Arrhythmias Flashcards
Key to Identifying Arrhythmias is?
The P wave!
Sinus Tachycardia Definition
regular, fast HR, Greater than 100 bpm. Usually no treatment needed. B-Blockers in thyrotoxicosis.
Sinus Bradycardia Definition
regular, slow HR, Less than 60 bpm. Usually no treatment needed. Atropine and pacemaker can be used for syncope.
First Degree AV Block
PR Interval greater than 0.2 seconds (one large block)
PR Interval Prolonged
Drug Induced (B-Blockers, some Calcium channel blockers, digitalis) Conduction System Disease
P Waves sometimes not followed by a QRS complex randomly
Second Degree AV Block (Mobitz Type 2). May move into 3rd degree AV block and consider using a pacemaker.
PR Interval Progressively increases until a P wave is not followed by a QRS complex
Second Degree AV Block (Mobitz Type 1)
Complete Heart Block EKG (3rd Degree)
No Relationship between P Waves and QRS. P waves are at a faster rate than QRS. (Lower Pacemaker has taken over)
Causes of 3rd Degree Heart Block. Treatment?
Severe Conduction system disease
Rarely Drugs
Treatment: Pacemaker if ventricular rate or BP are too low
Premature atrial beat appearance? Ventricular?
Atrial: P wave before QRS that is premature
Ventricular: No P Wave and wide QRS
Atrial Flutter EKG
Sawtooth Patter, P wave rate of 240-320/ minute. Pulse may be regular or irregular. Ventricular rate varies widely (usually rapid if untreated).
Atrial Flutter Treatments
Anticoagulation
Rate Control with Drugs (B-Blockers, Type IV and Digitalis)
Cardioversion
Ablation
Drugs that slow AV node conduction
Type II, Type IV and Digitalis/Digoxin
Atrial Tachycardia Definition.
Greater than 150 bpm. Narrow QRS. Abnormal P Waves.
Atrial Tachycardia Treatment
Adenosine, Vagal Maneuvers, B-Blocker, Verapamil or Diltiazem
Atrial Fibrillation Definition
No P waves AT ALL! w/ Irregular QRS Waves. (Irregularly Irregular ventricular rhythm).
Atrial Fibrillation Causes
NI Subjects (Lone A Fib) Aging Post-Operative Heart Disease Hyperthyroidism
AFib Problems
Rapid Hear Rate (Ischemia, heart failure)
Loss of Atrial Kick (Heart Failure)
Atrial Thrombi (Embolic Stroke)
AFib Treatment
Anticoagulation
Rate Control with Drugs
Cardioversion
Ablation
Junctional Rhythm Definition
Regular
Narrow QRS Usually
No antecedent P Waves (no p waves at all usually)
No treatment necessary!
QRS of Supraventricular Tachycardia
Narrow width!
Ventricular Tachycardia EKG
Usually regular, wide complexes (100 - 200 bpm)
No P waves visible
“Sustained” if greater than 30 seconds duration
Often Life Threatening!
Ventricular Tachycardia Treatments
Lidocaine (Class Ib)
Amiodarone (Class III)
Cardioversion
Wide QRS is suggestive of….?
Ventricular Arrhythmia!
Ventricular Fibrillation EKG
No consistent QRS complexes or coordinated contraction.
No cardiac contraction! No Blood Pressure!
Ventricular Fibrillation Treatment
GRAB DA PADDLES! Shock (hopefully) into a better rhythm.
Larry’s Awesome Algorithm Step 1
Look for the P Waves
Larry’s Awesome Algorithm Step 2
Does Each P Wave Precede a QRS?
Then it’s Sinus Rhythm!
Normal (60-100), tachy (>100), brady (<60)
Larry’s Awesome Algorithm Step 3
Is AV heart block present?
1st Degree Heart Block (PR int. > 0.2 seconds)
2nd Degree Heart Block (QRS rate slower than p rate because some P waves do not conduct to the QRS)
3rd Degree Heart Block (QRS slower than P rate because none of the P waves conduct to the QRS)
Larry’s Awesome Algorithm Step 4
Are occasional early QRS complexes present?
1) Atrial Premature beats (QRS is often narrow and preceded by an abnormal P wave)
2) Ventricular Premature beats (QRS complex is wide w/o a P wave)
Larry’s Awesome Algorithm Step 5
Are very fast, abnormal p waves present?
1) Atrial Flutter (p wave rate 240-320/min- P:QRS 2 to 4:1)
2) Atrial Tachycardia (Abnormal P waves before each QRS- HR 160-220/min)
Larry’s Awesome Algorithm Step 6
No P waves BUT QRS complexes present
1) Atrial Fibrillation (irregular QRS beats often with undulating baseline)
2) Junctional Rhythm (regular rhythm with flat baseline and often no P)
3) Ventricular Tachycardia (wide, regular, usually fast QRS)
Larry’s Awesome Algorithm Step 7
No P waves and no QRS?!?!
1) Ventricular Fibrillation! (wavy, irregular baseline)
2) Asystole (flat baseline)
