EKG part 2 Flashcards
Diagnosis:
* Regular rhythm
* Rate: 60-100 beats per minute (bpm)
* P waves: Present and upright in lead II
* QRS complex: Narrow and consistent
* PR interval: 120-200 ms
NORMAL SINUS RHYTHM (NSR)
- Regular rhythm
- Rate: < 60 bpm
- P waves: Present and upright
- QRS complex: Narrow
- PR interval: Normal (120-200 ms
SINUS BRADYCARDIA
normal sinus rhythm treatment
- No treatment required; normal heart rhythm
- Keep looking for your diagnosis
sinus bradycardia treatment
- If symptomatic (dizziness, syncope): Atropine 1 mg IV, repeat up to 3mg total
- If no response to atropine: pacing with ultimately pacemaker insertion
- Treat underlying causes (hypothyroidism, electrolyte imbalance, etc
sinus tachycardia treament
- Treat underlying causes (fever, anemia, hypoxia, sepsis, etc.)
- Beta-blockers (e.g., Metoprolol) for symptomatic management
- Fluid resuscitation if caused by hypovolemia
- Regular rhythm
- Rate: > 100 bpm
- P waves: Present and upright
- QRS complex: Narrow
- PR interval: Norma
SINUS TACHYCARDIA
Regular rhythm
* Rate: 150-250 bpm
* P waves: May be hidden in preceding T wave or appear
abnormal
* QRS complex: Narrow
PAROXYSMAL ATRIAL TACHYCARDIA
PAROXYSMAL ATRIAL TACHYCARDIA treatment
- Vagal maneuvers (e.g., Valsalva maneuver) = Stable,
symptomatic - Adenosine 6 mg IV bolus, followed by 12mg IV push when
fails - Cardiovert if refractory or becomes unstable
- Beta-blockers or calcium channel blockers for prevention
- Consider catheter ablation in refractory cases
- Look for other causes (anxiety, thyroid, electrolyte
abnormalities, anemia, etc.)
- Regularly irregular rhythm (sometimes variable)
- Rate: Atrial rate 250-350 bpm, ventricular rate varies
- P waves: Sawtooth pattern (F waves)
- QRS complex: Narrow
atrial flutter
atrial flutter treatment
- Rate control: Beta-blockers or calcium channel blockers
- Anticoagulation therapy (e.g., Warfarin or direct acting anticoagulants) to prevent stroke
- Electrical cardioversion for symptomatic patients or persistent flutter (after echo)
- Catheter ablation if recurrent
- Look for causes aside from presbycardia, thyroid, electrolytes, structural abnormalitie
- Irregularly irregular rhythm
- Rate: Varies (usually > 100 bpm)
- P waves: Absent, replaced by fibrillatory waves
- QRS complex: Narrow
atrial fibrillation
- PR interval: > 300 ms (prolonged)
- Regular rhythm
- Rate: Normal (60-100 bpm)
- P waves: Present and upright
- QRS complex: Narrow
first degree AV block
atrial fibrillation treatment
rate control: Beta-blockers, calcium channel blockers
* Rhythm control: Antiarrhythmic drugs (e.g., Amiodarone)
* Anticoagulation: Warfarin, Direct acting anticoagulants for stroke prevention
* Electrical cardioversion if needed (after echo)
* Look for causes aside from presbycardia, thyroid, electrolytes, structural abnormalities, screen for drugs/ETOH
first degree AV block treatment
- No treatment required if asymptomatic
- Monitor for progression to higher degree block
- Progressive prolongation of PR interval until a QRS is dropped
- Regular rhythm, but irregular due to dropped beats
- Rate: Normal to slow
Causes:
* Inferior MI, Digitalis toxicity, beta blocker
second degree AV block
Type I = Wenckebach or Mobitz I
second degree AV block treatment
Type I = Wenckebach or Mobitz I
- Atropine will work on bradycardia
- Pacemaker if symptomatic or progression to type II
- PR interval remains constant until QRS is dropped
- Regular rhythm with intermittent dropped beats
- Rate: Slower
Causes:
* Anteroseptal MI, cardiomyopath
SECOND DEGREE AV BLOCKS
Type II = Mobitz II
SECOND DEGREE AV BLOCKS
Type II = Mobitz II
treatment
- Pacemaker insertion is required, Atropine could worse
- High risk to progress to third-degree block, so early intervention is importa
- Complete dissociation between P waves and QRS complexes
- Ventricular rate is typically slow (30-40 bpm)
- P waves and QRS complexes have no relation
THIRD DEGREE AV BLOCK (COMPLETE
BLOCK)
THIRD DEGREE AV BLOCK (COMPLETE BLOCK) treatment
- Immediate pacemaker insertion
- Atropine can be used temporarily until pacemaker is available
- Treat underlying causes (e.g., ischemia, drug toxicity)
- Irregular rhythm due to premature ventricular beats
- Wide and bizarre QRS complexes
- No P wave associated with PVCs
PREMATURE VENTRICULAR CONTRACTIONS (PVCS)
PREMATURE VENTRICULAR CONTRACTIONS (PVCS) treatment
- No treatment if asymptomatic
- Beta-blockers for symptomatic PVCs
- Treat underlying causes (electrolyte imbalance, ischemia, watch for sleep/hydration/exercise)
- Early P waves, which may appear abnormal
- Irregular rhythm due to early atrial beats
- QRS complex: Narrow
PREMATURE ATRIAL CONTRACTIONS (PACS)
PREMATURE ATRIAL CONTRACTIONS (PACS) treatment
- Usually no treatment required
- If symptomatic: Beta-blockers or calcium channel blockers
- Treat underlying causes (e.g., stress, alcohol, caffeine)
- The pacemaker (SA node) isn’t working right = something is going wrong
- The backup generator/pacemaker if you will (AV node) takes over, but it has a set rate of 40-60bpm
o Gets confusing when we talk about junctional tachycardia because you can have the AV node develop an abnormal
automaticity where it starts generating impulses much faster
Causes: - Inflammation of the heart (recent cardiac surgery, chest radiation, MI, infection)
- Sick sinus syndrome (damage to SA node)
- Electrolytes (hypomag, hypok)
- Meds (BBs, CCBs, Adenosine) to name a few. You can have other things on the EKG, like a new LBBB,
STEMI, etc., but it is possible to see just the junctiona
JUNCTIONAL RHYTHMS
- Regular, rapid rhythm
- Rate: 100-250 bpm
- Wide QRS complexes
- P waves may be absent
VENTRICULAR TACHYCARDIA (VTACH)
VENTRICULAR TACHYCARDIA (VTACH) treatment
- Stable VT: Epi then Amiodarone
- Unstable VT/pVT: Immediate defibrillation
- Consider catheter ablation in recurrent cases
- Implantable cardioverter-defibrillator (ICD) for high-risk patients
- Irregular, chaotic rhythm with no identifiable QRS
complexes, P waves, or T waves - Rapid, erratic electrical activity
VENTRICULAR FIBRILLATION (VFIB)
VENTRICULAR FIBRILLATION (VFIB) treatment
- Immediate defibrillation (shock)
- CPR and advanced cardiac life support (ACLS)
protocol - Epinephrine and Amiodarone as per ACLS
guidelines
- No electrical activity on ECG
- Flatline
asystole
asystole treatment
- Immediate CPR
- Administer Epinephrine every 3-5 minutes
- Treat reversible causes (H’s and T’s e.g., hypoxia, hypovolemia, acidosis, tamponade)
- Poor prognosis, NO defibrillation
PEA: Electrical activity with no pulse, same treatment as above
