Sinus Arrhythmias

Question 1

Steps for Analyzing EKG

Answer 1

> Is it regular or irregular?
-look at the P-P (atrial) if present and R-R (ventricular)

> What is the rate?

> Are there P waves?

• do they look the same or are they different?
• is there a P wave in front of every QRS?

> If there are P waves, is there a regular PR interval?
-is it 0.12-0.20 seconds?

> What does the QRS look like?

• narrow (< 0.10)- above ventricles
• wide (> 0.10)- above the ventricles- wide QRS
• wide (> 0.10)- below the ventricles

> What is the QT interval?

• is it between 0.36-0.44 seconds?
• normal QT should be less than half the R-R interval (less than R-R interval is normal, the same it is borderline, and longer it is prolonged)

> Interpretation?
Intervention?

Question 2

Normal Sinus Rhythm

Answer 2

• Regular (R-R) interval
• Rate: 60-100 bpm
• P waves: normal in size, shape, and direction; 1 P wave in front of each QRS
• PR interval: 0.12 to 0.20 seconds (all PR intervals the same)
• QRS: 0.10 is a wide QRS
• QT interval: 0.36-0.44 seconds (normal)

Intervention: Nothing, NSR reflects the normal activity of the heart

Question 3

Sinus Tachycardia

Answer 3

SA node discharges impulses too fast; looks like sinus rhythm but it is faster

• Regular R-R interval
• Rate: 100-160 bpm
• P waves: normal; 1 P wave in front of every QRS
• PR interval: 0.12-0.20 seconds (normal)
• QRS complex: 0.10 is a wide QRS
• QT interval: 0.36-0.44

Question 4

Sinus Tachycardia Interventions

Answer 4

Persistent high HR can lead to myocardial ischemia and other signs of decreased cardiac output in persons w/ poor pump function or atherosclerotic disease

• monitor HR, blood pressure, and pulse oximetry
• correct underlying cause (fluid replacement, r/o hypovolemia before administrating medications, relief of pain, removal of offending substances or medications, reducing fever or anxiety)

Question 5

Sinus Bradycardia

Answer 5

SA node discharges impulses too slow; looks like sinus rhythm but is slower

• Regular P-P and R-R interval
• Rate: 40-60 bpm
• P waves: normal; 1 P wave for every QRS
• PR interval: 0.12-0.20 seconds (normal)
• QRS complex: 0.10 is a wide QRS
• QT interval: 0.36-0.44 seconds (lower the rate the longer the QT)

Question 6

Sinus Bradycardia Intervention

Answer 6

persistently low HR may lead to low BP, syncope and other symptoms of decreased cardiac output such as anxiety, chest pain, SOB, diaphoresis, cool clammy skin, cyanosis, decreased consciousness
>What is causing low HR?
-effect of vagal maneuvers? or medications?
-common vagal triggers = straining to have a bowel movement, heat exposure, standing for long periods of time, standing up too quickly
>Monitor and observe: is the patient having symptoms. with low HR?
-maintain patent airway, assist w/ breathing if needed; oxygen; cardiac monitoring, BP, and oximetry; IV access; 12 lead EKG
>Are symptoms causing patient to be unstable?
-call a RR
-Atropine IV dose: 1 mg bolus, repeat every 3-5 min. Max: 3 mg
-If atropine ineffective: Transcutaneous pacing and/or prepare for permanent pacemaker or
-Dopamine IV infusion: 2-20 mcg/kg/min titrate to patient response
-Epinephrine IV infusion: 2-10 mcg/min titrate to pt. response

Question 7

Sinus Bradycardia Intervention if Patient Unstable

Answer 7

-call a RR
-Atropine IV dose: 1 mg bolus, repeat every 3-5 min. Max: 3 mg
>If atropine ineffective:
-Transcutaneous pacing and/or prepare for permanent pacemaker or
-Dopamine IV infusion: 2-20 mg/kg/min or
-Epinephrine IV infusion: 2-10 mg/kg/min