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Atrial Rhythms

EKGs

TermDefinition
Premature Atrial Complex -occurs when an irritable site within the atria discharges before the next SA node impulse is due to discharge -may initiate episodes of atrial fibrillation and atrial flutter
How does the P wave of a PAC look? -biphasic -flattened -notched -pointed -Lost in preceeding T wave
Distinguishing factors of a PAC -P wave positive but differs in shape from sinus P waves -Regular Rhythm with premature beats
PAC Causes -atrial enlargement -Congestive Heart Failure -Valvular Heart Disease -electrolyte imbalance
How to Fix a PAC -occasionally require treatment -corrected by the underlying cause
Multiformed Atrial Rhythm -wandering atrial pacemaker -size, shape, and direction of P waves vary -can be tachycardic or bradycardic
Distinguishing Factors of a Multiformed Atrial Rhythm -Irregular Rhythm as the pacemaker site shifts from SA node to AV junction -P wave size, shape, and direction vary -Variable PR Interval
Causes of Multiformed Atrial Rhythm -normal, healthy, hearts (athletes) -sleep -organic heart disease -digitalis toxicity
Multiformed Atrial Rhythm Fixes -no signs and symptoms unless associated with a slow rate -if because of digitalis toxicity, drugs should be withheld
Multiformed Atrial Tachycardia -when wandering atrial pacemaker has a ventricular rate over 100 bpm
Multiformed Atrial Tachycardia Causes -severe COPD -Hypoxia -Acute Coronary Syndrome -Electrolyte Imbalance
How to fix Multiformed Atrial Tachycardia -treatment is directed at underlying cause -if patient is symptomatic and you are uncertain of MAT rhythm, use vagal maneuvers and adenosine -if rhythm is MAT and the patient is symptomatic, consult a cardiologist
Supraventricular Tachycardia (SVT) -something above the ventricles are causing them to beat fast -HR is increased at rest
Distinguishing Factors of SVT -rate of 100-250 -regular rhythm -P wave is missing or buried within T waves -P-R interval: shortened or not there
AVNRT -SVT -extra pathway where signal can come back through the AV Node
AVRT -SVT -extra pathway where the signal goes around in a circle causing fast HR at rest
How to fix a SVT -Carotid Sinus Massage
Contraindications of a Carotid Sinus Massage -elderly patients -patients with artery bruits -patients with a risk of stroke -patients with transient ischemic attacks or stroke within the past 3 months
Atrial Tachycardia -series of rapid beats from an atrial ectopic focus -rapid atrial rate overrides the SA node and becomes the pacemaker -3 or more PACs in a row -rate of more than 100 bpm
Distinguishing factors of Atrial Tachycardia -rate: 100-250 bpm -Rhythm: regular -P waves: differ in shape from sinus P waves; if rhythym originates from the low portion of the atrium, P waves will be negative in Lead II; difficult ito distinguish P from T in rapid rates: PR Interval varies
Causes of Atrial Tachycardia -stimulant use -electrolyte imbalance -drugs -infection -myocardial infarction
How to Fix Atrial Tachycardia -if symptomatic due to rapid rate -vagal maneuvers -adenosine drug of choice -calcium channel blockers -beta-blockers -amiodarone
Signs and Symptoms of Atrial Tachycardia -asymptomatic -palpitations -fluttering sensations -chest pressure -dyspnea -fatigue -dizziness or lightheadedness -syncope or near-syncope
Atrial Flutter -irritable site fires regularly at an extremely rapid rate -paroxysmal rhythm precipitated by a premature atrial complex -may last for seconds to hours -occasionally may last for 24 hours or more
Distinguishing Factors of Atrial Flutter -Rate: 250-450 -Rhythm: Regular in Atria, Regular or Irregular in Ventricles -No identifiable P waves -Saw-toothed
How to Fix Atrial Flutter -cardiologist consult -if rapid ventricular rate, control ventricular response -if rapid ventricular rate and serious signs and symptoms, synchronized cardioversion
Atrial Fibrillation -occurs because of an altered automaticity in one or several rapidly firing sites in the atria -or reentry involving one or mroe circuits in the atria
Distinguishing Factos of Atrial Fibrillation -Rate: A= 400-600 V= Variable --Controlled: <100 Uncontrolled: >100 -Rhythm: Irregular -P waves: none identifiable/erratic/wavy baseline -PR Interval: Not measureable -QRS Duration: 0.11s or less
Causes of Atrial Fibrillation -occurs in pts with or without detectable heart disease -blood may ppool in the atria and formm clots -can result in a stroke
How to Fix Atrial Fibrillation -cardiologist consult -ir rapid ventricular rate: control ventricular response -if rapid ventricular rate and serious signs and symptoms: synchronized cardioversion -anticoagulation if present for 48 hours or longer
Wolff-Parkinson-White (WPW) Syndrome -short PR Interval -Delta Wave -Widening of the QRS
Signs and Symptoms of WPW -palpitations -lightheadness -Shortness of breath -Anxiety -Weakness -Dizziness -Chest Discomfort
Distinguishing Factors of WPW -Rate: 60-100 bpm -Rhythm: Regular -P waves: normal -PR interval: less than 0.12s -QRS Duration: greater than 0.12s, delta wave (slurred upstroke)
Causes of WPW -one of the most common causes of tachydysrhythmias in infants and children -the pathway is likely congential in origin -symptoms do not appear until young adulthood
How to Treat WPW -depends on how unstable the patient is -consult with cardiologist
Created by: Mdarrielle09