Rhythms Flashcards
1
Q
Sinus Rhythm HR
A
60-100
2
Q
Sinus Rhythm Regularity
A
Regular
3
Q
Sinus Rhythm Measurements
A
PRI: 0.12-0.20 sec
QRS: 0.04-0.10 sec
QT: <0.5 sec
4
Q
Sinus Rhythm P: QRS ratio
A
1:1
5
Q
Sinus rhythm Treatment
A
None
6
Q
Sinus Bradycardia Hear rate
A
<60
7
Q
Sinus Bradycardia Regularity
A
Normal
8
Q
Sinus Bradycardia Measurements
A
Normal
9
Q
Sinus Bradycardia P:QRS ratio
A
Normal
10
Q
Sinus Bradycardia Treatment
A
Increase CO so give Atropine (0.5-1.0 mg IV q 3-5 minutes: 3 mg max) and then transcutaneous pacing, dopamine, or epinephrine if ineffective. Avoid Atropine if hypothermic.
11
Q
Sinus Bradycardia Cause
A
digoxin, Beta/Ca blockers, vasovagal, MI, athletes, SA node disease, increased ICP, hypoxemia, hypothermia
12
Q
Sinus Tachycardia Heart Rate
A
> 100
13
Q
Sinus Tachycardia Regularity
A
Normal
14
Q
Sinus Tachycardia Measurements
A
P wave maybe hidden at higher rates
QT may be shortened
15
Q
Sinus Tachycardia P:QRS ratio/Shape
A
Normal
16
Q
Sinus Tachycardia Treatment
A
Treat underlying cause: hyperthyroidism, hypovolemia, heart failure, pain, fever, exercise, stimulants, anxiety.
17
Q
Sinus Tachycardia May cause
A
decrease in CO b/c of shorter ventricular filling time.
18
Q
SVT (Atrial Tachycardia) Heart rate
A
150-250
19
Q
SVT (Atrial Tachycardia) Regularity
A
Normal
20
Q
SVT (Atrial Tachycardia) Measurements
A
PRI: <0.12 or not measurable
QRS: <0.04
21
Q
SVT (Atrial Tachycardia) Shape
A
P wave: maybe hidden in QRS or behind T wave
22
Q
SVT (Atrial Tachycardia) Treatment
A
Assess, vasovagal maneuver. If that fails or unstable give Adenosine 6mg. If does not convert, give 12mg IV. Then try electrical cardioversion (sync) if Adenosine is ineffective or emergency. May also give Beta/Ca blockers or Amiodarone.
23
Q
SVT (Atrial Tachycardia) Causes
A
Digoxin tox, electrolyte imbalance, lung disease, ischemic heart disease
24
Q
Premature Atrial Contractions (PACs) Heart rate
A
Determined by underlying rhythm
25
Premature Atrial Contractions (PACs) Regularity
Interrupts regularity of underlying rhythm for a single beat followed by a short pause
26
Premature Atrial Contractions (PACs) Measurements
PRI: <0.12
27
Premature Atrial Contractions (PACs) Shape
P wave: different than NSR
T wave: can be distorted
28
Premature Atrial Contractions (PACs) Treatment
None
29
Premature Atrial Contractions (PACs) Cause
caffeine, tobacco, ischemia, hypokalemia, hypomagnesemia, lung disease
30
A-Flutter (saw tooth) Heart rate
Atrial: 240-320
Ventricular: varies- normally >100
(rapid ventricular repolarization)
31
A-Flutter (saw tooth) Regularity
P wave: flutter consistent
QRS and T wave maybe irregular
32
A-Flutter (saw tooth) Measurement
PRI: None
33
A-Flutter (saw tooth) Shape
P wave: sawtooth
QRS can be altered from P wave
34
A-Flutter (saw tooth) Treatment
chronic anticoag therapy, elective cardioversion performed after taking anticoag for 3 weeks before and 4 weeks after. Ablation may be done (remove piece of myocardium causing irregular beat). AV blocking medications
35
A-Flutter (saw tooth) Cause
lung disease, heart failure, alcoholism
36
A-Fibrillation Heart rate
Atrial: uncountable
Ventricular: varies
37
A-Fibrillation Measurement
PRI: None
QRS, QT: normal if not bundle branch block
Usually will not see a T wave
38
A-Fibrillation Shape
No discernable P wave. Irregular waves are referred to as fibrillatory or F waves
QRS: <0.04 or >0.10
39
A-Fibrillation Treatment
Chronic antioag, AV blocking medications- Amiodarone, elective cardioversion, ablation. Emergency cardioversion considered if tachy is associated with hemodynamic instability
40
A-Fibrillation Cause
Ischemia, heart disease, valvular heart disease, hyperthyroidism, heart failure, lung disease, elderly.
41
A-Fibrillation Regularity
Irregularly irregular
(R-R has no discernable rhythm or pattern if you count it)
AV node is starting electrical impulse
42
Premature Junctional Contraction (PJC) Heart rate
Determined by underlying rhythm
43
Premature Junctional Contraction (PJC) Regularity
Interrupts regularity of underlying rhythm for a single beat.
44
Premature Junctional Contraction (PJC) Measurement
PJC early
PRI: <0.12 if present
45
Premature Junctional Contraction (PJC) Shape
P wave before QRS: inverted or upright
P wave after QRS or no P wave
QRS and T wave: same
46
Premature Junctional Contraction (PJC) Treatment
None
47
Premature Junctional Contraction (PJC) Cause
idiopathic, dig tox, ischemic heart disease, valvular heart disease, heart failure, response to catecholamines
48
Junctional Escape Rhythms Heart rate
40-60 from AV node
49
Junctional Escape Rhythms Regularity
Normal
50
Junctional Escape Rhythms Measurements
PRI: <0.12 if P wave is before QRS
51
Junctional Escape Rhythms Shape
P wave before QRS: inverted or upright
P wave after QRS or no P wave
QRS and T wave: same
52
Junctional Escape Rhythms Treatment
Atropine, Dopamine, Epinephrine, Transcutaneous pacing (want to increase HR)
53
Junctional Escape Rhythms Cause
SA node disease
54
Accelerated Junctional Rhythm/ Junctional Tachycardia Heart rate
AJR: 60-100
JT: >100
55
Accelerated Junctional Rhythm/ Junctional Tachycardia Regularity
Normal
56
Accelerated Junctional Rhythm/ Junctional Tachycardia Measurement
PRI if P wave is before QRS: <0.12
QRS and T wave: same
57
Accelerated Junctional Rhythm/ Junctional Tachycardia Shape
P wave before QRS: inverted or upright
P wave after QRS or no P wave
QRS and T wave: same
58
Accelerated Junctional Rhythm/ Junctional Tachycardia Treatment
address tachycardia if symptomatic
59
Accelerated Junctional Rhythm/ Junctional Tachycardia Cause
SA node disease, ischemic heart disease, electrolyte imbalances, dig tox, hypoxia
60
Premature Ventricular Contractions (PVCs) Types
```
Unifocal (form one area)
Multifocal
Bigeminy (every other beat)
Trigeminy (every 3rd beat)
Pair (2 in a row)
Nonsustained (3+ together- concern)
```
61
Premature Ventricular Contractions (PVCs) Heart rate
Determined by underlying rhythm
Normal: 20-40 (ventricular)
62
Premature Ventricular Contractions (PVCs) Regularity
Rhythm interrupted by premature beat
3+ cause for concern
63
Premature Ventricular Contractions (PVCs) Measurement
PRI: None
QRS: >0.12
Compensatory pause after PVC
64
Premature Ventricular Contractions (PVCs) Shape
QRS: wide (>0.10 and bizarre looking)
Possible R on T wave
R and T wave in opposite directions
No P wave because the beat starts in the ventricle
65
Premature Ventricular Contractions (PVCs) Treatment
treat the cause if PVC are increasing in frequency either with Lidocaine or Amiodarone, ablation
66
Premature Ventricular Contractions (PVCs) Cause
hypoxemia, hypokalemia, ischemic heart disease, acid base imbalance, anxiety
67
Ventricular Tachycardia (vtach) Heart rate
110-250
With or without pulse. Radial pulse: SBP must be at least 80
Femoral pulse: SBP must be at least 70
Carotid pulse: SBP must be at least 60
68
Ventricular Tachycardia (vtach) Regularity
Normal
69
Ventricular Tachycardia (vtach) Measurement
PRI: none
QRS: >0.10 often >0.16
P wave: none
70
Ventricular Tachycardia (vtach) Shape
QRS wave: consistent is shape but appear wide and bizarre.
T wave: opposite direction of QRS
71
Ventricular Tachycardia (vtach) Treatment
If no pulse: CPR and Dfib. If pulse and BP present: IV Amiodarone or Lidocaine
72
Ventricular Tachycardia (vtach) Cause
QT prolongation, hypoxemia, exacerbation of heart failure, cardiomyopathy, hypokalemia, hypomagnesemia, valvular heart disease
73
Asystole Heart rate
Absent
74
Asystole Regularity
Absent
75
Asystole Measurement
Absent
76
Asystole Shape
Slightly wavy or flat
77
Asystole Treatment
BLS and ACLS protocol is non-shockable
78
1st Degree AV Block Heart rate
Determined by underlying rhythm
| May look normal
79
1st Degree AV Block Regularity
Determined by underlying rhythm
80
1st Degree AV Block Measurement
PRI: >0.2 -prolonged
81
1st Degree AV Block Shape
P, QRS and T waves consistent
82
1st Degree AV Block Treatment
None
83
1st Degree AV Block Cause
aging, ischemic heart disease, valvular heart disease
84
2nd Degree Type 1 AV Block (Mobitz 1 or Wenckebach) Heart rate
Slower than underlying rhythm because of dropped beat
85
2nd Degree Type 1 AV Block (Mobitz 1 or Wenckebach) Regularity
R-R shorten until a dropped beat
Regularly irregular
P-P regular
86
2nd Degree Type 1 AV Block (Mobitz 1 or Wenckebach) Measurement
PRI: progressively longer until a QRS is dropped
87
2nd Degree Type 1 AV Block (Mobitz 1 or Wenckebach) Shape
P, QRS and T waves consistent, until dropped beat
88
2nd Degree Type 1 AV Block (Mobitz 1 or Wenckebach) Treatment
if symptomatic: review meds and consider pacer
| **NO ATROPINE**
89
2nd Degree Type 1 AV Block (Mobitz 1 or Wenckebach) Cause
aging, acute inferior MI, dig tox, ischemic heart disease, excess vagal response
90
2nd Degree Type 2 AV Block (Mobitz 2) Heart rate
Slower than underlying rhythm because of dropped beat
91
2nd Degree Type 2 AV Block (Mobitz 2) Regularity
P-P regular but R-R regular until dropped beat
92
2nd Degree Type 2 AV Block (Mobitz 2) Measurement
Constant for underlying rhythm
| QRS may be widened from bundle branch block
93
2nd Degree Type 2 AV Block (Mobitz 2) Shape
P, QRS, and T consistent except dropped beat
More P waves than QRS complexes
94
2nd Degree Type 2 AV Block (Mobitz 2) Treatment
Pacemaker
| **NO ATROPINE**
95
2nd Degree Type 2 AV Block (Mobitz 2) Cause
heart disease, increased vagal tone, conduction system disease, inferior MI, ablation of AV node
96
3rd Degree/ Complete AV Block Heart rate
Atrial rate > ventricular rate
Ventricles are out of rhythm from atria
Measure to determine intervals
97
3rd Degree/ Complete AV Block Regularity
P-P and R-R are regular
P waves are not associated with QRS
Atria and ventricles working separately from each other
98
3rd Degree/ Complete AV Block Measurement
PRI: None (because of inconsistency between P and QRS)
QRS: often >0.10
99
3rd Degree/ Complete AV Block Shape
Consistent
100
3rd Degree/ Complete AV Block Treatment
immediate transcutaneous or transvenous pacer
* *NO ATROPINE**
- Ultimate goal is to get a permanent pacemaker
101
3rd Degree/ Complete AV Block Cause
ischemic heart disease, MI, conduction system disease
