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19 Cards in this Set

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Sinus bradycardia
Rate: <60 bpm
Rhythm: Regular
Pacemaker site: SA node
P wave: Normal morphology
PR interval:
Normal (0.12-0.20 sec)
QRS complex:
Normal (0.04-0.12 sec)
Slowing of the SA node resultant of
Increased parasympathetic NS
Intrinsic disease
Drugs
Digitalis
Propranolol
Quinidine
Sinus tachycardia
Rate: >100 bpm
Rhythm: Regular
Pacemaker site: SA node
P wave: Normal morphology
PR interval: Normal (0.12-0.20 sec)
QRS complex:
Normal (0.04-0.12 sec)
At greater than 140 bpm decreases the effectiveness of stroke volume and can contribute to ischemia or infarction
Prolonged sinus tachycardia can be a sign of infarction
Treat the cause
Sinus dysrhythmia
Rate: 60-100 bpm
Rhythm: Irregular
Pacemaker site: SA node
P wave: Normal morphology
PR interval : Normal (0.12-0.20 sec)
QRS complex:
Normal (0.04-0.12 sec)
Often resultant of a variation of the RR interval pathologically resultant of the following:
Respiration
Changes in intrathoratic pressure
Enhanced vagal tone
Sinus Arrest
Rate: Normal or slow
Rhythm: Irregular
Pacemaker site: SA node
P wave: Normal morphology
PR interval: Normal (0.12-0.20 sec)
QRS complex:
Normal (0.04-0.12 sec)
Occurs when the SA node fails to discharge causing a short period of cardiac standstill and is resultant of the following:
Ischemia of the SA node
Digitalis toxicity
Excessive vagal tone
Degenerative fibrotic disease
Wandering Atrial Pacemaker
Rate: Normal
Rhythm: Slightly Irregular
Pacemaker site: Variable by definition
P wave: Varied morphology and presence
PR interval : <0.12 or >0.20 sec
QRS complex:
Normal (0.04-0.12 sec)
Passive transfer of pacing from the SA node to a different location resultant of
Sinus dysrhythmias
Ischemia
Atrial dilation
Multifocal Atrial Tachycardia (MAT)
Rate: >100
Rhythm: Irregular
Pacemaker site: Atrial ectopic sites
P wave: Organized, discrete, nonsinus, exhibiting at least 3 distinct forms
PR interval: Variable
QRS complex: <0.12 or >0.20 seconds
Patients exhibit about 60% pulmonary disease and medications which treat these conditions can worsen MAT
Three distinct P waves which indicates ectopic foci
Pulmonary disease
Metabolic disorders specifically hypokalemia
Cardiac ischemia
Recent surgery
Premature Atrial Contraction (PAC)
Rate: Dependant upon underlying rhythm
Rhythm: Dependant upon underlying rhythm, regular excluding PVCs
Pacemaker site: Ectopic focus in the atrium
P wave: Occurs early often hidden in the T wave
PR interval: Often normal
Ectopic foci near the SA node ≥0.12 seconds
Ectopic foci near the AV node ≤0.12 seconds
QRS complex: Normal possibly < 0.12 seconds
Resultant of a single impulse exterior to the SA node interior to the atria causing a premature depolarization which interrupts the normal cardiac resultant of:
Caffeine, Tobacco, ETOH
Ischemia heart disease
Hypoxia
Digitalis toxicity
Idiopathic
Paroxysmal Supraventricular Tachycardia (PSVT)
Rate: 150-250 bpm
Rhythm: Characteristically regular
Pacemaker site: Inner atrial exterior to the AV node
P wave: Often buried in the T wave
PR interval: Often normal
Ectopic foci near the SA node 0.12 seconds ish
Ectopic foci near the AV node ≤0.12 seconds
QRS complex: Normal
Rapid atrial depolarization overrides the SA node onsets suddenly and can last seconds-hours
Usually caused by automaticity in a single atrial foci or reentry phenomenon in the AV node
Precipitated by environmental factors
Frequently associated by underlying atherosclerosis CVD and rumatic heart disease
Atrial Flutter
Rate: 250-350 bpm Ventricular rate varies
Rhythm: Usually regular ventricular rate is dependant upon conduction
Pacemaker site: Inner atrial exterior to the AV node
P wave: Flutter wave present, usually regular, irregular in a variable block
PR interval: Often normal but variable
QRS complex: Normal
Results from a rapid atrial reentry circuit in a SA node that is nonconductive
AV junction allows conduction ratios of 1:1 rarely, 2:1, 3:1, or 4:1 or greater depending on the electric discrepancy present
Atrial Fibrillation
Rate
Atrial rate 350-750 bpm
Ventricular rate is dependant upon conduction
Rhythm
Irregularly irregular
Pacemaker site
Ectopic foci in the atria
P wave
Usually not discernable
PR interval
none
QRS complex
Normal
Multiple reentry sites or multiple foci within the Atrium
Frequently associated by underlying atherosclerosis CVD and rumatic heart disease
First degree AV block
Rate: Dependant upon underlying rhythm

Rhythm: Usually regular; sometimes slightly irregular
Pacemaker site: SA node or atria
P wave: Normal
PR interval: >0.20 seconds (diagnostic)
QRS complex: <0.12 seconds; morphology can be odd depending on conductive disease status
Not an intrinsically dangerous rhythm often proceeds a more advanced block
Baring significant bradycardia no treatment required
Contraindicated lidocane procanimide
Described by the P-QRS complex interval 5:4, 4:3, 3:2, or 2:1 pattern can be consistent or variable
Can occur in healthy heart but most commonly occurs as a result of ischemia at the AV node
Type I second-degree AV block (Morbitz I, or Wenckebach)
Rate: Atrial rate is unaffected the ventricular rate is ≤ normal
Rhythm: Atrial rhythm is regular, ventricular rhythm is irregular
Pacemaker site: SA node or atria
P wave: Not followed by QRS complexes
PR interval: Becomes progressively longer QRS is dropped
QRS complex: <0.12 seconds; morphology can be odd depending on conductive disease status
An intermediate block characteristically cyclic patter with progressively longer PR intervals eventually becoming a block with a constant PP interval
Described by the P-QRS complex interval 5:4, 4:3, 3:2, or 2:1 pattern can be consistent or variable
Can occur in healthy heart but most commonly occurs as a result of ischemia at the AV node
Type I second degree AV block
Rate: Atrial rate is unaffected the ventricular rate is ≤ normal
Rhythm: Atrial rhythm is regular, ventricular rhythm is irregular
Pacemaker site: SA node or atria
P wave: Not followed by QRS complexes
PR interval: Normal of conducted beats often >0.21
QRS complex: Normal or >0.12
An intermediate block characteristically cyclic patter with progressively longer PR intervals eventually becoming a block with a constant PP interval
Described by the P-QRS complex interval 5:4, 4:3, 3:2, or 2:1 pattern can be consistent or variable
Can occur in healthy heart but most commonly occurs as a result of ischemia at the AV node
Type II Second-Degree AV block
Rate: Atrial rate is unaffected the ventricular rate is bradycardic
Rhythm: Atrial rhythm is regular, ventricular rhythm is irregular
Pacemaker site: SA node or atria
P wave: Not followed by QRS complexes
PR interval: Normal of conducted beats often >0.21
QRS complex: Normal or >0.12
P waves which are not conducted to the ventricles the PR interval does no lengthen
Ratios are consistent or variable 4:1, 3:1, or 2:1
Usually caused by acute MI and septal necrosis
Third-Degree AV block
Rate: Atrial rate unaffected, ventricular rate 40-60
Rhythm: Rhythms are usually regular
Pacemaker site: SA node or atria
P wave: No relations to QRS within the T wave
PR interval: No relation between the waves
QRS complex: Dependant upon pacing location
A complete block of electrical conductivity between the atria and the ventricles
The two sections of the heart conduct entirely independently of one another
Resultant of acute MI digitalis poisoning or electrical deconditioning
Premature Junctional Contraction
Rate: Dependant upon underlying rhythm
Rhythm: Dependant upon underlying rhythm
Pacemaker site: Ectopic focus in AV junction
P wave: Inverted
PR interval: <0.12 greater if PJC is conducted
QRS complex:
>0.12 seconds if PJC is abnormally conducted
A signal from the AV node that occurs before the next sinus beat
Can result in either a compensatory or noncompensatory pause
Caffeine tobacco alcohol
Sympathomimetic drugs
Ischemia
Hypoxia
Digitalis toxicity
Idiopathic
Junctional Escape Complexes and Rhythms
Rate: 40-60
Rhythm: Regular in rhythm
Pacemaker site: AV junction
P wave: Inverted
PR interval: <0.12 greater if PJC is conducted
QRS complex: >0.12 seconds if PJC is abnormally conducted

The SA node rate is slower than the AV node so the AV node overdrives the SA node (40-60)
This is resultant of increased vagal tone
Accelerated Junctional Rhythm
Rhythm: regular
Pacemaker site: AV junction
P wave: Inverted
PR interval: <0.12 greater if PJC is conducted
QRS complex: Normal
Paroxysmal Junctional Tachycardia
Rate: 100-180
Rhythm: regular
Pacemaker site: AV junction
P wave: Inverted
PR interval: <0.12 greater if PJC is conducted
QRS complex: Normal
Rapid AV Junctional rhythm overriding the SA node
Also known as paroxysmal supraventricular tachycardia
Frequently associated with ASHD and rheumatic heart disease