EKG I- Arrythmias Flashcards
Supraventricular Arrhythmia (Ectopic and Re-entrant), Ventricular Arrhythmia (PVC, V-tach, V-fib)
NORMAL MEASUREMENTS
- PR interval
- QRS intervals
- QT interval
PR= 0.12-0.20 seconds
QRS= .06 - 0.10 seconds
QT= 40% of R to R interval (<0.40 seconds)
What constitutes an arrythmia?
- disturbance in rate, rhythm, site of origin, or conduction
- single beat v. sustained
Symptoms of Arrhythmias
- palpitations
- light headedness
- syncope
- chest pain
- heart failure
- sudden death
5 Types of Arrhythmias
- sinus origin
- ectopic origin
- reentrant arrhythmias
- conduction blocks
- pre excitation syndromes
Sinus Bradycardia
<60 bpm
normal in athletes, seen in hypothyroidism, vagal tone or sleep apnea, ischemia
Sinus Tachycardia
> 100 bpm
normal during exertion, pain, CHF, COPD, anemia, hyperthyroidism
CHF–> compensatory response to inc HR since heart isnt pumping properly
COPD–> compensatory response to dec O2 levels in circulating blood
anemia–> same as COPD
hyperthyroidism–>excess TH stimulates SA node
Sinus Arrest
pause in normal sinus rhythm
- stops firing/asystole
Escape Beats
Atrial: 60-100 bpm
Junctional: 40-60 bpm
Ventricular: 30-45 bpm
Escape Beats- Atrial
different P wave morphology
60-100 bpm
every P wave is followed by a QRS complex but the shape of the P wave is different than that of the sinus beat
Escape Beats- Junctional
absent or inverted P waves
40-60 bpm
DELAYED heart beat that occurs after a sinus beat
(SA failed to fire, AV junction takes over)
Escape Beats- ventricular
wide QRS complexes, no preceeding p waves
30-45 bpm
often seen in heart block***
Ectopic Rhythms
arise from area other than SA node
- PAC, PVC
- single or sustained
Reentrant Rhythms
impulse transmission disorders
- 2 tracts w diff conduction speeds
- conduction may get stuck revolving
ex) atrial flutter, afib, AVNRT
Supraventricular “Early Beats” – PAC’s, Premature Atrial Contractions
early beat with abnormally shaped p-waves occurring before repolarization can finish, interrupting the T wave
Supraventricular “early beat” – PJCs, Premature Junctional Complex
EARLY beat that occurs before a sinus beat (comes from AV junction)
also missing a p-wave (or diff morphology)
Supraventricular Arrhythmias (6)
- Paroxsymal Supraventricular Tachycardia
- Atrial Flutter
- Atrial Fibrillation
- Multifocal Atrial Tachycardia
- Wandering Atrial Pacemaker
- Paroxsymal Atrial Tachycardia
Paroxysmal Supraventricular Tachycardia
- MC is AVNRT
- sudden onset
- regular rhythm
- 150-250 bpm
- p waves may not be visible
narrow QRS
Paroxsymal Supraventricular Tachycardia- treatment
carotid massage to inc vagal tone (slows conduction)
OR
Adenosine
“Sarah’s Very Tachy–> Addy brings her backy”
SVT —> Adenosine
Atrial Flutter
- regular rhythm
- p waves at 250 bpm
- saw tooth pattern
- 2:1, 3:1, 4:1 conduction
Atrial Fibrillation
- no true p wave
- irregularly irregular rate
- ventricular rate is variable (slow, normal, or fast)
stroke risk***
MC sustained arrhythmia
confused AV node
must anti-coag pt
Multifocal Atrial Tachycardia
- present p waves, but 3 different morphologies
- irregular rhythm
- 100-120 bpm
irregular bc p waves differ, NOT irregularly irreg bc still GET p waves
Wandering Atrial Pacemaker
- present p waves, but 3 different morphologies
- irregular rhythm
- <100 bpm
***SAME as MAT, only diff is HR
Paroxsymal Atrial Tachycardia
- regular rhythm
- 100-200 bpm
- automaticity or reentry seen
the morphology of the p wave is NOT sinus (but its the same throughout rhythm)
Ventricular Arrhythmias
ventricular tachycardia and premature ventricular contractions (PVCs)
Premature Ventricular Contractions (PVCs)
- wide QRS complex
- pattern of bigeminy (1:1) or trigeminy (2:1)
R on T phenomenon cause for concern of MI (PVC on the T wave)
can happen randomly or be a pattern
rhythm would be ventricular bigeminy/trigeminy
PVC is just the beat
Ventricular Tachycardia
- 3 or more PVCs
- 120-200 bpm
- monomorphic or polymorphic morphology (torsades de pointe)
sustained VT- >30s (emergency/immediate tx)
non sustained VT- 3 beats<30s
Ventricular Fibrillation
no true QRS or cardiac output
