Sinus Bradycardia -Normal in atheletes Below 60 Regular Normal Normal Normal - Only treat if s/s are
during sleep bpm developed
- Not pathological -Oxygen is always appropriate
-At rest usually Intervention sequence:
asymptomatic Atropine 0.5 to 1 mg IV if
-Physical sign vagal mechanism
Transcutaenous pacing if
available
If S&S are sever, consider
catecholamine infusions:
o Dopamine 5 to 20
ug/kg/min
o Epinephrine 2 to 10
ug/min
o Isoproterenol 2 to 10
ug/min
Sinus Tachycardia - May be caused by Fast Regular Normal Normal Normal Treat only the causes of the
exercise, anxiety, fever, >100bp tachycardia. NEVER
hypoxemia, m countershock.
hypovolemia or cardiac Treat only if the client is at
risk/experiencing symptoms of
failure
MI or myocardial damage
- Not pathological,
B-blockers; verapamil
Physical sign Tachycardia is more life
threatening to a patient with
MI
Atrial Arrhythmias
(P waves differ in apperance from sinus P wave; After the dropped beat, cycles continue on time)
ECG Result Description Rate Rhythm P wave PR QRS Intervention
Interval Complex
Atrial Flutter -Atrial focus captures Atrial: Irregular - no true Variable Usually Treatment: digitalis preparations
the heart rhythm and 250-350 but P wave normal, but (enhances the block of AV node
discharges impulses at bpm; more - flutter may appear thus slows down atrial rate);
a rate bet. 200- regular waves widened if quinidine (controls ectopic foci);
400x/min Ventricul than in "saw flutter calcium channel blockers (for
dysrhythmias); Propanolol (B
-"saw tooth" pattern ar: atrial tooth waves are
adrenergic blocker); amnioderol;
-A-flutter may be the slow or fibrillatio pattern" buried in
electrical cardioversion (giving
first indication of fast n QRS small doses of electric current)
cardiac disease Emergency drugs:
-Causes: Atrial V - Verapamil
stretching, MI, CHF, I - Inderal
elevated atrial pressure, D - Diltiazem
hyperthyroidism,
pericarditis
Atrial Fibrillation - A fib is a dysrhythmia Atrial: "Irregula - no true None Normal Treatment (same sa Atrial Flutter)
that is caused by a 350 or rly P wave, Diltiazem, Ca channel blocker
(decreases work load & O2 demand),
rapid & chaotic firing by greater irregular chaotic
beta blocker
atrial impulses caused bpm; " atrial Amiodarone (B blocker; class III anti-
by a multitude of (too activity dysrhythmic; prolongs repolarization
ectopic foci rapid to during ventricular dysrhythmia)
- Causes: CHF, cor Digoxin (for purposes of reverting
count)
irregular rhythm to sinus rhythm)
pulmonale, CHD, Cardioversion (giving of small
pericarditis, pulmonary Ventricul electrical impulses (100 200
emboli, hyperthyroidism ar: joules)
-s/s: DOE, SOB, Acute For an impaired heart:
slow or
Heparin or other anticoagulants (but
Pulmonary Edema fast do NOT give to patients with
hemorrhagic stroke)
Quinidine (purpose: suppresses
ectopic foci)
Emergency drugs:
V - Verapamil
I - Inderal
D - Diltiazem
Atrial Tachycardia Causes: common in 150-250 Regular Normal May be Normal but Treatment:
elderly patients with bpm but short in can be Usually no treatment b/c
COPD differ in rapid aberrant at underlying cause cannot be
resolved
shape waves times
Usually refractory to any
from (<0.12 s)
treatment
sinus P Emergency drugs:
wave A - Adenosine
Junctional Arrhythmias
ECG Result Description Rate Rhythm P wave PR QRS Intervention
Interval Complex
Junctional Rhythm (Junctional Arrhythmias) 40 - 60 Regular Absent, None, Normal Treatment:
-The atria and SA node do If specific dx is unknown, attempt
bpm inverted short or
not perform their normal therapeutic/diagnostic maneuver
, buried retrograd with vagal stimulation,
pacemaking functions.
or e adenosine, THEN
A junctional escape retrogra Preserved heart function:
rhythm begins. de o B blocker, Ca channel
blocker, amiodarone
o No DC cardioversion!
If impaired heart function:
o Amiodarone
o No DC cardioversion!
Accelerated Junctional Rhythm 61 -100 Regular Absent, None, Normal - Monitor the patient for
bpm inverted short or clinical improvement, not just
, buried retrograd ECG
or e
retrogra
de
Junctional Tachycardia -s/s of decreased cardiac 101 - Regular Absent, None, Normal
output may be seen in 180 bpm inverted short or
response to the rapid rate
, buried retrograd
or e
retrogra
de
Junctional Escape Beat -an escape complex comes Depends Irregular Absent, None, Normal
later than the next on rate wheneve inverted short or
expected sinus complex
of r an , buried retrograd
underlyin escape or e
g rhythm beat retrogra
occurs de in
the
escape
beat
Premature Junctional Contraction -enhanced automaticity in Depends Irregular Absent, None, Normal
the AV junction produces on rate wheneve inverted short or
(PJC)
PJC
of r a PJC , buried retrograd
-before deciding that the
underlyin occurs or e
isolated PJC may be g rhythm retrogra
significant, consider the de in
cause the PJC
Ventricular Arrhythmias
ECG Result Description Rate Rhythm P wave PR QRS Intervention
Interval Complex
Ventricular Fibrilation Two types: Too rapid Chaotic None None None Treatment
Fine dili kaau distorted to count Early defib is essential
ang imong rhythm or Agents given to prolong
imong firing of impulses period reversible death
Indeter-
Coarse the firing of oxygen, CPR, intubation,
minate
impulses are either epinephrine, vasopressin
chaotic or disorganized Agents given to prevent refib
after a shock causes defib
Condition where patient lidocaine, amiodarone,
goes into a complete procainamide, B blockers
arrest Agents given to adjust
metabolic milieu sodium
Characterized by bicarbonate, magnesium
random & chaotic Priority management
discharging of impulses electrical defib; ideal current:
within the ventricles at 200-400 watts/sec
rates that exceed 300BPM Successful defib will stop the
heart and allowing it to
Produces clinical death restart; once restarted, it will
& must be reversed be controlled by the normal
immediately sinus pace
Emergency Drug
S&S
E - Epinephrine
Pulse disappears with V - Vasopressin
onset of VF A - Amiodarone
Collapse, unconscious L - Lidocaine
Agonal breaths --- apnea (the same emergency drug in
in <5 min Pulseless V-tach)
Onset of reversible death
Causes
Acute MI; deteriorating
ventricular rhythms;
acidosis; electrolyte
disturbances
ECG Result Description Rate Rhythm P wave PR QRS Intervention
Interval Complex
Ventricular Tachycardia Impulse conduction is 100-250 Regular None None Wide Treatment
(Monophormic) slowed around areas of bpm (not (> 0.10sec), Parenteral medications: any
ventricular injury, associat bizarre one
infarct or ischemia o B blockers
ed with appearance
These areas also serve as o Lidocaine (if pt. is
QRS)
source of ectopic unconscious, do not
impulses (irritable foci) give lidocaine;
These areas of injury can immediately defib
cause the impulse to instead)
take a circular course, o Amiodarone
leading to the reentry o Procainamide
o Sotalol
phenomenon and rapid
Impaired heart
repetitive
o Amiodarone
depolarizations
o Lidocaine then
Can be asymptomatic
discontinue
Majority of times,
cardioversion (to
symptoms of dec.
abolish all cardiac
cardiac output are seen
rhythms and allow
(orthostatic
normal pacemaker the
hypotension, syncope,
opportunity to restart)
exercise limitations,
if persists
etc.)
Endocardial resection,
Untreated & sustained will
removal of aneurysm,
deteriorate to unstable
aneurysmectomy,
V-Tach, often VF
antitachycardia pacemakers
Ventricular Tachycardia Areas serve as the 100-250 Regular None None Wide
if unresponsive to drugs
(Polymorphic) source of ectopic bpm or (not (> 0.10sec),
impulses (irritable irregular associat bizarre Emergency Drugs
foci); irritable foci ed with appearance A - Adenosine
occur in multiple areas QRS) A - Amiodarone
of the ventricles, thus
L - Lidocaine
polymorphic
P - Procainamide drip
These areas of injury
can cause impulses to
take a circular course,
leading to the reentry
phenomenon and
rapid repetitive
depolarizations
Manifestations
Rare: asymptomatic
polymorphic VT
Majority of times:
symptoms of dec. CO are
seen (orthostatic
hypotension, syncope,
exercise limitations)
Tends toward rapid
deterioration to pulseless
VT or VF
ECG Result Description Rate Rhythm P wave PR QRS Intervention
Interval Complex
Torsades de pointes spindle-node pattern 200 - Irregular None None Display Treatment
Consequence of 250 bpm ventricul classic Treat ischemia
quinidine therapy ar Correct electrolytes if
Signs abnormal
rhythm Wide
Majority of times, Then therapies (any one):
(>0.10sec), Magnesium
patients have
symptoms of dec. CO bizarre Overdrive pacing (ventricular
Asymptomatic appearance pacing to override the
torsades, sustained ventricular rate & capture the
torsades, or stable rhythm)
torsades is uncommon Isoproterenol (pharmacologic
Tends towards overdrive pacing) [shortens Q-
sudden T interval]
deterioration to Phenytoin
pulseless VT or VF Lidocaine
Prolonged Q-T interval
(>0.6sec)
3rd degree AV Block Injury or damage to Atrial: Usually Normal Varies Normal if Intervention for
the cardiac conduction 60100 regular, (upright greatly ventricles bradycardia
system so that no bpm; but atria and are (view 2nd degree)
impulses pass and uniform) (NO activated
between atria and ventricul ventricle ; may relations by
ventricles (complete)
ar: s be hip bet. P junctional
This can occur at
several different
4060 act super- wave escape
anatomical areas: bpm if indepen- imposed and R focus; wide
o AV node escape dently on QRS wave) if escape
(high/supra/jun focus is complex focus is
ctional nodal junctiona es or T ventricular
block) l, <40 waves
o Bundle of his
bpm if
o Bundle branch
escape
(low-
nodal/infranoda focus is
l block) ventricul
No relationship ar
between atrial activity
& ventricular activity
Both chambers are
discharging impulses