, embolization โ Etiology & treatment same as afib! Supraventricular Tachycardia (SVT) โ Rapid atrial contractions. HR > โ Hidden P waves in preceding T wave โ cardinal sign โ QRS narrow (less than 0.12). โ Etiology: Accessory pathways, MI, stimulants , CAD, COPD, anesthesia, cardiac irritation any kind of procedure irritating heart (ex: PICC line) โ Treatment: Carotid massage, Adenosine IV push, Beta Blocker, Calcium Channel Blocker, Cardioversion, Ablation Premature Ventricular Contractions (PVCs)
โ Ectopic Ventricular Contraction โ QRS wide and bizarre โ Unifocal vs. Multifocal โ Unifocal = multiple PVCs with same shape โ Multifocal = multiple shapes โ Bigeminy, Trigeminy โ Bigeminy = occur in pattern every other beat โ Trigeminy = occur in pattern every third beat โ Couplets -- if in groups of two right after each other โ Occasionally occur in healthy hearts โ Etiology: CAD, MI, stimulants, antiarrhythmics, electrolyte imbalances Consecutive PVCs/Runs of Vtach
โ No ventricular contractions โ No cardiac output โ Brain cells die in 4- 6 minutes. โ Call Code, Initiate CPR โ Defibrillation ASAP, ACLS Asystole โ V-fib deteriorates into asystole โ Rule out fine V-fib โ Poor prognosis โ Treatment: CPR, ACLS, epinephrine, atropine, pacing โ DO NOT SHOCK!!! Torsades de Pointes โ โTwisting around a pointโ โ Triggered by a long QT โ Treatment: Mag Sulfate, Pacing, Cardioversion
Artifact โ Waveforms not from a cardiac origin โ Patient movement or lead placement issue โ Tremors โ Can be resolved with lead correction/replacement โ Always check your patient Junctional Escape โ Rate: 40 - 60 beats per minute โ P waves: Usually absent. If visible, the P wave is inverted and may occur before, during, or after the QRS. โ Etiology: MI, Sick Sinus Syndrome, Digoxin Toxicity โ Treatment: Stop Digoxin, Atropine First Degree Heart Block โ Occurs on top of another rhythm โ Prolonged PR Interval (> 0.20) โ P waves conducted in regular pattern
โ Rate : Atrial rate greater than Ventricular. The ventricular rate is determined by the origin of the escape rhythm โ Rhythm: Atrial regular. Ventricular regular. No relationship between the atrial and ventricular rhythm โ Etiology: CAD, MI, myocarditis, digoxin toxicity โ Emergent Treatment: Quick action required. Transvenous or Transcutaneous Pacing. Often requires permanent pacemaker Pacemaker Malfunctions Cardioversion for Afib
Defibrillation
