EKG Atrial Rhythms

Question 1

Four Main Types of Arrhythmias

Answer 1

Sinus Arrhythmias
Atrial Arrhythmias
Junctional Arrhythmias
Ventricular Arrhythmias

Question 2

Other EKG Rhythm Abnormalities

Answer 2

Pre-Excitation Syndromes
Escape Rhythms
Extrasystoles
Conduction Blocks/Defects

Question 3

we classify arrhythmias according to ____

Answer 3

their focus (point of origin)

Question 4

Sinus Arrhythmias

Answer 4

■ Sinus Tachycardia
■ Sinus Bradycardia
■ Sinus Arrhythmia

Question 5

Atrial Arrhythmias

Answer 5

■ Atrial Flutter
■ Atrial Fibrillation
■ Multifocal Atrial Tachycardia
■ Paroxysmal Atrial Tachycardia
■ Wandering Pacemaker
■ Sick Sinus Syndrome

Question 6

Normal Sinus Rhythm EKG characteristics

Answer 6

○ Regularity = Regular
○ Rate = Between 60 and 100 beats per minutes (BPM)
○ P Waves = Uniform, Upright, 1 before each QRS
○ PR Interval = Normal at 3-5 little boxes (0.12-0.20 seconds)
○ QRS Complex = Normal at less than 3 little boxes (less than 0.12 seconds)

Question 7

Sinus Tachycardia EKG characteristics:

Answer 7

○ Regularity = Regular
○ Rate = Greater than 100 BPM (a rapid version of Normal Sinus Rhythm)
○ P Waves = Uniform, Upright, 1 before each QRS
○ PR Interval = Normal at 3-5 little boxes (0.12-0.20 seconds)
○ QRS Complex = Normal at less than 3 little boxes (less than 0.12 seconds)

Question 8

Sinus Bradycardia EKG characteristics

Answer 8

○ Regularity = Regular
○ Rate = Less than 60 BPM (a slow version of Normal Sinus Rhythm)
○ P Waves = Uniform, Upright, 1 before each QRS
○ PR Interval = Normal at 3-5 little boxes (0.12-0.20 seconds)
○ QRS Complex = Normal at less than 3 little boxes (less than 0.12 seconds)

Question 9

Sinus Arrhythmia EKG characteristics

Answer 9

(Considered a Normal Variant)
○ Regularity = Regularly irregular. Increases with inspiration, decreases with expiration.
○ Rate = Usually 60 to 100 BPM, but can vary up and down
○ P Waves = Uniform, Upright, 1 before each QRS
○ PR Interval = Normal at 3-5 little boxes (0.12-0.20 seconds)
○ QRS Complex = Normal at less than 3 little boxes (less than 0.12 seconds)

Question 10

Automaticity =

Answer 10

The cardiac cell’s ability to initiate their own impulses.

Question 11

Triggered Activity

Answer 11

A cell that is injured can sometimes only partly repolarize. Partial repolarization
can lead to repetitive firing called Triggered Activity. This is known as
afterdepolarization and can lead to Atrial or Ventricular tachycardia.

Question 12

Atrial Flutter EKG characteristics

Answer 12

○ Regularity = Generally Regular
○ Rate = Atrial rate is 250-350 BPM, Ventricular rate is variable (2:1, 3:1, 4:1, etc.)
○ P Waves = Not discernable, just flutter waves (often “sawtooth” appearance)
○ PR Interval = Not available
○ QRS Complex = Normal at less than 3 little boxes (less than 0.12 seconds)

Question 13

Pearl about atrial flutter

Answer 13

Characteristic flutter waves may not be easily visible in Lead II, so look
at the P waves in other leads as well.
○ Holding the EKG upside-down may highlight sawtooth flutter waves.
○ Carotid massage can slow ventricular response, highlighting flutter waves.

Question 14

Atrial Fibrillation

Answer 14

An erratic, chaotic rhythm caused by continuous firing of multiple atrial foci.

Question 15

Atrial Fibrillation EKG characteristics

Answer 15

○ Regularity = Irregularly Irregular (I2
). Often your PANCE Q buzz phrase.
○ Rate = Atrial rate 350-500 BPM, Ventricular rate is variable (often rapid)
○ P Waves = Not discernable, characteristic fibrillatory waves (hard to see if rapid)
○ PR Interval = Not available
○ QRS Complex = Normal at less than 3 little boxes (less than 0.12 seconds)

Question 16

T/F Atrial Fibrillation is much more common than A-Flutter

Answer 16

T

Question 17

Multifocal Atrial Tachycardia EKG characteristics

Answer 17

○ Regularity = Irregularly Irregular
○ Rate = Rapid at 100-200 BPM
○ P Waves = Not uniform, the morphology changes
○ PR Interval = Normal at 3-5 little boxes (0.12-0.20 seconds)
○ QRS Complex = Normal at less than 3 little boxes (less than 0.12 seconds)

Question 18

Multifocal Atrial Tachycardia

Answer 18

● The irregular rhythm is produced by the pacemaker actively “wandering”
from the SA node to nearby ectopic atrial foci.
● Often seen in very ill patients, especially those with significant lung disease like COPD. Treatment and prognosis depends on severity and cause. Oxygen may be helpful.
● If the rate is less than 100 BPM, we call it Wandering Pacemaker.

Question 19

Wandering Pacemaker EKG characteristics

Answer 19

○ Regularity = Irregularly Irregular
○ Rate = Less than 100 BPM
○ P Waves = Not uniform, the morphology changes
○ PR Interval = Normal at 3-5 little boxes (0.12-0.20 seconds)
○ QRS Complex = Normal at less than 3 little boxes (less than 0.12 seconds)

Question 20

Often caused by varying vagal tone

Answer 20

Wandering Pacemaker

Question 21

Paroxysmal Atrial Tachycardia EKG Characteristics

Answer 21

○ Regularity = Regular
○ Rate = Tachycardia (generally 100-250 BPM)
○ P Waves = One positive or negative P wave before each QRS (might be lost in QRS)
○ PR Interval = Normal at 3-5 little boxes (0.12-0.20 seconds) or not measurable
○ QRS Complex = Normal at less than 3 little boxes (less than 0.12 seconds)

Question 22

Sick Sinus Syndrome EKG Characteristics

Answer 22

○ Regularity = Variable (see next slide)
○ Rate = Variable (see next slide)
○ P Waves = Variable (see next slide)
○ PR Interval = Variable (see next slide)
○ QRS Complex = Normal at less than 3 little boxes (less than 0.12 seconds)

Question 23

Also called Tachy-Brady Syndrome

Answer 23

Sick Sinus Syndrome

Question 24

Sick Sinus Syndrome

Answer 24

● Also called Tachy-Brady Syndrome, it is typified by alternating episodes of a
supraventricular tachycardia, such as atrial fibrillation, and then bradycardia.
● When the arrhythmia terminates, there is often a long pause (often greater than
4 seconds) before the sinus node fires again (“sick sinus”). Ventricular escape
beats can also occur because of this long pause.
● Patients can experience fainting, fatigue, weakness, palpitations, and chest pain.
● Sick Sinus Syndrome usually reflects significant underlying disease of the
conduction system. Often seen in elderly patients, especially with those who
have had cardiac surgery, MIs, etc.
● It is one of the most important and leading reasons for pacemaker insertion