ECG & Dysrhythmias Flashcards
Sinus arrhythmia characteristics
Rate 80 Regularity Irregular P wave? Yes P:QRS ratio 1:1 PR interval .14 QRS width .06
Bradycardia & potential causes
<60 BPM Hypoxia Hypothermia Medications Sleep Normal in athletes
Bradycardia treatment & symptoms
Symptomatic
Syncope, chest pain, hypotension, shortness of breath, diaphoresis
Atropine .5mg IVP
Tachycardia & potential causes
100+ BPM
Fever Anemia Hypovolemia Hypotension Pulmonary embolism Myocardial infarction
Before treating tachycardia, what do you want to know?
Is pt symptomatic/compensating?
Treat the cause (blood products, fluid, etc)
tachycardia treatment
BB CCB
A-fib characteristics
Rate/rhythm/pwave?/P:QRS ratio/ PR interval
Slow:50
Fast: 170
Irregular
No Pwave , P:QRS, PR interval
Complications of Afib
Decreased CO & Clots
Treatment of Afib
Anticoagulation
• Heparin gtt (inpatient) • Oral anticoagulants
Rate control
• Digoxin, beta blockers, calcium channel blockers Rhythm control
• Antiarrhythmics, cardiac ablation, cardioversion (need TEE first!)
A flutter Characteristics Rate/rhythm/pwave?/P:QRS ratio/ PR interval
rate 100/50 irregular No P wave--F wave present P:QRS ratio n/a PR interval n/a
Possible a flutter causes
Acute MI • Mitral valve disease • Thyrotoxicosis (↑T4) • COPD • Chest surgery
A-flutter treatment
Rate control until SA node takes over again • Beta blockers, calcium channel blockers
► Antiarrhythmics or cardioversion if needed
SVT
Characteristics Rate/rhythm/pwave?/P:QRS ratio/ PR interval
Rate 100-167 Regular P wave present but can be hidden in t wave(?) P:QRS: 1:1 PR: w/in range
SVT treatment:
Determine underlying rhythm
Slow heart rate (BB/CCB)
give name & rate of 3 Junctional Rhythms
rate 40-60 junctional
rate 61-100 accelerated junctional
rate 100+ junctional tachy
Junctional wave characteristics Rate/rhythm/pwave?/P:QRS ratio/ PR interval
40-100+ depending on rhythm
regular
Inverted P wave/buried p wave/ no pwave
PR/P:QRS ratio depends on if pwave is present
Causes of Junctional rhythm
Digoxin toxicity
Acute MI
Heart Surgery
Treatment of Junctional rhythm
Supportive care (pacing) Treat the cause
Defibrillation
• Not synchronized
– Deliveredanytimeincardiaccycle
• Higher energy (electricity)
Debribrillation rhythms
Ventricular fibrillation
Ventricular tachycardia without a pulse
Cardioversion
- Synchronized
* Delivered on the R wave • Lower energy (electricity)
Cardioversion rhythms
̶ Atrial fibrillation (after
anticoagulation!)
̶ Unstable tachyarrhythmias
Epinephrine
- First line for pulseless rhythms • 1mg q 3-5 minutes
* PEA = Push Epi Always
Amiodarone
- Antiarrhythmic
- Reduces heart rate
- Drip used in tachyarrhythmias
Atropine
- Antimuscarinic anticholinergic • Increases heart rate
- Used in bradycardias
- .5mg IVP (“.5 alive”)
Adenosine
• Converts, stops or slows rhythms • 6mg IVP, then 12mg IVP if needed
types of pacemaker
Transcutaneous
Transvenous
Transthoracic (epicardial)
Internal
Types of pacing
Atrial, venticular, biventricular, dual chamber
Atrial Pacer spike
► Atrial
• Pacer spike prior to P wave
Ventricular pacer spike
• Pacer spike prior to QRS
Biventricular
• Two spikes prior to QRS (lead
in each ventricle)
Dual chamber
• Spike prior to P wave and QRS
Failure to fire
No pacer spikes where they should have been
Loss of capture
Pacer spikes not followed by P or QRS complex
Undersensing
Pace beats or spikes too close to previous beats results in spikes in T waves or Qrs
Assessing PM function
is the chamber being paced capturing? • P wave or QRS after a spike
► Is the pacemaker sensing the patient’s inherent rhythm? • Pacer spike when appropriate – not too many or too little
► Is there a pulse with each the pacer rhythm? • Palpate!