Atrial Arrhythmias Flashcards
Steps for interpreting EKGs
> Is it regular or irregular?
-look at the P-P (atrial) if present and R-R (ventricular)
> What is the rate?
> Are there P waves?
- do they look the same or are they different?
- is there a P wave in front of every QRS?
> If there are P waves, is there a regular PR interval?
-is it 0.12-0.20 seconds?
> What does the QRS look like?
- narrow (< 0.10)- above ventricles
- wide (> 0.10)- above the ventricles- wide QRS
- wide (> 0.10)- below the ventricles
> What is the QT interval?
- is it between 0.36-0.44 seconds?
- normal QT should be less than half the R-R interval (less than R-R interval is normal, the same it is borderline, and longer it is prolonged)
> Interpretation?
Intervention?
Different Types of Atrial Arrhythmias
- Premature Atrial Complex (PAC)
- Atrial Tachycardia/ SVT/ paroxysmal atrial tachycardia (PAT)
- Atrial Flutter
- Atrial Fibrillation
Premature Atrial Complexes (PACs)
occur when an irritable site within the atria discharges early before the next SA node impulse is ready to discharge
- P wave looks different than sinus “p”; abnormally shaped “p” wave
- its a single beat not an entire rhythm; identify underlying rhythm; rhythm will be regular except for the early beat
- measure R-R interval
- weird looking “p”; not like a sinus p
PAC on an EKG
- Rhythm: regular (R-R interval) for underlying rhythm; irregular w/ PAC; count the R-R, an early waveform will happen then go back to normal
- Rate: based on underlying rhythm (SB, SR, ST)
- P wave: configuration changes depending on the origin of the impulse
- PR interval: normal to underlying rhythm (0.12-0.20)
- QRS complex: 0.10 seconds (wide)
- QT interval: 0.44 seconds or less
Interventions for a PAC
- assess patient
- usually no tx
- treat underlying cause: electrolyte imbalance, reducing stress, reducing/eliminating stimulants, treating HF
Atrial Tachycardia/SVT on EKG
series of rapid beats from an atrial ectopic focus
- Regular (R-R interval)
- Rate: 150-250 bpm (leads to decreased cardiac output)
- P waves: usually pointed and hidden in the preceding T wave, 1 “p” for every QRS (with rapid rates its hard to distinguish P from T waves
- PR interval: not measurable
- QRS complex: narrow Paroxysmal atrial tachycardia (PAT): atrial tachycardia that starts or ends suddenly; “burst” or run, a short period
Interventions for Atrial Tachycardia/ SVT
if symptomatic b/c of the rapid rate (150-250 bpm)
- call RR
- vagal maneuvers
- calcium channel blockers (Diltiazem)
- beta-blockers; slow HR
- digoxin
- synchronized cardioversion if hemodynamically unstable
Atrial Flutter
ectopic atrial rhythm in which an irritable site within the atria fires regularly at an extremely rapid rate (>250)
-R-R interval is either irregular or regular depending on how many impulses the AV node allows to make it to the ventricles
-P waves: sawtooth deflections called flutter waves
-AV conduction ratio equals how many flutter eaves to each QRS; if conduction ratio remains constant at a 2:1 (or 3:1 or 5:1), the ventricular rate will remain regular and the rhythm is described as atrial flutter w/ a 2:1 AV conduction
“atrial flutter w/ a _ : _ AV conduction”
-if not constant, “variable conduction”
Interventions for Atrial Flutter
- cardiology consult
- if rapid ventricular rate, control ventricular response
- if rapid ventricular rate and sign of hemodynamic compromise, synchronized cardio version
- Meds: Diltiazem, Verapamil, Beta blockers
- prevent clot formation
Atrial Fibrillation
most common rhythm next to normal sinus rhythm
>irritable sites in the atria firing causing the atria to quiver; chaotic electrical activity in the atria; baseline fibrillatory waves rather than “p” waves
-Irregularly irregular (R-R interval)
-Atrial rate: 400-600 bpm
-Ventricular rate: determined by the degree of blocking by the AV node
(<100 stable or controlled ventricular response; >100 unstable or uncontrolled ventricular response)
-P wave: none
-PR interval: none, not measurable
-QRS complex: 0.10 (wide)
-QT interval: not measurable b/c T waves not clearly seen
Interventions for Atrial Fibrillation
- rate and rhythm control
- calcium channel blockers (Diltiazem)
- beta blockers
- if rapid ventricular rate and patient unstable; synchronized cardioversion
- anticoagulation (heparin/Coumadin); low intensity heparin
Cardioversion is treatment for which arrhythmias?
- Supra-ventricular Tachycardia (SVT)
- Unstable/rapid Atrial Flutter
- Unstable/rapid Atrial Fibrillation
