Rhythms Flashcards
R-R varies more than one small box…
Sinus dysrhythmia
Sinus dysrhythmia
R-R varies > 1 small box
Sinus dysrhythmia HR…
40-100bpm
P waves vary in appearance PRI varies but WNL R-R varies HR < 100bpm Impulse does not arise from SA node
Wandering atrial pacemaker
Wandering atrial pacemaker
P waves vary in appearance
PRI varies but WNL
R-R intervals vary
Wandering atrial pacemaker HR…
< 100bpm
Which artery commonly causes rhythm disturbances?
R coronary a.
P wave of early beat has different appearance
P wave before every QRS, but an early P wave may be right on the tail of the previous T wave
SA node does not initiate impulse
Atrial arrhythmia (PAC)
Is the impulse initiation c sinus dysthymia ectopic?
No - initiated by the SA node, but the rhythm varies
What condition can be a progression of PAC?
A-fib
Atrial arrhythmia (PAC)
P wave of early beat has a different appearance - early P wave is right on the tail of the previous T wave
Rapid atrial depolarization from abnormal area in atria
“Repeated firing”
Atrial rate of 250-350bpm
“Sawtooth” P waves
> 1 p wave before each QRS (bc firing rapidly)
R-R interval varies
A-flutter
A-flutter QRS…
Normal because the ventricles are okay
A-flutter
Rapid atrial depolarization from abnormal area in atria "Repeated firing" Atrial rate 250-350bpm "Sawtooth" P waves > 1 p wave before each QRS R-R interval varies
Can a-flutter be accompanied by a normal ventricular rate?
Yes, if not a lot of the impulses reach the ventricles - if the AV node does a good job gatekeeping ==> asymptomatic
If a lot of the atrial impulses get through the AV node to the ventricles in someone c a-flutter…
Fast ventricular rate and decreased CO ==> angina if there is underlying plaque
Increased O2 demand on heart and increased myocardial demand because there is no time for filling because of all the impulses
Quivering of atria because of multiple ectopic foci - depolarizing so no true P wave seen - none of the foci depolarize the atria
Absent P waves
“Wavy” baseline
R-R interval irregular
A-fib
Do the atria fully contract c a-fib?
No - they quiver
A-fib
Quivering of atria - no real contraction - multiple ectopic foci No true P wave "Wavy" baseline Absent P waves R-R interval irregular
What serves as the gatekeeper c a-fib?
AV node –> determines the ventricular response
Which heart condition is the #2 RF for stroke (after HTN)?
A-fib
A-fib can lead to what irregular finding during an examination?
Irregular radial pulse
Characteristics of NSR…
P wave: 0.06-0.12 sec (1.5-3 small boxes)
PRI 0.12-0.2 sec (3-5 small boxes) ==> AV delay for atrial kick
QRS 0.04-0.10 sec (1-2.5 small boxes)
ST segment ends @ beginning of T wave and on same isoelectric line as PRI
Normal T wave - upright
Impulse begins in SA node and follows normal pathways
P waves upright and identical
P wave before every QRS
QRS identical
normal R-R
HR 60-100bpm
Sinus bradycardia
NSR characteristics EXCEPT for HR < 60bpm
Sinus bradycardia possible causes…
Training
BBs
Decreased automaticity of SA node
Vagal response
Sinus tachycardia
NSR characteristics EXCEPT for HR > 100bpm
Sinus tachycardia possible causes…
Increased sympathetic NS Pain Exercise Emotion Caffeine Cigarettes Amphetamines Fever Infection
A-flutter possible causes
Mitral valve disease CAD MI Stress Hypoxemia Pericarditis
A-fib possible causes…
Age CHF; MI Digoxin toxicity Drug use Stress Loss of atrial kick
Controlled A-fib
V rate < 100bpm
Uncontrolled A-fib
V rate > 100bpm
Does controlled A-fib impact CO?
Not really
Does uncontrolled A-fib impact CO?
YES - MONITOR VITALS
