Rhythms Flashcards
what are the 3 irregularly irregular rhythms
Afib, wandering atrial pacemaker, multifocal atrial tachycardia
what is normal sinus rhythm
rate 60-100 BPM, regular rhythm, p wave present and upright in lead II, p/QRS ratio: 1:1, QRS width is normal
what is sinus arrhythmia
normal respiratory variation; rhythm gets faster on inhalation and slower on exhale; rate is still 60-100 BPM; p waves normal; P/QRS 1:1; and PR interval normal
what is sinus bradycardia
rate < 60 BPM; otherwise NSR
regular; p waves present; P/QRS ratio 1:1; PR interval- WNL to slightly prolonged; QRS width- WNL to slightly prolonged
May be caused by medication, vagal stimulation, sick sinus syndrome, inferior ischemia/infarct; also seen in athletes
what is sinus tachycardia
rate > 100 BPM; otherwise NSR
regular with p waves present; P/QRS 1:1; PR interval-slightly shortened; QRS width- slightly shortened
Found in high cardiac output states: exercise, fever, hyperthyroidism, hypovolemia
what is sinus pause/ arrest
rate varies; rhythm is irregular; p wave is present except in the pause area; P/QRS 1:1; PR interval is normal; QRS width is normal; grouping none; dropped beats YES!!
-time interval is NOT a multiple of the normal P-P interval
what is sinoatrial block
a dropped complex that is a multiple of the P-P interval
rate varies; rhythm is irregular; P wave present except in area of dropped beat; P/QRS 1:1; PR interval is normal; QRS width normal; dropped beat YES!!
- occurs in some multiple of the P-P interval; after the dropped beat the cycle continues on time
- the pathology is a non conducted beat from the normal pacemaker
what is atrial premature contraction (PAC)
PACs occur when another region of the atria depolarizes before the SA node and thus triggers a premature heartbeat
the pause after the PAC is non compensatory; meaning the underlying rhythm is disturbed and does not proceed at the same pace= PAC resets the SA node
rate varies; p waves PRESENT and UPRIGHT except in the PAC may be a diff shape; irregular rhythm; PR interval varies in the PAC otherwise normal; QRS width normal; P/QRS 1:1; grouping sometimes; dropped beats no
what is ectopic atrial tachycardia
a run of PACs
ectopic atrial focus fires quicker than the SA node; the p waves and PR intervals within the ectopic rhythmm are different; episodes are not sustained for a long period of time;
rate: 100-180 BPM
rhythm is regular
p wave: morphology of ectopic focus is diff;P/QRS 1:1; PR interval: diff in ectopic focus; QRS width narrow
what is wandering atrial pacemaker
irregularly irregular rhythm caused by multiple ectopic pacemakers in the atria
-atleast 3 different p wave morphologies**
-rate < 100 BPM
-P/QRS: 1:1
QRS width: narrow
What is multifocal atrial tachycardia
a tachycardic WAP: three or more different ectopic foci in the atria that fire at different rates
- atleast 3 different p wave morphologies**
- rate >100 BPM
P/QRS 1:1; QRS width is narrow
found in patients with severe lung disease**
what is atrial flutter
atrial rate 250-350 BPM ventricular rate 125-175 BPM usually regular P wave: saw toothed P/QRS 2:1, variable PR interval variable QRS width normal; grouping none; dropped beats none
what is atrial fibrillation
chaotic firing of numerous pacemaker cells in the atria; no discernible p waves and QRS complexes are in irregular pattern
rate: variable irregularly irregular p wave: NONE; chaotic atrial actibitiy P/QRS: none 0;1 PR interval: none QRS width normal; no grouping or dropped beats
if a p wave is upright what is it’s origin
high atria or SA node
if a p wave is inverted what is it’s origin
low atria or AV node
if a p wave is absent…
and the QRS is narrow?
or the if the QRS is wide?
what is it it’s origin
absent= AV node or ventricle
narrow QRS= AV node ( Junctional)
wide QRS= ventricular origin
what indicates sinus rhythm
an upright p wave in lead II
p waves in junctional rhythms: if the retrograde impulse is the same speed as the antegrade impulse then how should the p wave look?
there won’t be one
p waves in junctional rhythms: if the retrograde is faster than the ante grade impulse then how will the p wave look?
inverted and before QRS
p waves in junctional rhythms: if the retrograde is slower than the ante grade impulse then how will the p wave look?
inverted and after the QRS
if you see a narrow QRS with no p wave what should you be thinking….
JUNCTIONAL rhythm!
why do we want to see if the p wave and the QRS wave are married
it tells you the atria depolarized before the ventricles; if they aren’t married then it could be AV block
if the QRS is narrow what is the origin of the impulse
supraventricular
- sinus
- atrial
- junctional
if the QRS is wide what is the origin of the impulse
ventricular OR abnormal conduction (BBB)
what is the normal width of the QRS complex to be considered narrow
< .12 seconds or 3 small boxes
what is an ectopic beat
an impulse forming from somewhere other than the SA node
what is a premature beat
when another pacemaker cell fires at a rate faster than the SA node
happens before expected beat
EARLY ectopic beat
what is an escape beat
slowing of the SA node allows a faster pacemaker focus to pick up the beat
happens later than an expected beat
LATE ectopic beat
what is junctional premature contraction (PJC)
an premature beat that originates in the AV node
no p wave!! (sometimes inverted after QRS)
QRS is narrow
-if a beat occurs quicker than you expected look for the p wave….if it’s not there=PJC
what is ventricular premature complex (PVC)
beat that originates from ventricles no p wave WIDE QRS followed by long compensatory pause looks WIDE & WEIRD!
can be benign or malignant- if new onset in the setting of ischemic heart disease
what is 2 PVCs called
a couplet
what is >3 PVCs but lasting less than 30 seconds called
non-sustained ventricular tachycardia (NSVT)
what is a pattern of PVCs that is every other beat
ventricular bigeminy
what is a pattern of PVCs that is every third beat
ventricular trigeminy
what are the three premature beats
atrial premature contraction
junctional premature contraction
premature ventricular complex
what is a junctional escape beat
SA node fails to fire and AV node is next available
no p wave/ or inverted
narrow QRS
single dropped beat
what is a junctional escape rhythm
both the SA node and atria fail rate 40-60 BPM regular rhythm no p wave/ or inverted narrow QRS continuous rhythm
what is junctional tachycardia
otherwise similar to junctional escape rhythm just faster than >100 BPM
most common cause is digoxin toxicity!
what is accelerated junctional rhythm
otherwise junctional escape rhythm just faster; 60-100 BPM
no p wave/ inverted
narrow QRS
regular rhythm
what is a ventricular escape beat
occurs when the SA node fails to fire no p wave wide QRS wide & weird! dropped beat= occurs late
what is idioventricular escape rhythm
everything above the ventricles fail; so ventricles are pacemaker
rate 20-40 BPM
no p wave
wide QRS
rhythm is regular
what is accelerated idioventricular rhythm (AIVR)
otherwise similar to idioventricular escape rhythm except FASTERRR 40-100 BPM
what is the supra ventricular reentrant rhythm with abnormal conduction
WPW
what are the characteristics of PSVT
narrow QRS regular rhythm no p wave begins and ends abruptly rate 150-220 bpm
can be present even in pts without structural heart abnormalities
what is the most common Paroxysmal tachycardia
PSVT
what are the supraventricular reentrant rhythms that are regularly irregular
PSVT and Atrial flutter
what is an irregularly irregular supra ventricular rhythm
Afib
what are the characteristics of ventricular tachycardia
rate >120 bpm
regular
wide QRS
no p waves: AV dissociation
fusion and capture beats are diagnostic!!
what is a capture beat
found in ventricular tachycardia; it is a completely normal looking beat
what is a fusion beat
found in vtach; it is a 1/2 normal looking beat but 1/2 weird looking too. this is because both the SA and ventricular impulse fire at the same time
what could ventricular tachycardia be also….
SVT with aberrancy:
BBB
WPW
pacemaker/defibrillator: this would have a spacer spike line followed by a wide complex
what are the ways to help you distinguish v tach from SVT with abberancy
Vtach does not have p waves/ possible fusion & caption beats seen/ the first complex is always in the opposite direction from what the pts normal first complex is
SVT does have a p wave
describe torsades de pointes
polymorphic vtach
very fast >200 bpm
begins from a prolonged QT interval
what are the causes of torsades de pointes
drugs, congenital heart dz, or electrolyte disturbances
what is the treatment for torsades de pointes
IV magnesium
which rhythm is classified as cardiac arrest
ventricular fibrillation
what is the term for flatline
asystole
what is the term for NSR without a pulse
pulseless electrical activity
