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A3 Values to Know > Rhythms > Flashcards

Rhythms Flashcards

1
Q

Sinus Rhythm HR

A

60-100

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2
Q

Sinus Rhythm Regularity

A

Regular

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3
Q

Sinus Rhythm Measurements

A

PRI: 0.12-0.20 sec
QRS: 0.04-0.10 sec
QT: <0.5 sec

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4
Q

Sinus Rhythm P: QRS ratio

A

1:1

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5
Q

Sinus rhythm Treatment

A

None

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6
Q

Sinus Bradycardia Hear rate

A

<60

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7
Q

Sinus Bradycardia Regularity

A

Normal

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8
Q

Sinus Bradycardia Measurements

A

Normal

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9
Q

Sinus Bradycardia P:QRS ratio

A

Normal

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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.

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11
Q

Sinus Bradycardia Cause

A

digoxin, Beta/Ca blockers, vasovagal, MI, athletes, SA node disease, increased ICP, hypoxemia, hypothermia

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12
Q

Sinus Tachycardia Heart Rate

A

> 100

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13
Q

Sinus Tachycardia Regularity

A

Normal

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14
Q

Sinus Tachycardia Measurements

A

P wave maybe hidden at higher rates

QT may be shortened

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15
Q

Sinus Tachycardia P:QRS ratio/Shape

A

Normal

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16
Q

Sinus Tachycardia Treatment

A

Treat underlying cause: hyperthyroidism, hypovolemia, heart failure, pain, fever, exercise, stimulants, anxiety.

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17
Q

Sinus Tachycardia May cause

A

decrease in CO b/c of shorter ventricular filling time.

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18
Q

SVT (Atrial Tachycardia) Heart rate

A

150-250

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19
Q

SVT (Atrial Tachycardia) Regularity

A

Normal

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20
Q

SVT (Atrial Tachycardia) Measurements

A

PRI: <0.12 or not measurable

QRS: <0.04

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21
Q

SVT (Atrial Tachycardia) Shape

A

P wave: maybe hidden in QRS or behind T wave

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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.

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23
Q

SVT (Atrial Tachycardia) Causes

A

Digoxin tox, electrolyte imbalance, lung disease, ischemic heart disease

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24
Q

Premature Atrial Contractions (PACs) Heart rate

A

Determined by underlying rhythm

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25
Q

Premature Atrial Contractions (PACs) Regularity

A

Interrupts regularity of underlying rhythm for a single beat followed by a short pause

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26
Q

Premature Atrial Contractions (PACs) Measurements

A

PRI: <0.12

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27
Q

Premature Atrial Contractions (PACs) Shape

A

P wave: different than NSR

T wave: can be distorted

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28
Q

Premature Atrial Contractions (PACs) Treatment

A

None

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29
Q

Premature Atrial Contractions (PACs) Cause

A

caffeine, tobacco, ischemia, hypokalemia, hypomagnesemia, lung disease

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30
Q

A-Flutter (saw tooth) Heart rate

A

Atrial: 240-320
Ventricular: varies- normally >100
(rapid ventricular repolarization)

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31
Q

A-Flutter (saw tooth) Regularity

A

P wave: flutter consistent

QRS and T wave maybe irregular

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32
Q

A-Flutter (saw tooth) Measurement

A

PRI: None

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33
Q

A-Flutter (saw tooth) Shape

A

P wave: sawtooth

QRS can be altered from P wave

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34
Q

A-Flutter (saw tooth) Treatment

A

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

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35
Q

A-Flutter (saw tooth) Cause

A

lung disease, heart failure, alcoholism

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36
Q

A-Fibrillation Heart rate

A

Atrial: uncountable

Ventricular: varies

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37
Q

A-Fibrillation Measurement

A

PRI: None
QRS, QT: normal if not bundle branch block

Usually will not see a T wave

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38
Q

A-Fibrillation Shape

A

No discernable P wave. Irregular waves are referred to as fibrillatory or F waves

QRS: <0.04 or >0.10

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39
Q

A-Fibrillation Treatment

A

Chronic antioag, AV blocking medications- Amiodarone, elective cardioversion, ablation. Emergency cardioversion considered if tachy is associated with hemodynamic instability

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40
Q

A-Fibrillation Cause

A

Ischemia, heart disease, valvular heart disease, hyperthyroidism, heart failure, lung disease, elderly.

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41
Q

A-Fibrillation Regularity

A

Irregularly irregular
(R-R has no discernable rhythm or pattern if you count it)
AV node is starting electrical impulse

42
Q

Premature Junctional Contraction (PJC) Heart rate

A

Determined by underlying rhythm

43
Q

Premature Junctional Contraction (PJC) Regularity

A

Interrupts regularity of underlying rhythm for a single beat.

44
Q

Premature Junctional Contraction (PJC) Measurement

A

PJC early

PRI: <0.12 if present

45
Q

Premature Junctional Contraction (PJC) Shape

A

P wave before QRS: inverted or upright

P wave after QRS or no P wave

QRS and T wave: same

46
Q

Premature Junctional Contraction (PJC) Treatment

47
Q

Premature Junctional Contraction (PJC) Cause

A

idiopathic, dig tox, ischemic heart disease, valvular heart disease, heart failure, response to catecholamines

48
Q

Junctional Escape Rhythms Heart rate

A

40-60 from AV node

49
Q

Junctional Escape Rhythms Regularity

50
Q

Junctional Escape Rhythms Measurements

A

PRI: <0.12 if P wave is before QRS

51
Q

Junctional Escape Rhythms Shape

A

P wave before QRS: inverted or upright

P wave after QRS or no P wave

QRS and T wave: same

52
Q

Junctional Escape Rhythms Treatment

A

Atropine, Dopamine, Epinephrine, Transcutaneous pacing (want to increase HR)

53
Q

Junctional Escape Rhythms Cause

A

SA node disease

54
Q

Accelerated Junctional Rhythm/ Junctional Tachycardia Heart rate

A

AJR: 60-100

JT: >100

55
Q

Accelerated Junctional Rhythm/ Junctional Tachycardia Regularity

56
Q

Accelerated Junctional Rhythm/ Junctional Tachycardia Measurement

A

PRI if P wave is before QRS: <0.12

QRS and T wave: same

57
Q

Accelerated Junctional Rhythm/ Junctional Tachycardia Shape

A

P wave before QRS: inverted or upright

P wave after QRS or no P wave

QRS and T wave: same

58
Q

Accelerated Junctional Rhythm/ Junctional Tachycardia Treatment

A

address tachycardia if symptomatic

59
Q

Accelerated Junctional Rhythm/ Junctional Tachycardia Cause

A

SA node disease, ischemic heart disease, electrolyte imbalances, dig tox, hypoxia

60
Q

Premature Ventricular Contractions (PVCs) Types

A 
Unifocal (form one area)
Multifocal
Bigeminy (every other beat)
Trigeminy (every 3rd beat)
Pair (2 in a row)
Nonsustained (3+ together- concern)
61
Q

Premature Ventricular Contractions (PVCs) Heart rate

A

Determined by underlying rhythm

Normal: 20-40 (ventricular)

62
Q

Premature Ventricular Contractions (PVCs) Regularity

A

Rhythm interrupted by premature beat

3+ cause for concern

63
Q

Premature Ventricular Contractions (PVCs) Measurement

A

PRI: None

QRS: >0.12

Compensatory pause after PVC

64
Q

Premature Ventricular Contractions (PVCs) Shape

A

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
Q

Premature Ventricular Contractions (PVCs) Treatment

A

treat the cause if PVC are increasing in frequency either with Lidocaine or Amiodarone, ablation

66
Q

Premature Ventricular Contractions (PVCs) Cause

A

hypoxemia, hypokalemia, ischemic heart disease, acid base imbalance, anxiety

67
Q

Ventricular Tachycardia (vtach) Heart rate

A

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
Q

Ventricular Tachycardia (vtach) Regularity

69
Q

Ventricular Tachycardia (vtach) Measurement

A

PRI: none

QRS: >0.10 often >0.16

P wave: none

70
Q

Ventricular Tachycardia (vtach) Shape

A

QRS wave: consistent is shape but appear wide and bizarre.

T wave: opposite direction of QRS

71
Q

Ventricular Tachycardia (vtach) Treatment

A

If no pulse: CPR and Dfib. If pulse and BP present: IV Amiodarone or Lidocaine

72
Q

Ventricular Tachycardia (vtach) Cause

A

QT prolongation, hypoxemia, exacerbation of heart failure, cardiomyopathy, hypokalemia, hypomagnesemia, valvular heart disease

73
Q

Asystole Heart rate

74
Q

Asystole Regularity

75
Q

Asystole Measurement

76
Q

Asystole Shape

A

Slightly wavy or flat

77
Q

Asystole Treatment

A

BLS and ACLS protocol is non-shockable

78
Q

1st Degree AV Block Heart rate

A

Determined by underlying rhythm

May look normal

79
Q

1st Degree AV Block Regularity

A

Determined by underlying rhythm

80
Q

1st Degree AV Block Measurement

A

PRI: >0.2 -prolonged

81
Q

1st Degree AV Block Shape

A

P, QRS and T waves consistent

82
Q

1st Degree AV Block Treatment

83
Q

1st Degree AV Block Cause

A

aging, ischemic heart disease, valvular heart disease

84
Q

2nd Degree Type 1 AV Block (Mobitz 1 or Wenckebach) Heart rate

A

Slower than underlying rhythm because of dropped beat

85
Q

2nd Degree Type 1 AV Block (Mobitz 1 or Wenckebach) Regularity

A

R-R shorten until a dropped beat

Regularly irregular

P-P regular

86
Q

2nd Degree Type 1 AV Block (Mobitz 1 or Wenckebach) Measurement

A

PRI: progressively longer until a QRS is dropped

87
Q

2nd Degree Type 1 AV Block (Mobitz 1 or Wenckebach) Shape

A

P, QRS and T waves consistent, until dropped beat

88
Q

2nd Degree Type 1 AV Block (Mobitz 1 or Wenckebach) Treatment

A

if symptomatic: review meds and consider pacer

NO ATROPINE

89
Q

2nd Degree Type 1 AV Block (Mobitz 1 or Wenckebach) Cause

A

aging, acute inferior MI, dig tox, ischemic heart disease, excess vagal response

90
Q

2nd Degree Type 2 AV Block (Mobitz 2) Heart rate

A

Slower than underlying rhythm because of dropped beat

91
Q

2nd Degree Type 2 AV Block (Mobitz 2) Regularity

A

P-P regular but R-R regular until dropped beat

92
Q

2nd Degree Type 2 AV Block (Mobitz 2) Measurement

A

Constant for underlying rhythm

QRS may be widened from bundle branch block

93
Q

2nd Degree Type 2 AV Block (Mobitz 2) Shape

A

P, QRS, and T consistent except dropped beat

More P waves than QRS complexes

94
Q

2nd Degree Type 2 AV Block (Mobitz 2) Treatment

A

Pacemaker

NO ATROPINE

95
Q

2nd Degree Type 2 AV Block (Mobitz 2) Cause

A

heart disease, increased vagal tone, conduction system disease, inferior MI, ablation of AV node

96
Q

3rd Degree/ Complete AV Block Heart rate

A

Atrial rate > ventricular rate

Ventricles are out of rhythm from atria
Measure to determine intervals

97
Q

3rd Degree/ Complete AV Block Regularity

A

P-P and R-R are regular

P waves are not associated with QRS

Atria and ventricles working separately from each other

98
Q

3rd Degree/ Complete AV Block Measurement

A

PRI: None (because of inconsistency between P and QRS)

QRS: often >0.10

99
Q

3rd Degree/ Complete AV Block Shape

A

Consistent

100
Q

3rd Degree/ Complete AV Block Treatment

A

immediate transcutaneous or transvenous pacer

  • *NO ATROPINE**
  • Ultimate goal is to get a permanent pacemaker
101
Q

3rd Degree/ Complete AV Block Cause

A

ischemic heart disease, MI, conduction system disease

A3 Values to Know (3 decks)

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