PowerPoint 4 Flashcards
Draw and know a normal sinus rhythm?
See book page 52
NSR mean?
Normal sinus rhythm
Describe the elements of a normal sinus rhythm?
Normal SA Node signal
Organized rhythm – 1 P wave : 1 QRS Complex
Atrial depolarization and Ventricular Depolarization in coordination
PR interval is also normal length consistently
“Normal” is when everything is looking good.
Sinus rhythm can be said about other asymptomatic situations.
Conduction is abnormal but sinus rhythm remains
What is sinus bradycardia?
HR < 60BMP
Electrical conduction is normal – 1 P wave : 1 QRS Complex
RR intervals and PP intervals equal
What is nonsymptomatic sinus bradycardia?
Healthy heart – HR 50-59
Highly trained athlete – HR <50 bpm
What is marked or symptomatic bradycardia?
HR 30-50BPM
Lightheadedness, Hypotension, Syncope
Beta blockers
What are 5 conditions presting with bradycardia?
1st ° AV block, bundle branch blocks, hemiblocks, ventricular or atrial ectopy, and chamber enlargements
Causes of sinus bradycardia?
Increased Vagal Tone
Inferior Wall MI (occlusion of the R coronary Artery)
Sick Sinus Syndrome
Med – Beta Blockers, Calcium channel blockers, Digitalis glycosides
Treatments for sinus bradycardia?
Atropine – increases HR
Pacemaker
Describe tachycardia?
HR > 100 bpm
Normal organized electrical conduction
1 Pwave : 1 QRS complex
Pathophysiology of sinus tachycardia?
Decreased Vagal tone or Increased sympathetic tone
Asymptomatic
Exercise
Pediatric
Increased Myocardial demand for Oxygen with decreased coronary blood flow
Early sign of Myocardial ischemia or escalating ischemia
Accompanied with angina
Acute MI occurring with exacerbated need for O2
Causes of sinus tachycardia?
Asthma
Caffeine
Nicotine
Cocaine
Amphetamines
Stress
Anxiety
Acute MI
Congestive Heart Failure
Pulmonary edema
Pulmonary embolism
Treatments for sinus tachycardia?
Most sinus tachycardia is benign
Look for root cause and treat it
Remove drug
Change medication
Eliminate Stress/anxiety
Treat Asthma
What are sinus arrhythmias?
Irregular Electrical activity in Atria and/or Ventricles
RR intervals are irregular
HR < 60 bpm and irreg sinus = ____ ____?
Sinus bradyarrhythmia
HR > 100 bpm and irreg sinus = ____ ____?
Sinus tachyarrhythmia
What is automaticity?
Intrinsic ability of myocardial cells to depolarize on their own
Order of depolarization signals, Atria –> AV junction –> Ventricles
The fastest rate wins!
Typical HR 60-100bpm
< 60 Bradycardia
>100 Tachycardia
Describe atrial fibrillation?
Most common arrhythmia
Atria beating at 300-400bpm
Quivering of the Atria’s
Note no Pwave
Pt’s susceptible to stroke, blood clots, and pulmonary embolism
Often given an anticoagulant
Describe wandering pacemaker/multifocal atrial tachycardia?
One automaticity area depolarizes and suppresses other sites
Followed by another area depolarizing and suppressing
Assuming the SA node is not able to do its job.
P waves look different
Describe escape rhythms?
Normal Phenomenon that occurs when there is a sufficient pause to allow a lower pacemaker to depolarize
Escape rhythms show up on ECG with different shapes
Atria escape
Junctional escape
Ventricular escape
PAC?
Premature atrial contraction
One Foci (for some reason) does not depolarize with others. Eventually Triggers and sends signal to SA node “resetting Pacemaker”
Junctional premature beat?
AV node sends signal up to SA node and down to Ventricles at same time. Resetting Pacemaker.
PVC?
Premature ventricular contraction
Ventricle foci goes off sending signal to rest of ventricles. No SA node Reset.
Describe a sinus block/pause/arrest?
Impaired conduction from SA Node to Atria then to ventricles
No P wave or QRS Complex
No symptoms
Dizziness or lack of awareness or consciousness show sinus arrest
Scary!!- can happen when sleeping
R-R intervals are consistent before Pause
What is a sinus block?
Multiples of 2 or more R-R intervals skipped
What is a sinus pause?
Delay is longer than direct multiples of the RR interval
What is sinus arrest?
Pause is greater than 2 R-R intervals
What causes a sinus block/pause/arrest?
Ischemia disease of SA node
Extreme Vagal Tone
Digitalis
Degenerative changes of electrical conduction system
Aging
What are treatments for a sinus block/pause/arrest?
Find Cause and treat
Pacemaker if pause is > 3 sec
What is asystole?
Flat line
No electrical activity – no pqrst
DEAD
CPR
AED has to find rhythm
Ventricular fibrillation
Epinephrine every 3-5 min
10 cycles of CPR
Causes of asystole H’s and T’s?
Hypovolemia
Hypoxia
Hydrogen ions (acidosis)
Hypothermia
Hyperkalemia
Hypoglycemia
Tablets (drug OD)
Tamponade
Tension pneumothorax
Thrombosis (MI)
Thrombosis (pulmonary embolism)
Trauma (blood loss)
