Atrial rhythms can have..
positive or negative QRS complexes depending on the lead being monitored
Wandering Atrial Pacemaker (WAP) (HR)
60-100 bpm
Wandering Atrial Pacemaker (WAP) (Regularity)
Irregular
Wandering Atrial Pacemaker (WAP) (P waves)
At least three different shapes
Wandering Atrial Pacemaker (WAP) (Intervals)
PR varies--QRS <0.12 seconds
Wandering Atrial Pacemaker (WAP) (Causes)
Medication side effects, MI, vagal stimulation
Wandering Atrial Pacemaker (WAP) (Adverse effects)
usually none
Wandering Atrial Pacemaker (WAP) (Treatment)
usually none needed
Multifocal Atrial Tachycardia (MAT) (Rate)
> 100 bpm
Multifocal Atrial Tachycardia (MAT) (Regularity)
Irregular
Multifocal Atrial Tachycardia (MAT) (Pwaves)
At least three different shapes
Multifocal Atrial Tachycardia (MAT) (Intervals)
PR varies--QRS <0.12 seconds
Multifocal Atrial Tachycardia (MAT) (Causes)
typically COPD
Multifocal Atrial Tachycardia (MAT) (Adverse effects)
signs of decreased cardiac output if the heart rate too fast
Multifocal Atrial Tachycardia (MAT) (treatment)
beta blockers, calcium channel blockers
Premature Atrial complexes (PAC)
Electrical impulses originate in the atria and initiate an early impulse, disrupting the regular rhythm.
Premature Atrial complexes (PAC) (HR)
Can occur at any rate
Premature Atrial complexes (PAC) (regularity)
Causes the rythm to be regular but interrupted by a premature beat
Premature Atrial complexes (PAC) (P waves)
different shape than sinus p waves--PT may be hidden inside T waves
Premature Atrial complexes (PAC) (intervals)
PR: 0.12-2.0 seconds (sometimes not measureable); QRS: premature <0.12 seconds
Premature Atrial complexes (PAC) (causes)
Stimulants, medications, hypoxia, hear disease
Premature Atrial complexes (PAC) (adverse effects)
Ususlaly none
Premature Atrial complexes (PAC) (treatment)
oxygen , calcium channell blockers, beta blockers, omit stimulants, treat CHF if present
paroxysmal atrial tachycardia (PAT)
sudden burst of three or more PAC's in a row that usurps the underlying rhythm and then becomes its own rhythm for a period of time
paroxysmal atrial tachycardia (PAT) (HR)
160-250 Rhythm it interrupts will have a different HR
paroxysmal atrial tachycardia (PAT) (Regularity)
The atrial tach itself is regular, but it will cause the whole strip to look regular but interrupted because it interrupts another rhythm
paroxysmal atrial tachycardia (PAT) (P waves)
different from sinus Ps; uniform shape
paroxysmal atrial tachycardia (PAT) (Intervals)
PR: 0.12-0.20 seconds--QRS: <0.12 seconds
paroxysmal atrial tachycardia (PAT) (Causes )
Same as PACS (Stimulants, medications, hypoxia, hear disease)
paroxysmal atrial tachycardia (PAT) (Adverse effects )
Decreased HR
paroxysmal atrial tachycardia (PAT) (Treatment )
Digitalis, calcium channel blockers, beta blockers, adenosine, oxygen, electrical cardioversion
Atrial Flutter
one irritable atrial focus fires out regular impulses at a rate so rapid that a fluttery pattern is produced instead of P waves
Atrial Flutter (HR)
Atrial rate: 250-350; Ventricle rate varies depending on conduction ratio
Atrial Flutter (Regularity)
Regular, irregular or regular but interrupted--depends on conduction ratio
Atrial Flutter (P waves)
No P waves. Flutter waves are present (zigzag waves of uniform shape)
Atrial Flutter (Intervals)
No PR interval because no P waves; QRS <0.12 seconds
Atrial Flutter (Causes)
Heart disease, pulmonary embolus, lung disease, heart valve disease
Atrial Flutter (Adverse effects)
Decreased cardiac output if heart rate too fast or slow
Atrial Flutter (Treatment)
Oxygen, calcium channel blockers, beta blockers, adenosine, digitalis
Atrial Fibrillation (A-Fib)
hundreds of atrial impulses from different locations all fire at the same time.
Atrial Fibrillation (A-Fib) (HR)
Atrial rate:350-700 bpm; ventricle rate varies
Atrial Fibrillation (A-Fib) (Regularity)
Irregularly irregular
Atrial Fibrillation (A-Fib) (P waves)
No P waves. Fibrillatory waves present (undulating baseline)
Atrial Fibrillation (A-Fib) (Intervals)
No PR interval because no P waves; QRS <0.12 seconds
Atrial Fibrillation (A-Fib) (Causes)
MI, lung disease, heart valve disease, hyperthyroidism
Atrial Fibrillation (A-Fib) (Adverse effects )
Decrease cardiac output, blood clots that can cause strokes, pulmonary emboli, or MI
Atrial Fibrillation (A-Fib) (Treatment)
If duration <48 hours--digitalis, calcium channel blockers beta blockers, amiodarone, or electrical cardio version
If duration >48 hours--anticoagulants for 2-3 weeks; then cardioversion.
In emergencies --start on heparin do a TEE to check for blood clots
Supraventricular Tachycardia (SVT)
catchall term given to tachycardias that are supraventricular.
AKA they originate above the ventricles.
Supraventricular Tachycardia (SVT) (HR)
130 or higher
Supraventricular Tachycardia (SVT) (Regularity)
Regular
Supraventricular Tachycardia (SVT) (P waves )
none seen
Supraventricular Tachycardia (SVT) (intervals)
no PR interval because can't see P waves; QRS <0.12 second
Supraventricular Tachycardia (SVT) (causes)
Same as PAT (Stimulants, medications, hypoxia, hear disease)
Supraventricular Tachycardia (SVT) (Adverse effects)
Decreased cardiac output
Supraventricular Tachycardia (SVT) (Treatment)
Adensoine, digitalis, ibutilide, calcium channel blockers, bet blockers, oxygen electrical cardioversion
Junctional rhythms
Arise from tissue located between the right atrium and right ventricle, an area known as the AV junction
In junction rhythm then impulse travels antegrade toward the ventricles and retrograde toward the atria
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P waves in junctioncal rhythms can be inverted preceding the QRS, inverted following the QRS or hidden inside the QRS (invisible).
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The QRS in junctional rhythms will be positive or negative depending on the lead being monitored
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Premature Junctional Complexes (PJCs)
Premature beats that originate in the AV junction before the next sinus beat is due
Premature Junctional Complexes (PJCs) (HR)
Can occur at any HR
Premature Junctional Complexes (PJCs) (Regularity)
Regular but interrupted by premature beat
Premature Junctional Complexes (PJCs) (P waves)
Inverted preceding or following the QRS ,or hidden inside the QRS
Premature Junctional Complexes (PJCs) (intervals)
PR: <0.12 seconds if P wave precedes QRS; QRS <0.12 seconds
Premature Junctional Complexes (PJCs) (Causes)
Stimulants such as caffeine or drugs, nicotine, hypoxia, heart disease
Premature Junctional Complexes (PJCs) (Adverse effects)
Usually none
Premature Junctional Complexes (PJCs) (Treatment)
None except treat the cause
junctional brachycardia
a junctional rhythm with a heart rate slower than usual
junctional brachycardia (HR)
<40
junctional brachycardia (regularity)
regular
junctional brachycardia (p waves)
inverted preceding or following the QRS, or hidden inside QRS
junctional brachycardia (Intervals)
PR: <0.12 seconds if P was precedes QRS; QRS <0.12 seconds
junctional brachycardia (causes)
vagal stimulation, hypoixa, sinus node ischemia, heart disease
junctional brachycardia (adverse affects)
decreased cardiac output
junctional brachycardia (treatment)
Atropine, pacemaker, epinephrine or dopamine infusions, oxygen, stop any heart rate--slowing medications
Junctional Rhythm
the SA node is nonfunctional, P waves are absent, Occurs because of escape or usurpaiton
Junctional Rhythm (HR)
40-60
Junctional Rhythm (regularity)
regular
Junctional Rhythm (p waves)
inverted preceding or following the QRS, or hidden inside the QRS
Junctional Rhythm ( intervals)
PR: <0.12 seconds if P wave precedes QRS; PRS <0.12 seconds
Junctional Rhythm (causes)
vagal stimulation, hypoxia, sinus node ischemia, heart disease
Junctional Rhythm (adverse effects)
usually none if hear rate closer to 50-60; decreased cardiac output possible at slower rates
Junctional Rhythm (Treatment)
Atropine, pacemaker, epinephrine or dopamine infusion, oxygen, stop heart rate --slowing medications
Accelerated Junctional Rhythm
Can occur because of escape or usurpation
Accelerated Junctional Rhythm (HR)
60-100
Accelerated Junctional Rhythm (regularity)
Regular
Accelerated Junctional Rhythm (P waves)
Usually inverted and may precede, follow or fall within the QRS complex. May not be visible at all.
Accelerated Junctional Rhythm (Intervals)
PR: <0.12 seconds if P wave precedes QRS; QRS <0.12 seconds
Accelerated Junctional Rhythm (causes)
heart disease, stimulant drugs, caffeine
Accelerated Junctional Rhythm (adverse)
usually none
Accelerated Junctional Rhythm (treatment)
None except to treat the cause
Junctional Tachycardia
A rhythm that begins in the AV bundle with a ventricular rate of more than 100 beats/min.
Junctional Tachycardia (HR)
>100
Junctional Tachycardia (Regularity)
regular
Junctional Tachycardia (P waves)
Inverted preceding or following the QRS, or hidden inside QRS
Junctional Tachycardia (Interval)
PR: <0.12 seconds if P wave precedes QRS; QRS <0.12 seconds
Junctional Tachycardia (causes)
digitalis toxicity is main cause; heart disease, stimulants
Junctional Tachycardia (adverse effects)
Decreased cardiac output if heart rate too fast
Junctional Tachycardia (treatment)
stop digitalis; start beta blockers, calcium channel blockers or adenosine consider cardioversion
MAP and WAP
are the same except the heart rate