Basic Dysrhythmia — I Hate CBT's

normal sinus rhythm

Answer: heart rhythm originating in the sinoatrial node with a rate in patients at rest of 60 to 100 beats per minute

Sinus Arrhythmia

Answer: Appearance is ALMOST NORMAL:

Respiratory – Circulatory interaction

Rate INCREASES with INSPIRATION (IN=IN)

Sinus Bradycardia

Answer: <60

normal sinus rhythm

Sinus Tachycardia

Answer: >100 (100-150)

normal sinus rhythm

Premature Atrial Contraction (PAC)

Answer: Heart Rate: Depends on underlying rhythm

Regularity: Interrupts the regularity of underlying rhythm

P-Wave: can be flattened, notched, or unusual. May be hidden within the T wave

PRI: measures between .12-.20 seconds and can be prolonged; can be different from other complexes

QRS: <.12 seconds

Sinus Arrest/Pause

Answer: – SA node doesn’t fire

– notice absence of P-wave for a complete cycle (a missed cycle)

length of pause ≠ multiple of normal rate (block)

Atrial Fibrillation (A-Fib)

Answer: an irregular and often very fast heart rate originating from abnormal conduction in the atria

Atrial Flutter

Answer: irregular beating of the atria; often described as “a-flutter with 2 to 1 block or 3 to 1 block”

Junctional Rhythm

Answer: 40-60 Regular!

-impulse from AV node w/ retro/antegrade transmission

– P wave often inverted/buried/follow QRS

– slow rate

– narrow QRS (not wide like ventricular)

Junctional Tachycardia

Answer: >60 bpm (ms. K; 150-250)

– KEY: will be regular (consistent)

– AV junction produces a rapid sequence of QRS-T cycles

– p-wave often inverted/buried/follow QRS

Premature Junctional Contraction

Answer: Inverted p wave or hidden p wave

PRI<0.12 or none

Normal QRS

Supraventricular Tachycardia (SVT)

Answer: an abnormal heart rhythm arising from aberrant electrical activity in the heart; originates at or above the AV node

First degree heart block

Answer: atrioventricular (AV) block in which the atrial electrical impulses are delayed by a fraction of a second before being conducted to the ventricles

2nd degree heart block type 1 (Wenkebach)

Answer: Progressively longer PR interval until the P wave is not followed by a QPR

2nd Degree Heart Block (Mobitz II)

Answer: Rare, but more serious

Sudden appearance of a nonconducted P-wave

P-waves are nl, but some aren’t followed by a QRS complex

PR & RR intervals are constant

3rd degree heart block

Answer: no obvious correlation between p and qrs, need pace maker

premature ventricular contraction (PVC)

Answer: a ventricular contraction preceding the normal impulse initiated by the SA node (pacemaker)

Bigeminy PVC

Answer: every other beat is a PVC

PVC couplets

Answer: PVC occurring in pairs, no adequate C.O. when this occurs

monomorphic ventricular tachycardia

Answer: presents with wide QRS complexes of a common shape.

Torsades de pointes

Answer: Rate: 120 – 200 usually

P wave: Obscured by ventricular waves

QRS: Wide QRS – “Twisting of the Points”

Conduction: Ventricular only

Rhythm: Slightly irregular

Ventricular fibrillation (V-fib)

Answer: abnormal heart rhythm which results in quivering of ventricles

Idioventricular Rhythm

Answer: <40

*looks like vtach but slow*

– no P waves (from vent foci)

– Wide QRS

(serious, death like rhythm)

– called “dying heart” rhythm…occasional ventric beat b4 death (asystole)

Accelerated Idioventricular Rhythm

Answer: Rate: 50 – 100 usually (usually slow)

P wave: Obscured by ventricular waves (occur during ventricular contraction) – SA node slower than faster ventricular pacing than should be

QRS: Wide QRS

Conduction: Ventricular only

Rhythm: Regular- benign rhythm that is sometimes seen during acute MI or early after reperfusion. – Rarely sustained, does not progress to vfib, rarely requires treatment

Asystole

Answer: absence of contractions of the heart

Atrial paced rhythm

Answer: spike before P wave

Ventricular paced rhythm

Answer: ventricular contractions which occur in cases of complete heart block.

Normal sinus rhythm

Answer: Regular

Rate: 60-100

P Wave: Present, upright

PR Interval: 0.12-0.20 sec

QRS: <0.12 sec

Sinus Bradycardia

Answer: Regular

Rate: <60

P Wave: Present, upright

PR Interval: 0.12-0.20 sec

QRS: <0.12 sec

Sinus Tachycardia

Answer: Regular

Rate: 100-150

P Wave: Present, upright

PR Interval: 0.12-0.20 sec

QRS: <0.12 sec

Premature Atrial Contraction

Answer: IRREGULAR

Rate: depends on underlying rhythm

P wave: Present or hidden in T wave

PR Interval: 0.12-0.20 sec

QRS: <0.12 sec

Atrial Fibrillation

Answer: IRREGULAR

Atrial rate: UNMEASURABLE

Ventricular rate: variable

P wave: unable to see

PR Interval: N/A

QRS: <0.12 sec

A fib RVR

Answer: IRREGULAR

Ventricular rate: 100-175

P wave: unable to see

PR Interval: N/A

QRS <0.12 sec

Atrial Flutter

Answer: Usually REGULAR can be irregular

Atrial rate: 250-350

Ventricular rate: variable BUT < atrial rate

P Wave: Flutter

PR Interval: N/A

QRS: <0.12 sec

Supraventricular Tachycardia

Answer: Regular

Rate: 150-350

P wave: Hidden in QRS or T wave

PR: unable to determine

QRS: <0.12 sec

Junctional Rhythm

Answer: Regular

Rate: 40-60

P Wave: ABSENT or INVERTED

PR Interval: None or <0.12

QRS: <0.12 sec

Accelerated Junctional Rhythm

Answer: Regular

Rate: 60-100

P Wave: NONE or INVERTED

PR Interval: None or <0.12

QRS: <0.12 sec

Junctional Tachycardia

Answer: Regular

Rate: >100

P Wave: NONE or INVERTED

PR Interval: None or <0.12

QRS: <0.12 sec

Premature Ventricular Contraction

Answer: IRREGULAR

Rate: refer to underlying rhythm

P Wave: NONE

PR Interval: N/A

QRS: WIDE and BIZARRE , >0.12 sec

Ventricular Tachycardia

Answer: Regular

Rate: >100

P Wave: NONE

PR Interval: N/A

QRS: WIDE and BIZARRE, >0.12 sec

Ventricular Fibrillation

Answer: Chaotic

Coarse: big waves

Fine: small waves

Rate: unmeasurable

P Wave: NONE

PR Interval: N/A

QRS: N/A

Idioventricular

Answer: Regular

Rate: 20-50

P wave: NONE

PR Interval: N/A

QRS: WIDE, >0.12 sec

Accelerated Idoventricular Rhythm

Answer: Regular

Rate: 50-100

P wave: NONE

PR Interval: N/A

QRS: WIDE, >0.12 sec

1st Degree AV Block

Answer: Regular

Rate: 60-100

P Wave: Present, upright

PR interval: >0.20 sec CONSISTENTLY LONG

QRS: <0.12 secHusband stays late till 9 consistently

2nd Degree AV Block Type I Mobitz, Wenckebach

Answer: IRREGULAR

Rate: 60-100

P wave: Present, upright

PR Interval: Progressively longer until drop (PR interval longer and longer until drop)

QRS: <0.12 secHusband stays late till 9, then 11, then 1, then doesn’t come home at all

2nd Degree AV Block Type II

Answer: Irregular or regular

Rate: <60

P wave: Present, upright

PR Interval: PR interval consistently LONGER like type 1 but then a QRS will drop

QRS: <0.12 secHusband stays late till 9 consistently, then wife goes out and doesn’t come home

3rd Degree AV Block

Answer: Atrials and ventricles don’t communicate

Rate: regular atrial

P wave: Present, upright

No relationship between P waves and QRS

PR Interval: VARIABLE

QRS: variableP-P ad R-R consistent but NO correlationHusband and wife live separate lives and don’t communicate

Unifocal PVCs

Answer: Only 1 shape PVC

Bigeminy

PVC occurs every OTHER beat

Trigeminy

PVC occurs every THIRD beat

Couplet

2 PVCs together

Triplet

3 PVCs together

Multifocal

Multiple shapes

Monomorphic V Tach

Answer: Same Shapes V Tach

Polymorphic V Tach

Answer: Different Shapes V tach

Coarse V Fib

Answer: Chopy but not as high as polymorphic V tach

Fine V Fib

Answer: Fine and fibrillatory

Failure to Capture

Answer: Spikes with no QRS

Failure to Sense

Answer: Spikes happen regardless of QRS on their own

How to determine the rhythm

Answer: Regular or irregular?

Rate?

P before every QRS? QRS for every P?

QRS wide or narrow?

QT Interval

Answer:0.34-0.43

P Wave

Answer:0.06-0.12 sec

PR Interval

Answer:0.12-0.20 sec

SA Node Firing Rhythms

Answer: *Fires normally @ 60-100*

-SR 60-100

-SB <60

-ST 100-150

-SVT 150-350

AV Node Firing, SA Node Failed Rhythms

Answer:*Fires normally @ 40-60*

-Junctional rhythm 40-60

-Accelerated junctional rhythm 60-100

-Junctional tachycardia 100-150

Only Purkinje Fibers Firing Rhythms (Everything else has failed)

Answer:*Fires normally @ 20-50*

-Idioventricular 20-50

-Accelerated idioventricular 50-100