Cardiac rhythm practice material PDF

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practice dysrhythmias and cardiac rhythms. EKG....

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Sinus Bradycardia 1. Rate: less than 60bpm 2. Heart rhythm: regular 3. P wave: Normal and consistent shape. Always in front of the QRS 4. PR interval: Consistent interval between 0.12 and 0.20 seconds 5. QRS complex: 0.06 – 0.12 seconds. 6. Cause: hypoglycemia, hypothermia, hypothyroidism, medications, MI 7. Treatment: Atropine, pacing if patient is hemodynamically compromised, give oxygen is needed. Monitor BP, HR.

Sinus Tachycardia 1. Rate: greater than 100 bpm 2. Heart rhythm: regular 3. P wave: Normal and consistent shape. Always in front of the QRS but may be buried in the preceding T wave 4. PR interval: Consistent interval between 0.12 and 0.20 seconds 5. QRS complex: 0.06 – 0.12 seconds. 6. Cause: damage to heart tissue from heart disease, hypertension, fever, stress, alcohol, caffeine, nicotine, drugs (cocaine), pain, hyperthyroidism, imbalanced electrolytes. 7. Treatment: aimed at finding and treating cause. Narrow QRS: adenosine, beta blockers, calcium channel blocker or synchronized cardioversion. Wide QRS: consider anti-arrhythmic such as procainamide, amiodarone, or sotalol.

Sinus Arrhythmia 1. Rate: less than 60 to 100bmp 2. Heart rhythm: Irregular 3. P wave: normal and consistent shape. Always in front of the QRS. 4. PR interval: Consistent interval between 0.12 and 0.20 seconds 5. QRS complex: 0.06 – 0.12 seconds. 6. Cause: heart disease, moderate to extreme stress, caffeine, nicotine, alcohol, cough and cold medicine. 7. Treatment: treatment is usually not required unless patient is symptomatic.

Premature Atrial Complex 1. Rate: usually regular but depends on the underlying rhythm. 2. Heart rhythm: irregular. 3. P wave: an early and different P wave may be seen or may be hidden in the T wave. 4. PR interval: The early P wave has a shorter than normal PR interval but sill 0.12 and 0.20 seconds 5. QRS complex: 0.06 – 0.12 seconds. 6. Cause: occurs in healthy patient without heart disease, stress, stimulants, hypertension, valvular condition, infectious disease, hypoxia 7. Treatment: No treatment is necessary if asx. Beta blockers, calcium channel blockers.

Atrial Fibrillation 1. Rate: atrial: 300 to 600 bpm, ventricular: 120 to 200 bpm. 2. Heart rhythm: highly irregular. 3. P wave: No discernible P waves. Irregular undulating waves that vary in amplitude and shape are seen and referred to as fibrillatory or f waves. 4. PR interval: Cannot be measured. 5. QRS complex: 0.06 – 0.12 seconds. 6. Cause: hypoxia, hypertension, congestion heart failure, dysfunction of sinus node, mitral valve disorder, rheumatic heart disease, pericarditis, hyperthyroidism, alcohol, caffeine 7. Treatment: digoxin, beta-adrenergic blockers, calcium channel blockers, antithrombic therapy.

Atrial Flutter 1. Rate: atrial rate: 250 to 400 bpm, ventricular: 75 to 150 bpm. 2. Heart rhythm: atrial: regular / ventricular: may be irregular. 3. P wave: Normal P waves are absent. Flutter wave (sawtooth pattern) 4. PR interval: multiple F waves may make it difficult to determine the PR interval. 5. QRS complex: 0.06 – 0.12 seconds. 6. Cause: > 60 years old, mitral valve disorder, thickening heart muscle, ischemia, cardiomyopathy, COPD, Emphysema. 7. Treatment: cardioversion, diltiazem, verapamil, digitalis, beta blockers. Heparin to prevent thrombus formation.

Premature Ventricular Complex 1. Rate: depends on the underlying rhythm. 2. Heart rhythm: irregular due to early QRS. 3. P wave: Visibility of the P wave depends on the timing of the PVC. May be absent (hidden in the QRS or T wave) 4. PR interval: if the P wave is in front of the QRS, the PR interval is less than 0.12 and 0.20 seconds 5. QRS complex: 0.06 – 0.12 seconds. 6. Cause: exercise, stress, caffeine, MI, CHF, cardiomyopathy, mitral valve prolapse, electrolyte imbalance, hypoxia, tricyclic antidepressant, digitalis toxicity. 7. Treatment: oxygen, lidocaine, procainamide.

Ventricular Tachycardia 1. Rate: ventricular rate: 100 to 200 bpm, arterial rate depends on the underlying rhythm. 2. Heart rhythm: usually regular. Atrial rhythm may also be regular. 3. P wave: very difficult to detect. 4. PR interval: very irregular if P waves are seen. 5. QRS complex: wide and bizarre (> 0.12 seconds) 6. Cause: heart disease, MI, electrolyte imbalance, digitalis toxicity, congestive heart failure. 7. Treatment: if there are no pulse, begin CPR and follow ACLS protocol. If there are pulse and the patient is unstable, cardiovert and begin drug therapy. -amiodarone, lidocaine. Defibrillate.

Ventricular Fibrillation 1. Rate: ventricular rate greater than 300bpm. 2. Heart rhythm: extremely irregular 3. P wave: none 4. PR interval: none 5. QRS complex: none 6. Cause: AMI, untreated VT, electrolyte imbalance, hypothermia, myocardial ischemia, drug toxicity or overdose,trauma. 7. Treatment: CPR with immediate defibrillation, initiate ACLS algorithm....