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MED SURG II EXAM #1
Rhythm Strip Analysis & Dysrhythmias
| Question | Answer |
|---|---|
| A normal heart rhythm contains | a P wave, QRS complex, and T Wave. |
| Amplitude | Measures the voltage of the beat and is determined by how high the waves reach going vertically |
| Deflection | Determined by which lead on the patient it is coming from |
| Duration | Determined by how long it is as measured by squares going horizontal |
| PR Interval | Indicates atriventricular conduction time. The time needed for sinus node depolarization, and conduction through the AV node before ventricular depolarization. Usually is 0.12-0.20 seconds |
| QRS Complex | Indicates ventricular depolarization. Usually is less than 0.12 seconds |
| QT Interval | Indicates ventricular activity. The total time for both depolarization and repolarization. Usually 0.32-0.40 seconds in a patients whos HR is between 65-96 bpm |
| ST Segment | Traces the early part of ventricular repolarization. Normally it is isoelectric, so it is analyzed to identify whether it is above or below the isoelectric line, which may be a sign of cardiac ischemia |
| PP Interval | Used to determine atrial rate and rhythm |
| RR Interval | Used to determine ventricular rate and rhythm |
| Atrial rhythms originate in | The SA Node |
| Normal Heart Rate | 60-100 bpm |
| Tachycardia | Greater than 100 bpm |
| Bradycardia | Less than 60 bpm |
| External Pacing | Temporary means of pacing a patient's heart. This can occur through transcutaneous pacing or external wires coming from the atrium or ventricle |
| P Wave | Represents the electrical impulse that starts in the SA node and spreads through the atria (Atrial repolarization). Normally is 2.5 mm or less in height, and 0.11 seconds in duration |
| T Wave | Represents ventricular repolarization, when the cells regain a negative charge, also called the resting state. Usually in the same direction as the QRS, and follows the QRS. |
| U Wave | Thought to represent repolarization of the Purkinje Fibers. This wave is rare but it sometimes appears in patients with hypokalemia, hypertension, or heart disease. It usuall follows the T wave, and can often be mistaken for a P wave |
| A normal sinus rhythm | Contains a rate between 60-100 bpm with a regular rhythm. The QRS is usually normal in shape and duration, P wave is normal and consistent, and always in front of QRS. The PR interval is consistent and between 0.12 and 0.20 seconds, with a PQRS Ratio of 1 to 1 |
| Dysrhythmias | Disorders of the formation, conduction, or both, of the electrical impulse within the heart. These disorders can cause disturvances of the heart rate, rhythm, or both |
| Sinus Bradycardia | Occurs when the SA node creates an impulse at a slow than normal rate. Often caused by lower metabolic needs such as sleep, athletic training, and hypothyroidism, vagal stimulation such as vomiting, suctioning, severe pain, medications such as calcium channel blockers, or beta blockers, idopathic sinus node dysfunction, ICP, and CAD. |
| Sinus Bradycardia Treatment | May give atropine IV repeated every 3-5 minutes until max dose of 3 mg is given. Rarely, it is unresponsible, but if it is, emergency transcutaneous pacing can be instituted, or medications such as dopamine or epinephrine is given. |
| Sinus Tachycardia | Occurs when the sinus node creates an impulse at a faster than normal rate. Can be caused by physiological or psychological stress such as acute blood loss, anemia, shock, hypervolemia or hypovolemia, heart failure, pain, fever, medications, nicotine, caffeine, drugs, enhanced automaticity of the SA node, and excessive sympathetic tone with reduced parasympathetic tone that is out of proportion to physiological demands Autonomic dysfunction. |
| Sinus Tachycardia Treatment | Vagal manuevers, such as carotid sinus massage, gagging, bearing down in bowel movements, forceful coughing. Administration of adenosine followed by synchronized cardioversion. Beta-blockers, and calcium channel blockers may also be used if the other treatments fail. |
| Inappropriate Sinus Tachycardia | Enhanced automaticity of the SA node or excessive sympathetic tone with reduced parasympathetic tone that is out of proporation to physiologic demands. Catheter ablaion of the SA node may be used in cases of persistent and unresponsive to other treatments |
| Postural Orthostatic Tachycardia Syndrome | Characterized as tachycardia without hypotension, and by presyncope, palpitations, lightheadedness, weakness, blurred vision, which can occur suddenly with postrual changes. |
| Premature Atrial Complex | Occurs when the electrical impulse starts in the atrium before the next normal impulse of the sinus node. Often caused by nicotine, alcohol, hypervolemia, anxiety, hypokalemia, pregnancy, or atrial ischemia, injury, or infarction. They are often seen in tachycardia and patients may report palpitations. They are ectopic beats that originate in the atria and are not rhythms, often have an abnormal looking P wave |
| Premature Atrial Complex Treatment | If they are infrequent, no treatment is necessary. If there are more than 6 per minute, this is a sign of a worsening condition, and may need antidysrhythmics such as procainamide, and quinidine, carotid sinus massage, and reducing caffeine and fixing hypokalemia |
| Premature Atrial Complex Characteristics | The rate depends on the underlying rhythm. The rhythm is irregular due to early P waves. The QRS that follows the P wave is usually normal, but may be abnormal or even blocked. The PR interval is shorter than normal but still between 0.12-0.20 seconds. The ratio remains between 1 and 1 |
| Atrial Fibrillation | The most common sustained dysrhythm. It causes an electrophysiologic change in the atrial myocardium, and fibrosis. Often caused by atherosclerosis, heart failure, congenital heart disease, COPD, hypothyroidism, and thyrotoxicosis. Some may be asymptomatic but the clinical manifestations include palpitations, dyspnea, and pulmonary edema. |
| Atrial Fibrillation Characteristics | Atrial rate is 300 to 600 bpm, and ventricular rate is usually 120 to 200 bpm. The rhythm is highly irregular. QRS is usually normal. There are no discernible P waves, often show as F waves, or snakes in the grass. The PR interval cannot be measured, and the PQRS ratio is many to one |
| Atrial Flutter | When the atrial ectopic pacer fires at a rate of 250 to 400 bpm, and occurs in a variety of dieases such as rhuematic, coronary, hypertensiove, cardiomyopathy, hypoxia and heart failure. Usually caused by heart failure, tricuspid valve or mitral valve disease, PE, corpulmonale, inferior wall MI, carditis, or digoxin toxicity. |
| Atrial Flutter Characteristics | Atrial rate between 250 and 400 bpm, ventricular rate between 75 and 150 bpm. The rhythm usually regular but can turn irregular in the ventricular valves, the QRS is usually normal but can be abnormal or absent. P wave shows a saw toothed appearance. PQRS rate is 2 to 1, three to 1, or four to one |
| Atrial Fibrillation Treatment | The goal is the administration of prescribed treatment to decrease ventricular response, decreasing atrial irritability, and eliminating the cause |
| Atrial Flutter Treatment | If the patient is unstable with a ventricular rate of greater than 150 bpm, prepare for immediate cardioversion. if they are stable treatment may include calcium channel blockers, beta blockers, or antidysrhythmics. Anticoagulation may be necessary as there would be pooling of blood in the atria |
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