Chapter 8 Flashcards
High lateral leads
I and aVL
Inferior leads
II III and aVF
Septal leads
V1 and V2
Anterior leads
V3 and V4
Low lateral
V5 and V6
Cheat rule for establishing rate
300 150 100 75 60 and 50
General major concepts for approaching arrythmias
Is the rhythm fast or slow
Is it regular or irregular
If irregular, regularly irregular or irregularly irregular
General concepts for approaching the p wave
Upright Uniform Present Does each QRS have a p wave Is the PRI constant, or prolonged
General concepts for approaching the QRS complex
Narrow or wide
Grouped or not grouped
Any dropped beats
Sinus arrhythmia
A sinus rhythm with some variation in TP intervals due to normal variations caused by respiration. It occurs because inhalation increases venous return by lowering intrathoracic pressure.
Sinus pause or arrest
It is not a multiple of the normal P-P interval. It is a sinus rhythm with a pause with no sinus pacemaker working
Sinoatrial block
The block occurs in some multiple of the P-P interval. IT is a non conducted beat from the normal pacemaker. The rhythm returns to normal after
Premature atrial contraction
A pacemaker in the atria fires sooner than expected. P wave may be different than the rest
Ectopic atrial tachycardia
An alternate site fires earlier than expected creating a different p-wave and rapid heart rate. Usually not sustained for an extended period. May cause some ST and T-wave abnormalities
Wandering atrial pacemaker
Irregularly irregular. Three different p wave morphologies are present. Rate has to be less than 100. Each have their own PRI, they are longer when the origin site is further away
Multifocal atrial tachycardia
WAP with a rate of 100bpm or greater. May cause cardiac instability
A flutter
Atrial rate of 250-350.
Ventricular rate of 125-175.
Rhythm is usually regular.
Presence of F waves (saw tooth appearance)
Normally a 2:1 P to qrs ratio
Possible to have a truly variable ventricular response
A-fib
Ventricular rate is variable.
Irregularly irregular
Caused by numerous atrial pacer sites firing in a haphazard way
Premature junctional contraction
Irregular
P waves (none, antegrade or retrograde)
It is a beat which arises prematurely in the AV node. Can occur in bi or trigeminy, or sporadically
P wave inverted in II III and aVF (inferior leads)
Retrograde p wave occurs after the QRS
Junctional escape beat
Irregular
P waves - none, antegrade or retrograde
The distance of the junctional escape beat will be greater than the normal rhythm.
The difference between this and PVC is a PVC is from an early AV node depolarization, where this is from the SA node failing to depolarize
Junctional rhythm
Rate is 40-60
Occurs when the SA fails to depolarize, or in AV dissociation or 3rd degree AV block
Accelerate junctional rhythm
P waves may be absent retrograde or antegrade
Rate is 60-100 which is faster than expected for normal junctional pacemakers
If the rate is over 100 it is junctional tachycardia
Compensatory pause
A pause where the premature contraction, added to the pause following it before the regular rhythm resumes, is equal to the regular rhythm
Premature ventricular contraction
A ventricular pacer fires before the SA node, which causes the ventricles to be in a refractory state. The underlying rhythm is not interuppted, hence the compensatory pause
