ATRIAL ARRHYTHMIAS Definition and Pathology Significance Etiology Clinical Manifestations Intervention

Premature Atrial Contraction - originates outside - healthy hearts in - coronary or valvular - irreg peripheral - asymptomatic: no
[PAC] the SA node period of stress/ heart dse pulse rhythm treatment needed
- appears earlier fatigue, alcohol, - atrial hypertrophy, - occasional - symptomatic or pts
than expected caffeine and tobacco valve insufficiency, palpitation having 6 or more
- P-wave is - Hyperthyroidism atrial ischemia, PAC: Digitalis or
premature & - Elevated athrosclerosis and Propanolol
abnormally shaped catecholamines  conduction defects
& sometimes inc sympa. NS tone
hidden -
- T-wave maybe
distorted
- Sinus impulse is
blocked
Paroxysmal Atrial - atrial rate range: - dangerous in the - conduction problem - Synchronized
Tachycardia [PAT] 160-250 bpm; reg presence of AMI  in Av node cardioversion
rhythm inc myocardial - AV node= - Carotid sinus
- p- wve is hidden oxygen consumption pacemaker massage
frm the previous t- - sometimes normal in - Gag reflex
wave pts w/ COPD, chronic - Valsalva’s maneuver
- impulse starts at CAD & dig toxicity - All produces vagal
the atrium and not timulation to control
at the SA node HR
- Beta-blockers
Atrial Flutter - atrial rate: 250- 400 - atrial rate is faster - chest pain - analgesic for chest
bpm w/ N QRS than the AV node - SOB pain
complex can conduct - Low BP - Betablockers and dig
- SAW-TOOTHED - not all impulses are to regulate heart
- Known as F-wave conducted  contraction
therapeutic block at - Synchronized
Av node cardioversion
Atrial Fibrillation - Rapid, - atrial enlargement/ - too fast radial pulse - Tx is symptomatic
disorganized and CAD/ that may not be - If pt is hypotensive or
uncoordinated cardiomyopathy palpable has anginal pain/
twitching of atrial - pericarditis - acute A fib: dec syncope: give dig,
musculature. - ischemia cardiac output procainamide,
- The heart is - cardiac valve - chronic A fib: heart quinidine & propanolol
QUIVERING disorder compensate  inc - Valsalva’s maneuver,
- Most common - COPD/ CHF risk of developing carotid sinus
dysrhythmia pulmonary, cerebral massage and gag
causing pts to seek or peripheral emboli reflex
med attention
- Rate: 300-600 bpm
- P-wave is erratic ;
PR interval can’t be
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 measured
- Chaotic F-wave d/t
rapid atrial depo
and ventricular
aberrancy
- Rapid vent
response 
reduce vent filling
 dec coronary
arterial perfusion
 inc risk for MI
SINUS DYSRHYTHMIAS Definition and Pathology Significance Etiology Clinical Manifestations Intervention
Sinus Tachycardia - sinus node creates - acute blood loss - peripheral pulse - pts showing dec
an impulse faster - anemia greater than 100 cardiac ouput/
than N rate - shock bpm w/ reg rhythm hemodynamis
- rate: 100-160 bpm - hypovolemia - hypotension, instability : Tx is not
- rate above 160= - CHF syncope and required
Ectopic Focus - Extreme pain blurring of vision - Propanolol to regulate
- QRS are normal - Hypermetab states HR
- High fever - Tx on the cause of the
- Too strenuous Sinus Tachycardia
exercise
- Too much anxiety
Sinus Bradycardia - impulse at a slower - N in athletes; maintain stroke - pts w/ slower metab. Needs: - peripheral rate lower - Atropine Sulfate [IV
rate than normal volume w/ reduced effort sleep, hypothermia, than 60 bpm push to regulate HR]
below 60bpm hypothyroidism, vagal - hypotension, - Temporary
- w/ N P, QRST but stimulation activities [vomiting, syncope, blurring of pacemaker
lowered rate suctioning, severe pain, vision and
extreme emotion] palpitation
- MI pts inc vagal
tone  SB
- Anti-cholinesterase,
beta blockers,
digitalis and
morphine [knocks
out cardio respi
center at the brain
stem]
Sinus Arrhythmia - HR stays within normal limit - N in athletes, children and to - Inhibition of reflex of vagal - peripheral pulse rate inc - asymptomatic: no Tx needed
but there is irreg rhythm adults tone. The vagus nerve during inspiration and dec - Atropine Sulfate for HR=less
Difference b/t the shortest & alternately inc & dec during expiration; rhythm is 40bpm
longest P-P interval & R-R automaticity sec to respi irreg - Tx of underlying cause
interval is irreg - inferior wall infarct and dig - S/Sx of underlying cause
- P-P interval is shorter toxicity
during inspiration, longer
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 during expiration

VENTRICULAR
Definition and Pathology Significance Etiology Clinical Manifestations Intervention
DYSRHYTHMIAS
Premature Ventricular - ventricles are - cardiac glycosides - N PR but irreg - Tx of the underlying
Contraction (PVC) stimulated by - sympathomimetic rhythm cause
ectopic focus drugs [epinephrine] - Longer than normal - Lidocaine 50-100mg
outside on their - Electrolyte pause Iv bolus or 1-4mg/min
walls and outside imbalance - Dec cardiac output IV drip
the N pathways - Hypokalemia, [hypotension, - Atropine Sulfate
and travels at a hypocalcemia syncope, blurring of
slower - Exercise, ingestion vision]
- ventricles contract of caffeine
early giving an - Tobacco and alcohol
extra heart beat - Hypoxia, myocardial
- WIDE AND ischemia and
BIZARRE QRS myocardial irritation
COMPLEX
- 6 or more PVC=
pathologic
Torsades de Pointes - rate: 150-250 bpm; - congenital prolonged - same as Sinus tachycardia - DO NOT GIVE LIDOCAINE IV
wide QRs complex QT syndrome, BOLUS!!
- tracing will show myocardial ischemia, PROPANOLOL, PHENYTOIN,
twisted, SA node dses, mech pacemaker
UNDULATED profound
[]moves in a wavy bradycardia,
fashion but subarachnoid
preceeded w/ hemorrhage, AVB,
rhythm w/ electrolyte
prolonged QT imbalance and anti-
interval depressant overdose
- if left uncorrected
 V fib
- there is more than
1 ventricular
pacemaker
Ventricular Fibrillation - rapid disorganized - VENTRICLES - AMI - no audible heart - DEFIBRILLATION
quivering of the QUIVER RATHER - Cardiomyopathy sounds, no palpable - EPINEPHRINE &anti-
ventricles d/t rapid THAN CONTRACT - Dig & quinidine pulse, no response; arrhythmic like:
impulse formation  fail to pump blood toxicity THIS IS A MAJOR LIDOCAINE &
& irreg impulse & CO=0 - Irritation of ARRHYTHMIA PROCAINAMIDE [IV
transmission. - Leads to pacemaker electrode THAT MAY BE push]
- QUIVERING VENTRICULAR - Acidosis FATAL. - CPR & other life
MOTION & are ASYSTOLE OR - Electrolyte - THIS IS A support
unable to fill or STANDSTILL imbalance MEDICAL
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 expel blood with - During cardiac cath/ EMERGENCY;
any rhythmic TYPES OF V FIB cardiac surgery DEATH COULD
pattern. - Coarse Fib [more - Immediately OCCUR IN
electrical activity than following MINUTES
ECG INTERPRETATION Fine Fib] electrocution - Cardiopulmonary
- atrial rate & rhythm - Fine Fib [Fib waves arrest
can’t be determined become closer and [unresponsive; no
- ventricular rate & finer as acidosis & palpable
rhythm can’t be hypoxemia may pulse(carotid &
determined develop] femoral)]
- P wave is - If pt is responsive &
indiscernible; PR pulse is palpable:
interval is check for shivering.
indiscernible Shivering creates a
- QRS complex is muscle movement
indiscernible same as in V fib
- T wave is - Electrical
indiscernible interference
[electrical razor]
Ventricular Asystole/ Cardiac - electrical activity of - LIFE THREATENING. No - any condition that causes - unresponsive; no - CPT; other life
Standstill the ventricles stop. cardiac output or perfusion inadequate blood flow palpable pulse support measures
- ECG: ALMOST - pulmonary/ air embolism & - pt’s electrodes falls - For pt with temporary
FLAT LINE hemorrhage off or monitor is not demand pacemakers:
- There might be - ineffective cardiac turned on turn it on and check
atrial activity but contractility stemming from *evaluate pt before performing the electrodes as well
impulse is not heart failure, heart rupture emergency measures.
conducted in the [intraatrioventricular septum],
ventricles. MI or cardiac tamponade &
- P waves continue; insufficient conduction, AVB, &
QRS disappears cocaine overdose.
ECG INTERPRETATION
- atrial rate & rhythm
is indiscernible
- ventricular rate &
rhythm doesn’t
exist
- P wave is absent
- PR interval is not
measurable; QRS
complex is absent;
T wave is absent

Ventricular Tachycardia - 3 or more PVC - result from - peripheral pulses are not - check for responsiveness and
occurs in a row and myocardial irritability palpable anymore bec rate is LOC
the rate exceeds - cardiac conditions too fast d/t low perfusion - if pt is alert: LDOCAINE [IV
100/min can bring V tach: - S/Sx of dec cardiac output bolus]
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 - maybe paroxysmal AMI, CAD, RHD, and suddenly unresponsive - synchronized cardioversion
[lasting for a few mitral valve - - if pt has CV collapse/
beats] or sustained prolapse, heart unconscious: defibrillate;
[longer time] failure & precordial thump
- (-) association with cardiomyopathy
atrial and - pulmonary
ventricular rhythm embolism,
- MAJOR electrolyte
ARRHYTHMIA that imbalance & dig,
can lead to low BP quinidine and epi
and dec CO toxicity
- V FIB CAN
DEVELOP
ECG INTERPRETATION
- ECG series is wide,
slightly irreg QRS
complex
- P wave can’t be
determined or looks
absent; but is is
actually obscured
by QRS; QRS rapid
100-200/min & very
wide
- PR interval and Q
is not measurable
GOALS OF CMV CRITERIA FOR WEANING OFF CMV VAGAL STIMULATION ACTIVITIES
1. maintain adequate ventilation 1. when there is improvement, correction and stabilization 1. Synchronized Cardioversion
2. deliver precise concentration of F102 of the dse process 2. Valsalva Maneuver
3. deliver adequate tidal volume [vol inspired and 2. nutritional and flid status is sufficient to maintain 3. Gag reflex
expired in quiet breathing] to obtain an adequate metabolic demand of respiration 4. carotid sinus massage
minute ventilation and oxygenation 3. adequate physical strength and mental alertness
4. lessen the work of breathing in those client who afebrile – infection is controlled *synchronized cardioversion [25-30 joules]-synchronized – Vtach
cannot sustain adequate blood works w/in acceptable level – ABG Hgb etc. *Defibrillation [250-300 joules]- asynchronized - Vfib

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