Atrial Arrhythmias

Question 1

Wandering Atrial Pacemaker (WAP)

Answer 1

Natural pacemaker shifts to latent pacemaker sites (SA to AV junction & back to SA node) Common in athletes, geriatric, children, dig toxicity Happens while exercising or sleeping Does not require treatment

Question 2

Wandering Atrial Pacemaker (WAP) Tracing

Answer 2

Noticeable change in P wave PR interval varies QRS complex normal Rate normal but rhythm irregularity

Question 3

Multifocal Atrial Tachycardia (MAT)

Answer 3

Caused by increased impulses sent from atria to ventricles 100+bpm Different areas in atria release impulses simultaneously Confused with A-fib, but MAT has visible P wave Caused by CAD, HF, valvar heart disease, DM, hypokalemia, hypomagnesemia, azotemia, sepsis, pulmonary embolism, pneumonia, post-op state

Question 4

Multifocal Atrial Tachycardia (MAT) Tracing

Answer 4

3+ different P waves PR interval varies QRS complex normal but rhythm irregular

Question 5

Premature Atrial Contraction (PAC)

Answer 5

Electrical impulse released earlier than expected impulse of SA node Caused by stress or stimulants, HTN, MI, valve disorder, electrolyte imbalance sx: “fluttering” sensation

Question 6

Premature Atrial Contraction (PAC) Tracing

Answer 6

Present, but irregularly shaped, P waves PR interval varies QRS complex normal

Question 7

Atrial Tachy

Answer 7

Electrical impulse generated in atrial chambers rather than SA node SA node overriden sx: palpitations, syncope, dyspnea, fatigue

Question 8

Atrial Tachy Tracing

Answer 8

P waves different shape

Short PR interval less than 0.12 sec

Question 9

Supraventricular Tachy

Answer 9

Heart rhythm originates in ventricle or AV node

Triggers: heart disease, caffeine, alcohol, smoking, stress

May lead to heart failure

Question 10

Two main types of Supraventricular Tachy

Answer 10

Atrioventricular nodal reentral tachy (AVNRT)

Atrioventricular reciprocating tachy (AVRT)

Question 11

Supraventricular Tachy Tracing

Answer 11

P waves difficult to see (buried in T waves)

PR interval can’t be measured

QRS interval normal

Regular heart beat

Question 12

Atrial Flutter

Answer 12

Atria release impulses 250-400x/minute

Not all impulses conducted to ventricles = therapeutic block at AV node

Heart fails to pump ample blood supply

Question 13

Atrial Flutter Tracing

Answer 13

P waves sawtooth

PR interal varies

QRS normal

Question 14

Atrial Fibrillation

Answer 14

Irregular, rapid, uncoordinated twitching of atrial cardiac muscle

Question 15

Atrial Fibrillation Tracing

Answer 15

Absence of P waves

No PR interval

QRS complex normal

Rhythm irregular