Heart Rhythms

Normal Sinus Rhythm

100

Ventricular activity (QRS complex-depolarization)

-Rate(60-100) (QRS x 10)

-Rhythm (same distance between R-R interval)

-Shape (all QRS same size, shape, and duration <0.12s = <3boxes)

Atrial Activity (P wave; atrial depolarization)

-Rate (p wave x 10)( # of p wave = # of QRS wave)

-Rhythm (same distance between P waves)

Shape( same shape, size, duration)

AV relationship 

-Is every p wave followed by a QRS

PR interval(time it takes for impose to travel from SA-AV node)

-(0.12-0.20s) (3-5 small squares)

QT interval (full time ventricles fully contract + relax)

-(0.35-0.45s) (9-11 small squares

ST segment (completion of ventricular systole)

-should be flat

T wave

-not peaked/depressed, more like a almond shape

What is "Bird's Eye View"?

200

Birdseye view> Abnormal ventricular activity> QRS complex 

rate < 60bpm, rhythm, shape (very narrow, 1 box= smaller duration)

What is Sinus Bradycardia?

300

HYPO: glycemia, thyroidism, thermia

MEDS: beta blockers, Ca+ blockers, opioids

Increased Inter cranial Pressure 

PNS stimulation> Valsalva maneuver 

MI

Causes of Sinus Bradycardia

400

• Hypotension, dizziness, confusion, weakness, chest pain, SOB, pale, cool, calmly skin
  
  

Signs/Symptoms of Bradicardia

500

treat underlying cause(liver, renal, electrolytes)

Atropine

Translucent pacing

Internal Pacing(pacemaker)

Treatment for Sinus Bradycardia

Sinus Tachycardia

100

abnormal QRS rate 101-150bpm

What is Sinus Tachycardia

200

• Underlying cause

• Check TSH

• Vagal stimulation> Carotid massage(ensure no bruit, apply form pressure 10-15secs), Valsalva maneuver(take breath, hold+strain, push out)

• Meds: Ca+ blockers, beta blockers, cardovert, IV fluids

Sinus Tachycardia Treatment

300

myocardium damage, HTN/Hypo, SNS stimulation(stress pain,fever,pin), Meds(epi, atropine, caffeine, theophyline), electrolyte imbalances

Cause of Sinus Tachycardia

400

1. Defib to shock abnormal rhythm (on R wave of QRS)

2. Cardiac cath lab

3. FOR

   1. Symptomatic patients(low BP, with pulse

4. Voluntary, sedate pt

5. Place leads RA-white(above), RL-green(below), LA-black(above), LL-red(below) + V1-V5

6. Push sync, charge to correct jules(up to 200)> charge> clear> shock

7. If patient becomes pulseless turn off sync and defiberalate with cpr protocols

8. USE

   1. Atrial Arrhythmias with RVR(hr>100)

   2. SVT

   3. Ventricular tachycardia 

Synchronized conversion

500

1. Invasive procedure

2. Scars tissue in heart to block irregular signals

3. Performed in cardiac cath lab

4. Treatment

   1. Symptomatic patients with Wolff-Parkinsons-White syndrome> SVT

   2. Elective for

      1. Atrial dysrhythmias

      2. SVT

      3. Ventricular tachycardia with a pulse

What is an Ablation?

Atrial Fibrillation

100

• EKG:

  • No p wave/ AV relationship

  • PR interval: unidentified

  • ST segment: unidentified

  • T wave: not peaked/depressed

• Patho: Atrial chaos> AP from SA node travels around atrium and does not go to AV node, instead down septum

What is Atrial Fibrillation?

200

• Causes:Age, heart disease/surgery hyperthyroidism, alcohol, caffeine, stress

• S/S:pounding pulse, hypotension, dizzy, confused, palpitations, SOB, chest tightness

Causes of Afib

300

decreased CO> clot> stroke

A fib complications

400

• HR> 100bpm

  • Rate control> Ca+ blockers, beta blockers, digoxin(toxicity)

  • Digoxin hold if (Apical pulse <60, Toxcity: visual disturbances, n/v, Potassium<3.5)  

  • Rhythm> amiodarone, sotalol, flecainide

• Anticoagulants> warfarin, clopidogrel, rivaroxaban

• Synchronized cardioversion

• Ablation(insertion to decrease HR)

A fib treatment

500

S/S:pounding pulse, hypotension, dizzy, confused, palpitations, SOB, chest tightness

Symptoms of Afib

Atrial Flutter

100

• EKG:

  • No p waves/ AV relationship

  • PR interval: not measurable

  • ST segment: Unidentifiable

  • T wave: unidentifiable

• “Saw tooth” rhythm

  • 2:1 flutter-QRS ratio

  • 3:1 flutter-QRS ratio

• Patho: abnormal atrial depolarization> not conducting impulses down to ventricles
  
  

What is A flutter?

200

• Cause: COPD, anemia, infection, heart disorders, electrolyte imbalances

Causes of A fluuter

300

• S/S: palpitations, SOB, anxiety, weakness, angina, syncope

S/S of A flutter

400

Complications: Decreased CO> ^ clots

Complications of A flutter

500

• HR> 100bpm

  • Rate control> Ca+ blockers, beta blockers, digoxin(toxicity)

  • Digoxin hold if (Apical pulse <60, Toxcity: visual disturbances, n/v, Potassium<3.5)  

  • Rhythm> amiodarone, sotalol, flecainide

• Anticoagulants> warfarin, clopidogrel, rivaroxaban

• Synchronized cardioversion

• Ablation(insertion to decrease HR)

A flutter treatment

Supra-ventricular Tachycardia

100

• EKG:

  • No P wave/ AV relationship

  • PR interval: not measurable

  • ST segment: depressed 

  • T wave: abnormal/elevated

• “Supra”=above

What is SVT?

200

• Cause:  Wolff-Parkinson White Syndrome, Coke, Meth, caffeine, hypoxia, hypovolemia, pain, fever, stress, CAD

Causes of SVT

300

dcereased CO> Heart Failure

Complications of SVT

400

• Vagal stimulation> Carotid massage(ensure no bruit, apply form pressure 10-15secs), Valsalva maneuver(take breath, hold+strain, push out)

• Meds:

• 
  

  •  Adenosine > monitor ekg, O2, 6mg iv quickly, flush, may repeat up to 12mg

  • Ca+ blockers, beta blockers, amiodarone

• Synchronized conversion with pulse

• 
  

  • No pulse + unresponsive to meds> defib + CPR

• Ablation 

Treatment for SVT