Normal Sinus Rhythm
60-100 bpm
all complexes normal and evenly spaced (P, QRS, T)
Sinus Arrest
- SA node doesn't fire
- notice absence of P-wave for a complete cycle (a missed cycle)
Sinus arrhythmia
all complexes normal but rhythmically irreg
- normal finding (esp in young pts) that has to do with breathing (rate: inhale-increase, exhale-decrease)
Sinus Bradycardia
<60
normal sinus rhythm
Sinus Tachycardia
>100 (100-150)
normal sinus rhythm
P wave vs T wave
P generally smaller than T
Atrial Fibrillation
A: 350-450 (atria quivering)
- irreg-irreg rhythm (R-RI=irreg)
*
unsure/no P-wave (non-distinguishable)
*
- irreg rhythm BUT reg QRS!
Danger: increase the risk of thromboemoblic events don't convert unless occurring less than 48 hrs, if don't know pt need
Atrial Flutter
A: 250-350
- "saw tooth" p-waves
- a continuous rapid sequence of atrial complexes from a single rapid-firing atrial focus
(hint: if see 2 P waves and QRS think A Flutter)
Premature junctional contractions (PJC)
- premature slightly widened QRS
- +/- inverted P', before or after QRS, sometimes disappears w/in QRS
Premature atrial contractions (PAC's)
- originates suddenly in irritable atrial foci
- P' is earlier than expected and diff shape than P (often have a pause following PAC)
- can occur in Bigeminy, Trigeminy, Quadgeminy pattern
Supraventricular Tachycardia (SVT)
aka
Paroxysmal atrial tachycardia (PAT)
150-250 "sudden rapid heart rate"
- an irritable atrial focus discharging
- very fast and EVEN!
- +/- inverted P waves
- P often overlaps prior T wave
Asystole
- dead
- no electrical activity, only straight line (no rate/pulse)
A dire form of cardiac arrest in which the heart stops beating -- there is no systole -- and there is no electrical activity in the heart. The heart is at a total standstill.
Premature ventricular contractions (PVC's)
Wide QRS
- may be unifocal or multifocal
- will have compensatory pause
- irreg rythm PVCs may be bigeminy, trigeminy, or quadrigeminy
- "run of" PVCS
- 3+ PVCs = Vtach!
Ventricular tachycardia
150-250 (>120 from onysko)
- ventricle irritated and moving fast
- rapid, bizarre, wide QRS complexes
- 1 large QRS after another!
(in vtach pt may not have pulse)
Ventricular Flutter
250-350
- smooth sine-waves w/ similar amp
- can lead to deadly arryth
goes right into vfib
Ventricular Fibrillation
350-450
- "chaotic"
- mult vent foci rapidly discharging -> erratic vent rhythm
- no identifiable waves
- RESPOND IMMEDIATELY!
- no pulse or perfusion, pt=dead
Myocardial Infarction (MI)
Ischemia: inverted Twave
Injury: ST seg elevation
Necrosis: Q wave present
- area of infarct doesn't conduct electrical activity
- infarction=cell death
(A MI (heart attack is) when blood vessels that supply blood to the heart are blocked, preventing enou
Ischemia
- T wave inversion
- Ischemia is caused by a decrease in oxygen to the myocardial tissue (hypoxia/diminished blood supply)
- can still save heart cells/reverse
Injury
ST segment elevation (a sign of acute injury going on presently) (look for sad face)
- Injury indicates the acuteness of an infarct (acute or recent)
- can still save heart cells/reverse
Necrosis
significant Q waves
(?than 1 square wide or ?1/3 amplitude)
- indicated by Q-waves which make the dx
- Infarction is completed, now dead tissue
(canNOT be reversed, permanent damage)