Ekg Ch. 4 Atrial Rhythms Slides

Front 1

Atria

Back 1

-Thin walled, low pressure chambers

-Receive blood from systemic circulation and lungs

Front 2

Atrial dysrhythmias

Back 2

-Reflects ABNORMAL electrical impulse formation and conduction in the atria

-Most are not life threatening

Some are associated w extremely fast ventricular rates

Hint 2

An excessively rapid hr may compromise cardiac output

Front 3

Premature Complexes

Back 3

These occur early, or before the next expected beat; and they're identified by their site of origin

Hint 3

PAC, PJC, and PVCs

Front 4

Premature Atrial Complexes PACs

Back 4

Rate: usually w/in normal limits, depends on underlying rhythm

Rhythm: regular w premature beats

P waves: premature, positive and upright in lead II, and onebbefore ea qrs complex

(Often differ in shape from sinus p wave-may be flattened, notched, pointed, biphasic, or lost in the preceding t wave)

Front 5

Pairs or coupled

Back 5

2 pacs in a row is called

Front 6

Runs or bursts

Back 6

3 pacs in a row is called

Front 7

Atrial bigeminy

Back 7

Every other beat is a pac

Front 8

Atrial trigeminy

Back 8

Every 3rd beat is a pac

Front 9

Atrial quadrigeminy

Back 9

Every 4th beat is a pac

Front 10

Causes of PACs

Back 10

*Emotional stress

*Stimulants, tobacco, caffeine, coke

CHF

Mental/physical fatigue

Electrolyte imbalance

Atrial enlargement

Acute coronary syndrome

Front 11

Frequent

Back 11

If pacs are __, pt may complain of a skip or occasional palpitations

Front 12

Tell pt to sleep better and dont drink too much coffee

Back 12

In pts with healthy hearts and an occaisional pac, what do you tell pt

Hint 12

Not clinically significant

B/c rhythm is irregular count pts pulse for 1 full minute

Front 13

Frequent PAC treatment

Back 13

Correct the underlying cause to do this:

Rx options--

Stress reduction

Reduced consumption of caffeine containing beverages

Treatment of congestive heart failure

Correction of electrolyte imbalance

Front 14

Supraventricular tachycardia (svt)

Back 14

This begins above the bifurcation of the bundle of His

HR faster than 150 bpm and normal qrs complexes (skinny, under 0.12 sec)

Includes rhythm that begins in sa node, atrial tissue, av junction

Hint 14

Call dr to get meds for slowing down rate

Front 15

Recognizing SVT

Back 15

Rate: 150-250 bpm

Rhythm: ventricular rhythm regular

P wave: usually unidentifiable. Hidden in t wave of preceding beat

Hint 15

Pt cant go home w this hr, pt will pass out

Front 16

Causes of SVT

Back 16

Hypoxia, stress, anxiety, smoking, caffeine, sleep deprived, meds

Hint 16

Common in young healthy ppl w no structural heart disease

Front 17

Signs and symptoms of SVT

Back 17

Palpitations, lightheaded, neck vein pulsations, syncope, dyspnea, weakness, anxiety, chest pain, signs of shock, chf

Front 18

Treatment of svt

Back 18

Oxygen, iv access, cardiac monitor, vagal maneuvers, *adenosine (elderly), beta blockers-slows down the heart (young ppl)

Hint 18

For stable pts

Front 19

SVT signs and symptoms

Back 19

Chest pain, hypotension, sob, pulmonary congestion, chf, acute myocardial infarction, decreased level of consciousness

Hint 19

For unstable pts

Front 20

Treatment of svt in unstable pt

Back 20

Oxygen, iv, cardiac monitor, med admin, consider sedation, synchronized cardioversion

Hint 20

If pt is unstable

Front 21

Synchronized cardioversion

Back 21

Delivery of an electrical shock to the heart timed to occur during qrs giving the chance for sa node to start working

Hint 21

100 jolts. Pt needs to be sedated

Front 22

Atrial flutter

Back 22

An ectopic atrial rhythm in which an irritable site fires regularly at an extremely rapid rate. Results in waveforms that resemble the teeth of a saw or picket fence (flutter waves)

Hint 22

Not contracting how they should, it's shaky. Increased risk of thrombus and stroke

Front 23

Causes of atrial flutter

Back 23

Usually a paroxysmal (sudden, violent outburst) rhythm associated by a pac

Front 24

Atrial fibrillation

Back 24

This occurs because of altered automaticity or reentry.

Irritable sites in the atria fire at a rate of 400-600 times/min

Resulting in: ineffectual atrial contraction, decreased stroke volume, subsequent decrease in cardiac output, loss of atrial kick

Hint 24

Tiny tremor

Front 25

Recognizing Atrial fibrillation

Back 25

Rate: 400-600bpm (atrial)

Rhythm: ventricular rhythm usually irregularly irregular

P waves: no identifiable p waves. Chaotic, erratic, wavy baseline

Hint 25

! It can also occur with complete av block causing ventricular rhythm to be slow and regular, wavy lines between qrs waves

Front 26

Ideopathic, no know reason

Back 26

Most common reason for atrial fibrillation

Front 27

Atrial fibrillation-what causes it

Back 27

Increased stroke risk. Atria don't contract effectively. Blood pools within the atria, forming clots. Clot dislodges and moves to artery in the brain. Have to put on blood thinners, can kill because of clots. Call dr.

Front 28

What to do abt atrial fibrillation

Back 28

If rapid ventricular rate, control ventricular response

If rapid ventricular rate and serious signs and symptoms, synchronized cardioversion

Front 29

Ectopic beats/rhythms

Back 29

Rhythms originated by ectopic automaticity foci (sites, other than sa node, to generate impulses)

Front 30

Ectopic atria beat

Back 30

P wave: positive, pointed (spiky)

narrow qrs (less than 0.12)

Front 31

Ectopic av junction

Back 31

Absent or negative p wave

Narrow qrs, less than 0.12 sec

Or

First p wave is absent, second one is negative

Front 32

Ectopic ventricular beat

Back 32

Absent p wave

Wide, bizarre, more than0.12 sec qrs wave

Negative t wave

Front 33

Premature beats

Back 33

These appear early, occuring before the next expected beat.

Hint 33

The r-r interval appears sooner than expected

Front 34

Escape beats/rhythms

Back 34

These appear later than expected