Heart Dysrhythmia Flashcards
Exam at the end of September
Atrial Dysrhythmia ⤷ premature atrial complex
Rhythm ⤷ P-P and R-R are constant except early complexes
Rate ⤷ atria and ventricles are within normal limits of 60 to 100 bpm
P wave ⤷ early complex has a different shape being flattened, notched, or bi-phasic
PR interval ⤷ normal limits of 0.12 to 0.20 second with the early complex being different
QRS duration ⤷ normal limits of 0.06 to 0.10 second
Interpret ⤷ occurs too soon and has a positively deflected P wave that is likely to change morphology
Atrial Dysrhythmia ⤷ wandering atrial pacemaker
Rhythm ⤷ slightly irregular
Rate ⤷ within normal limits of 60 to 100 bpm
P wave ⤷ continuous change in appearance with three different P waves
PR interval ⤷ varies
QRS duration ⤷ normal limits of 0.06 to 0.10 second
Interpret ⤷ changing P wave morphology with at least three variations
Atrial Dysrhythmia ⤷ atrial flutter
Rhythm ⤷ R-R usually regular but may be irregular depending on AV node to limit impulses to the ventricles
Rate ⤷ atrial rate is between 250 to 350 bpm
P wave ⤷ P waves are not seen only the flutter waves are present resembling a “picket fence” in leads II, III, and aVF
PR interval ⤷ cannot be measured
QRS duration ⤷ normal limits of 0.06 to 0.10 second
Interpret ⤷ “saw-tooth” atrial pattern between QRS complexes
Atrial Dysrhythmia ⤷ multi-focal atrial tachycardia
Rhythm ⤷ irregular
Rate ⤷ between 101 and 150 bpm
P wave ⤷ changes in appearance from beat to beat
PR interval ⤷ varies due to changing origin of electrical activity
QRS duration ⤷ normal limits of 0.06 to 0.10 second with all complexes looking alike
Interpret ⤷ clearly changing P wave and a heart rate of 101 to 150 bpm
Atrial Dysrhythmia ⤷ atrial fibrillation
Rhythm ⤷ P-P cannot be measured because of the fibrillation while R-R is irregular
Rate ⤷ atrial rate cannot be determined while the electrical impulse ranges from 375 to 700 bpm
P wave ⤷ are not present
PR interval ⤷ not identifiable
QRS duration ⤷ normal limits of 0.06 to 0.10 second
Interpret ⤷ shows chaotic atrial electrical activity with irregular R-R intervals
Junctional Dysrhythmia ⤷ premature junctional complex
Rhythm ⤷ occasionally irregular depending on the underlying rhythm
Rate ⤷ depends on the underlying rhythm
P wave ⤷ inverted and immediately precedes the QRS complex
PR interval ⤷ may be shorter if the P wave precedes the QRS complex or buried within the QRS complex
QRS duration ⤷ normal limits of 0.06 to 0.10 second
Interpret ⤷ P wave may appear before, during, or after the QRS complex
Junctional Dysrhythmia ⤷ accelerated junctional rhythm
Rhythm ⤷ P-P and R-R intervals are regular and occur at similar intervals but the P interval may be difficult to measure due to the location of the P wave
Rate ⤷ ventricular rate is between 60 to 100 bpm and the atrial rate is between 60 to 100 bpm if the P wave is measurable
P wave ⤷ if seen will be inverted and may precede, follow, or fall within the QRS complex
PR interval ⤷ if P wave is seen before QRS complex the PR interval measures less than 0.12 second and is constant
QRS duration ⤷ normal limits of 0.06 to 0.10 second
Interpret ⤷ may have an inverted or absent P wave or a P wave that follows the QRS complex
Junctional Dysrhythmia ⤷ junctional escape rhythm
Rhythm ⤷ P-P and R-R intervals are regular and occur at similar intervals but the P wave might be difficult to measure
Rate ⤷ ventricular and atrial rate is 40 to 60 bpm but may not be measurable if the P wave is not identifiable
P wave ⤷ usually inverted and may precede, follow, or fall within the QRS complex
PR interval ⤷ if the P wave is before the QRS complex the PR interval measures less than 0.12 second and is constant but if it was not before the interval cannot be determined
QRS duration ⤷ normal limits of 0.06 to 0.10 second
Interpret ⤷ P wave may occur before, during, or after QRS with the P wave if seen is inverted
Junctional Dysrhythmia ⤷ junctional tachycardia
Rhythm ⤷ P-P and R-R intervals are regular and occur at similar intervals but the P-P interval may be difficult to measure due to the combination of the location of the P wave
Rate ⤷ ventricular and atrial rates are between 100 to 180 bpm but atrial rate may not be measurable if P waves are not identifiable
P wave ⤷ if seen will be inverted and may precede, follow, or fall within the QRS complex
PR interval ⤷ if the P wave is before the QRS complex the PR interval measures less than 0.12 second and is constant
QRS duration ⤷ normal limits of 0.06 to 0.10 second
Interpret ⤷ may be inverted or absent P wave that follows the QRS complex with a rate of 100 to 180 bpm
Junctional Dysrhythmia ⤷ supra-ventricular tachycardia
Rhythm ⤷ R-R rhythm is usually regular but the atrial rhythm may or may not be seen because of other electrical activity occurring at the same time
Rate ⤷ ventricular rate is between 150 to 250 bpm but the atrial rate is difficult to determine when P waves are unidentifiable
P wave ⤷ usually not identified when the heart rate is this rapid and if present may occur simultaneously with the T wave
PR interval ⤷ cannot be determined
QRS duration ⤷ QRS measurement will be 0.12 second or greater with a delta wave
Interpret ⤷ describes a group of dysrhythmias that present with a normal-to-narrow appearing QRS complex and a greater 150 bpm
Heart Block Dysrhythmia ⤷ first-degree atrioventricular block
Rhythm ⤷ regularity between the P-P and R-R interval is constant
Rate ⤷ atria and ventricles are within normal limits of 60 to 100 bpm
P wave ⤷ the same morphology with each QRS complex has a P wave before it
PR interval ⤷ greater than 0.20 second
QRS duration ⤷ normal limits of 0.06 to 0.10 second
Interpret ⤷ PR interval is constant and measures greater than 0.20 second
Heart Block Dysrhythmia ⤷ second degree atrioventricular block type I
Rhythm ⤷ P-P interval is regular while the R-R interval is irregular
Rate ⤷ atrial rate is within normal limits but the ventricular rate is slower
P wave ⤷ normal size with an upright P wave with an extra P wave with every QRS complex
PR interval ⤷ varies from one measurement to the next becoming progressively longer with each subsequent conducted P wave until the QRS complex is blocked
QRS duration ⤷ normal limits of 0.06 to 0.10 second
Interpret ⤷ has a cycling prolonging PR interval until the QRS is blocked then the cycle resets
Heart Block Dysrhythmia ⤷ second degree atrioventricular block type II
Rhythm ⤷ P-P interval is regular but the R-R interval may or may not be regular due to the unpredictable nature of the blocked impulses
Rate ⤷ atrial rate is within normal limits while the ventricular rate is slower
P wave ⤷ morphology will be normal with an upright waves and at least one P wave for every QRS complex
PR interval ⤷ constant and remains constant even after QRS drop occurs
QRS duration ⤷ normal limits of 0.06 to 0.10 second
Interpret ⤷ QRS complexes are missing but wherever a P is with the QRS complex the PR interval measures the same
Heart Block Dysrhythmia ⤷ third degree atrioventricular block
Rhythm ⤷ P-P interval and R-R are regular but their intervals are different
Rate ⤷ atrial rate is within normal limits but the ventricular rate is slow between 20 to 40 bpm or 40 to 60 bpm
P wave ⤷ normal size but the location may be buried within the QRS complex therefor having no correlation between the P waves and QRS complex
PR interval ⤷ variable due to the atrial and ventricular depolarizing at different rates
QRS duration ⤷ duration and morphology are at the same but the measurements may be within normal limits or wide
Interpret ⤷ the P-P and R-R intervals are regular but the atria and ventricles are firing at different rates with this being the only block in which P waves are buried inside a QRS complex
Ventricular Dysrhythmia ⤷ premature ventricular complexes
Rhythm ⤷ P-P intervals are regular and the R-R intervals are regular with the exception of the early complexes from the PVCs but there may be a compensatory pause
Rate ⤷ influenced by the number of ectopic complexes present so the six-second method must be used
P wave ⤷ not present for the early ventricular complexes
PR interval ⤷ early complex no P wave is present
QRS duration ⤷ must be analyzed for both the underlying rhythm and the premature complexes measuring 0.12 second or greater
Interpret ⤷ early QRS complex that measures 0.12 second or greater and has a bizarre, wide appearance with no P wave
Uni-focal PVC
All complexes have a similar shape, suggesting only one irritable focus
Multi-focal PVC
PVCs have varied shapes and forms, suggesting more than one irritable focus
Interpolated PVC
PVC occurs during the normal R-R interval without interrupting the underlying rhythm
Occasional PVC
Less than six PVCs per minute
Frequent PVC
Six or more PVCs per minute
Trigeminy
Every third complex is a PVC
Quadgeminy
Every fourth complex is a PVC
R-on-T PVC
PVC occurs on the down-slope of the T wave which signifies the vulnerable period of the relative ventricular refractory period
Coupling
Two PVCs that occur back to back
Run of ventricular tachycardia
Three or more PVCs in a row at a rate greater than 100 bpm (known as triplet PVCs or salvo)
Paroxysmal event
Change from sinus rhythm to SVT showing a change from ventricular tachycardia to ventricular fibrillation
Ventricular Dysrhythmia ⤷ agonal rhythm
Rhythm ⤷ R-R interval may or may not be regular but there are no P-P intervals
Rate ⤷ atrial rate cannot be determined due to the absence of atrial depolarization but the ventricular rate is less than 20 bpm
P wave ⤷ no analysis
PR interval ⤷ cannot be measured
QRS duration ⤷ measure 0.12 second or greater and have a wide, bizarre appearance
Interpret ⤷ absence of P waves and ventricular rate of less than 20 bpm with wide and bizarre QRS complexes
Ventricular Dysrhythmia ⤷ idioventricular rhythm
Rhythm ⤷ P-P cannot be determined but the R-R is regular
Rate ⤷ cannot be determined due to the absence of atrial depolarization while the ventricular rate is a slow 20 to 40 bpm
P wave ⤷ usually absent
PR interval ⤷ cannot be measured
QRS duration ⤷ measures 0.12 second or greater and the QRS complex has a wide, bizarre appearance
Interpret ⤷ an absence of P waves, a slow ventricular rate of 20 to 40 bpm, and wide and bizarre QRS complexes
Ventricular Dysrhythmia ⤷ accelerated idioventricular rhythm
Rhythm ⤷ P-P cannot be determined but the R-R is regular
Rate ⤷ cannot be determined due to the absence of atrial depolarization while the ventricular rate is a slow 40 to 100 bpm
P wave ⤷ usually absent
PR interval ⤷ cannot be measured
QRS duration ⤷ measures 0.12 second or greater and the QRS complex has a wide, bizarre appearance
Interpret ⤷ absence of P waves, a ventricular rate of 40 to 100 bpm, and wide and bizarre QRS complexes
Ventricular Dysrhythmia ⤷ ventricular tachycardia
Rhythm ⤷ P-P interval is usually not identifiable while the R-R is usually regular but may be slightly irregular at times
Rate ⤷ atrial rate cannot be determined because the P-P interval cannot be recognized but the atrial rate is fast and between 100 to 200 bpm
P wave ⤷ absent
PR interval ⤷ cannot be measured
QRS duration ⤷ measure 0.12 second or greater and have a wide and bizarre appearance with an increase in amplitude with the T wave in the opposite direction
Interpret ⤷ wide and bizarre QRS complexes with a “sawtooth” appearance and an excess rate of 100 bpm with no P wave
Ventricular Dysrhythmia ⤷ ventricular fibrillation
Rhythm ⤷ cannot be determined because neither P nor R waves are present on strips
Rate ⤷ atrial and ventricular rates cannot be identified because neither the atria nor ventricles are full depolarizing
P wave ⤷ no P waves
PR interval ⤷ no interval
QRS duration ⤷ cannot be measured because only fibrillatory waves are present
Interpret ⤷ absence of organized electrical activity
Ventricular Dysrhythmia ⤷ asystole
Rhythm ⤷ no wave-forms
Rate ⤷ no rates present
P wave ⤷ no waves present
PR interval ⤷ cannot be measured
QRS duration ⤷ cannot be measured
Interpret ⤷ flat-line
Bundle Branch Block Dysrhythmia ⤷ left bundle branch block
Rhythm ⤷ depends on the underlying rhythm with the possibility of both being regular or irregular
Rate ⤷ atrial and ventricular rates depend on the basic rhythm
P wave ⤷ depend on the basic rhythm
PR interval ⤷ normal measurement of 0.12 to 0.20 second
QRS duration ⤷ 0.12 second or greater in length with the widening of the QRS duration indicating the presence of a block
Interpret ⤷ j-point is deflected down
Complication of pacemaker ⤷ malfunctioning
Cause ⤷ pacemaker does not send impulse
Occurs ⤷ intervals are irregular and the impulse is slower than the set rate
Symptom ⤷ may experience hypo-tension, light headed, and black-out periods
Pacemaker complication ⤷ failure to sense
Cause ⤷ pacemaker does not send electrical impulse to the myocardium
Occurs ⤷ may send current to heart during relaxation phase
Symptoms ⤷ atrial fibrillation can occur along with ventricular pacing, ventricular tachycardia, or ventricular fibrillation
Pacemaker complication ⤷ loss of capture
Cause ⤷ pacing activity occurs but the myocardium is not depolarized
Occurs ⤷ pacing spikes will occur without capture of a wave form
Symptoms - depends on the basic dysrhythmia and the patients condition
Pacemaker complication ⤷ over-sensing
Cause ⤷ perceives electrical current from sources other than the heart
Occurs ⤷ patients own heart rate is recorded and is slower than the pacemaker or the pacemaker spikes
Symptoms ⤷ signs of low cardiac output
Pacemaker complication ⤷ under-sensing
Cause ⤷ pacemaker is unable to detect any activity
Occurs ⤷ never turns off resulting in competition between intrinsic and electronic pacemakers
Symptoms ⤷ signs of low cardiac output depending of the severity of the rhythm
