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35 Cards in this Set
- Front
- Back
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Normal Sinus Rhythm (NSR)
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Rate: 60-100 bpm
Rhythm: Regular Waveform: PQRST P-R Interval: 0.12-0.2 sec QRS Duration: 0.04-0.12 sec |
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Sinus Tachycardia
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Rate: 100-160 bpm
Rhythm: Regular Waveform: PQRST P-R Interval: 0.12-0.2 sec QRS Duration: 0.04-0.12 sec |
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Sinus Bradycardia
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Rate: <60 bpm
Rhythm: Regular Waveform: PRQST P-R Interval: 0.12-0.2 sec QRS Duration: 0.04-0.12 sec |
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Wandering Atrial Pacemaker (WAP)
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Rate: 60-100 bpm
Rhythm: Irregular Waveform: PRQST with at least 3 DIFFERENT shaped P waves P-R Interval: 0.12-.20 sec QRS Duration: 0.04-0.12 sec (usually normal) Cause: dig toxicity; normal for that pt TX: none needed unless rate slow enough to make pt symptomatic, then use atropine |
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Multifocal Atrial Pacemaker (MAT)
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Rate: >100 bpm
Rhythm: Irregular Waveform: PRQST with at least 3 DIFFERENT shapped P waves P-R Interval: 0.12-0.2 sec QRS Duration: 0.04-0.12 sec Look for cause: pulmonary disease, digitalis toxicity, hypoxia and CHF (may or may not be symptomatic) TX: CCB, cardiazem; Beta Blocker, metaprolol |
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Premature Atrial Contractions (PAC)
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Rate: Variable/Indiviual beat only (usually normal)
Rhythm: Irregular (R's get closer) P wave: precede every QRS; Pwave of the PAC has a different shape than the sinus P wave; very early p waves may be buried int eh preceding T wave P-R Interval: Normal or prolonged QRS Duration: normal, wide, or absent Usually single events; generally unifocal (look the same); most people don't know they are having these; occassionally will go into A.Fib Causes: stress, ischemia, atrial enlargement, caffeine, nicotine, inflammation; pulmonary disease; CHF, MI, anxiety TX: Not usually required, unless more than 6 per minute occur; then discuss lifestyle changes suchas stress reductin, limit caffeine and alcohol, and get adequate rest with exercise |
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Atrial Flutter
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Rate: Atrial 250-350, Ventricular dependent on degree of block
Rhythm: A-regular, V-variable or regular Waveform: sawtooth P-R Interval: Cannot be determined QRS Duration: 0.04-0.12 sec Patients can develop blood clots. Stable patients, do not cardiovert unless/until clot free; use coumadin for 4 wks then recheck; unstable patients, cardiovert quickly Cause: cardiac disease; HTN; CHF; COPD; mitral valve disease; pulmonary embolism Goal is rate control. TX: 1st line: cardizem; digoxin; beta blocker, if vent rate is high. 2nd line: Amiodorone |
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Atrial Fibrillation
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Rate: A-350-600; V-variable
Rhthm: Irregularly irregular Waveform: A-chaotic fib waves; V-QRST P-R Interval: Cannot be determined QRS Duration: 0.04-0.12 sec Unstable patient: Cardioversion TX: Amiodarone; digoxin; metoprolol; cardizem Monitor coagulation studies: (heparin=PTT; warfarin=PT and INR) |
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Atrial Tachycardia
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Rate: >150 bpm
Rhythm: Regular unless multifocal Waveform: PQRST -f multifocal, p different shapes P-R Interval: 0.12-0.20 sec QRS Duration: 0.04-0.12 sec unless aberrant conduction |
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Premature Junctional Contractions
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Rate: Variable; individual beat only
Rhythm: Irregular early P Wave: absent, inverted before or after QRS P-R Interval: If P; precedes QRS, <0.12 sec QRS duration: 0.04-0.12 sec unless aberrant conduction looks like skipping a T wave Cause: dig toxicity; post CABG TX: usually not necessary; if rate is too slow use atropine |
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Supraventricular Tachycardia (SVT)
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Rate: >140 hr
Rhythm: Regular Waveform P'QRST or QRST or QRSTP'; P' may be superimposed on preceding T wave or inverted P-R Interval: Shortened, prolonged, or absent QRST Duration: 0.04-0.12 sec TX: adenosine (causes a pause then restart); Beta Blocker; CCB (cardizem); ablation Unstable pt: sedate and cardiovert (50-100 jules) Stable pt: vagal manuever (cough; bare down like having bm) |
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Junctional Rhythm
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Rate: 40-60 bpm
Rhythm: Regular P Wave: inverted, absent, immediately after QRS and inverted P-R Interval: If present, <0.12 sec QRS Duration: 0.04-0.12 sec Cause: digitalis toxicity TX: none necessary |
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Accelerated Junctional Rhythm
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Rage: 60-100
Rhythm: Regular P Wave: absent or inverted before or after QRS P-R Interval: If present, <0.12 sec QRS Duration: 0.04-0.12 sec Cause: dig toxicity; post CABG TX: stop med; remove stimulant; may no tdo anything postop; may give CCB or Beta blocker |
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Junctional Tachycardia
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Rate: >100
Rhythm: Regular P Wave: absent, or inverted before or after QRS P-R Interval: If present, <0.12 sec QRS Duration: 0.04-0.12 sec TX: cardizem; beta blocker |
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Premature Ventricular Contractions (PVC)
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Rate: Variable
Rhythm: Irregular early Waveform: QRST with opposite T-wave, WIDE & bizzare P-R Interval: None QRS Duration: >0.12 sec Causes: high caffeine, nicotine, or alcohol; HF; electrolyte imbalances; hypokalemia Types: bigeminal - every other beat is a PVC; coupled - occurs in pairs; trigeminal - two normal beats and a PVC |
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Idioventricular Rhythm (IVR)
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Rate: 20-40
Rhythm: Regular or irregular Waveform: QRST with opposite T-wave, wide & bizzare P-R Interval: None QRS Duration >0.12 sec patient probably not conscious; dying heart; perkinje fibers are the pacemaker; wide QRS; decreased CO; SA and AV nodes are given out; often last stage before asystole in a very sick heart and may not respond to tx TX: IV fluids; atropine; never give lidocaine |
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Accelerated Idioventricular Rhythm (AIVR)
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Rate: 40-100
Rhythm: Regular or irregular Waveform: QRST with opposite T-wave, WIDER & bizzare P-R Interval: None QRS Duration: >0.12 sec occurs with inferior MI, and is th emost common reperfusion arrhythmia in patients receiving thrombolytic therapy for acute MI Causes: dig toxicity; hypoxemia |
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Ventricular Tachycardia (V-Tach)
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Rate: >100
Rhythm: Regular or slightly irregular Waveform: QRST; P waves independent of or hidden in QRS P-R Interval: None QRS Duration: >0.12 sec find out cause and treat cause TX: vagal manuever; cough If stable, use adenosine and amiodarone; won't stay stable very long Unstable, sedate and synchronize cardiovert Pulseless V-Tach must be treated with defibrillation LIFE-THREATENING HEART RHYTHM!!! CHECK YOUR PATIENT!!! |
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Ventricular Fibrillation (V-Fib)
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Rate: Not measurable
Rhythm: Irregular Waveform: Chaotic fibrillaroty waves P-R Interval: None QRS Duration: Inconsistent URGENT DEFIBRILLATE! Always fatal unless treated immediately;dead and pulseless Causes: ischemia, infarction, severe electrolyte imbalance, acidosis, hypoxia or end-stage cardiac disease TX: CPR, Drug, Shock (repeat cycle) Drugs: amiodarone; lidocaine; magnesium; procainamide |
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First Degree Heart Block
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Rate: 60-100
Rhythm: Regular P Wave: normal P-R Interval: >0.20 sec QRS Duration: 0.04-0.12 sec Causes: beta blockers, CCB, amiodarone TX: disontinue causative drug; no specific tx necessary; watch for progression to higher degrees of block |
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Second Degree Heart Block (Mobitz I)(WENCKEBACH)
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Rate: A-60-100; V-slightly less than atrial rate; some atrial waves not conducted
Rhythm: A P-P regular; V irregualr repetitive cycles of "group beating" Waveform: PQRST, intermittent nonconducted P waves "2:1 ration" P-R Interval: Progressively lengthens until P wave is not followed by QRS, then cycle begins again QRS Duration: 0.04-0.12 sec only strip that has progressive P waves followed by a dropped QRS usually asymptomatic usually follows an inferior wall MI if becomes bradycardic, use atropine |
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Second Degree Heart Block Mobitz II
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Rate: A-60-100; V-slightly less than atrial rate; some atrial waves not conducted
Rhythm: A-P-P regular; V-regular or irregular if AV conduction ration varies Waveform: PQRST, intermittent non-conducted P waves P-R Interval: Normal or prolonged, but not all P waves are conducted QRS Duration: Usually >0.12 sec associated with anterior wall MI Always an emergency situation 2 consecutive, constant PR intervals before a blocked P QRS usually wide atropine will probably NOT work if hypotensive = dopamine may have t transcutaneously pace until get to a hospital cath lab |
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Third Degree Heart Block (Complete Heart Block)
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Rate: A-60-100; V-20-60, depending on escape rhythm origination
Rhythm: Both A & V are regular but unrelated; P wave may follow QRS Waveform: QRST, P waves independent of QRS complexes P-R Interval: None QRS Duration: Normal or wide Complete dissociation between p wave and QRS wave (P waves are all over the place) generally bradycardic most having anterior MI Acute Emergency!! transcutaneous pace until get to hospital cath lab for a transvenous pacemaker to be placed if left untreated, will lead to asystole |
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Sinus Arrhythmia
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Rhythm: irregular
Rate: usually 60-100 bpm Pwaves: before each QRS, identical PRI: .12-.20 QRS: usually normal, <.12 Looks like NSR, except R- will be irregular Usual cause: change in respiratory pattern; precursor to sick sinus syndrom in elderly TX: atropine, if any used |
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Sinoatrial Block
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Rate: usually normal, possibly bradycardic
Rhythm: regular except for missing beats P wave: present and uniform, except during missing beats QRS: normal, except for missed beats Occurs when one heartbeat is dropped within an NSR sequence. P waves can be plotted thru the pause and lasts exactly the same time interval as the previously conducted beats. Causes: hypoxia, ischemia, digoxin/digitalis overdose, high potassium levels, excessive vagal stimulation TX: atropine or permanent pacemaker |
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Sinus Pause (Arrest)
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Rate: usually normal, possibly bradycardic
Rhythm: regular except for missing beats P wave: present and uniform, except during missing beats (new rhythm begins after the pause) PR Interval .12-.20 QRS: normal (<.12), except for missed beats Occurs when more than one heartbeat is dropped within an NSR sequence. The pause, or flatline, is of an unpredictable length of time Causes: hypoxia, ischemia, beta blocker digoxin/digitalis overdose, high potassium levels, excessive vagal stimulation TX: atropine or permanent pacemaker |
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Complete Right Bundle Branch Block (RBBB)
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Positive deflection of QRS looks like rabbit ears
Widening of QRS & above baseline QRS >.12 Cause: CHF (only way to diagnose is with a 12 lead) TX: not treatment; chronic problem |
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Left Bundle Branch Block (LBBB)
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Looks like NSR then switches to negative QRS deflection with wide QRS
If old, don't worry bc it's chronic If new, should be concerned about MI NEVER do a stress test on a complete LBBB |
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Atrial Pacing
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The placing lead is inserted into the atrium to cause atrial depolarization
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Ventricular Pacing
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The pacing lead is inserted into the ventricle to cause ventricular depolarization
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A-V Sequential Pacing
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The pacing leads are inserted into both the atrium and ventricle stimulating at set intervals (same side)
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Bi-VICD
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One lead is placed in each of left atria and both ventricles
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Pacemaker General Info
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Pacemaker wires can migrate (hiccups can be an indicator)
Very important post procedure: Xray to confirm placement of lead wires Never put in a pacemaker in a patient with an active infection Transcutaneous - thru skin; least effective Important to get patient amtibiotic prior to surgery Most pt get about 10 yrs on a battery All pacemakers are set on demand, usually will be set to work if HR is <70 bpm Postprocedure: pt cannot raise arem on affected side above head for 24 hrs; arm is in sling; Cannot lift anything >5 lbs for 6 wks |
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Failure to Capture
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The pacemaker does not generate a pacemaker spike when it is needed.
Call physician immediately! Lead wires may have migrated, were not placed properly, or pt has an infection. Watch for fever. Won't see endocarditis right away; if infection is from lead wires = really bad |
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Failure to Sense
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The pacemaker does not recognize normal beats and generates an unnecesary pacemaker spike
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