Dysrhythmias Part 2

Question 1

Normal sinus rhythm

Rhythm
Rate
PRI and QRS

Answer 1

Regular
60-100
Normal PRI (0.12-0.20)
Normal QRS (0.06-0.10)

Question 2

Sinus bradycardia (SB)

Rhythm
Rate
PRI and QRS

Answer 2

Regular
Less than 60
Normal PRI (0.12-0.20)
Normal QRS (0.06-0.10)

Question 3

Sinus bradycardia (SB)

Causes
Treatment

Answer 3

Vasovagal response
Meds: BB, CCB, digoxin
Hypoxemia, hypothermia, MI, increases ICP
Atheletes

Tx:
Atropine if symptomatic (1mg IV)

Question 4

Sinus tachycardia (ST)

Rhythm
Rate
PRI and QRS
Issues with p wave

Answer 4

Regular
100-150 to up to 180

Normal PRI (0.12-0.20)
Normal QRS (0.06-0.10)

May not see a p wave if too fast (buried in T wave)

Question 5

Sinus dysrhythmia

Rhythm
Rate
PRI and QRS
Tx

Answer 5

Irregular (often corresponds w/ resp cycle)
60-100

Normal PRI (0.12-0.20)
Normal QRS (0.06-0.10)

Tx: none

Question 6

Sinus pauses

Ryhthm
Rate
PRI and QRS
Issues

Answer 6

Regular then irregular
Rate varies

Normal PRI (0.12-0.20)
Normal QRS (0.06-0.10)

SA node fails to initiate one or more impulses

Question 7

Sinus pauses

Pt response
Causes
Tx

Answer 7

Pt: feel like their going to pass out (fall risk)

Cause:
-inferior wall MI
-vagal stimulation
-hypoxemia
-meds: BB, CCB, Digoxin

Tx: adjust or d/c meds
-consider pacemker if symptomatic

Question 8

Early beats

Abnormal
Bigeminy
Trigeminy

Most common early beats

Answer 8

Abnormal: ectopy

Bigeminy: early beat occurs every other beat

Trigeminy: every 2nd beat

Premature contractions (PAC, PVC, PJC)

Question 9

Early beat: PAC (premature atrial contraction)

Rhythm
Pwaves
PRI and QRS

Answer 9

Rhythm normal w/ Premature atrial beats

-1 P wave for every QRS complex
-PAC P wave will have different shape and occurs prematurely

Normal PRI (0.12-0.20)
Normal QRS (0.06-0.10)

Question 10

Compensatory pause

Answer 10

Time after PAC for SA node to reset

Question 11

PAC

causes
Tx

Answer 11

Stimulants: caffeine, smoking
Myocardial hypertrophy
Dilations, ischemia
Lung disease
Hypokalemia
Hypomagnesemia

Tx: monitor (none)

Question 12

Atrial tachycardia
(or SVT-supraventricular tachycardia)

Rhythm
Rate
PRI and QRS

Answer 12

Regular
151-250 (its tachycardia until 151)

Normal PRI (0.12-0.20)
Normal QRS (0.06-0.10)

Question 13

Atrial tachycardia
(or SVT-supraventricular tachycardia)

Rhythm
Rate
PRI and QRS

Answer 13

Regular
151-250 (its tachycardia until 151)

Normal PRI (0.12-0.20)
Normal QRS (0.06-0.10)

Question 14

Atrial tachycardia
(or SVT-supraventricular tachycardia)

Pt response
Tx

Answer 14

Higher HR more symptomatic:
-SOA, chest pain, HOTN, decreased CO

Tx:
If rate >150 and pt symptomatic:
-cardioversion for unstable
-BB, CCB, adenosine, amiodarone, vagal maneuvers
(Adenosine: 6mg 1st, then 12mg)

Question 15

Atrial flutter (shark tooth)

Rhythm
Rate
PRI and QRS

Answer 15

Flutter waves
240-320 HR

PRI: cant measure
QRS: normal (0.06-0.10)

Question 16

Atrial flutter (shark tooth)

Pt response
Tx

Answer 16

May be asymptomatic:
-unless flutter results in tachycardia AKA RVR
a flutter w/ RVR may see same symptoms as ST or SVT

Tx:
Control HR w/ meds
(BB, CCB, digoxin, adenosine, amiodarone)

Anticoagulates (heparin/coumadin)

Cardioversion 3-4wks after anticoagulants started or ablation

Question 17

Atrial fibrillation

Rhythm
Rate
PRI and QRS

Answer 17

Irregular rhythm

Rate:
Controlled Afib: <100 (under)
Uncontrolled Afib: >100 (over)

PRI: unmeasurable
QRS: normal (0.06-0.10)

Question 18

Atrial fibrillation

Causes
Tx

Answer 18

Causes:
-ischemic heart disease, valve disease
-hyperthyroidism
-lung disease, HF, aging

Tx:
Control HR w/ meds
(BB, CCB, digoxin, adenosine, amiodarone)

Anticoagulates (heparin/coumadin)

Cardioversion