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Cardiac Dysrhythmia Chart Med-Surg NUR4

Cardiac Dysrhythmia Chart Med-Surg NUR4

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Published by ktfosterfd20
ECG dysrhythmia chart for med-surg 2 cardiac module; Nursing school
ECG dysrhythmia chart for med-surg 2 cardiac module; Nursing school

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Published by: ktfosterfd20 on Apr 09, 2013
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06/21/2015

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Rhythm Clinical Associations ECG Characteristics Clinical Significance Treatment Strip
Sinus Bradycardia
-Conduction path same as NSR-SA node fires at <60 bpm-Symptomatic- HR <60 resulting insymptoms (chest pain, syncope-Normal in some aerobic athletesand some pts during sleep-Carotid sinus massage, Vasalvamaneuver, Hypothermia, Increasedintraocular pressure, Vegalstimulation-Drugs (b-blockers, CCB)
-HR:
<60 bpm-
Rhythm:
regular-
P wave:
normal, before eachQRS-
PR Int:
normal-
QRS:
normal shape/duration-Depends on how pt hemodynamicallytolerates-S/sx of symptomatic Bradycardia:pale, cool skin; hypotension;weakness; angina; dizziness orsyncope; confusion or disorientation;shortness of breath-Atropine (anticholinergic) if symptomatic-Possible pace maker-D/t drugs: d/c, reduce dose, hold
Sinus Tachycardia
-Conduction path same as NSR-D/c rate from sinus node increasesb/c vagal inhibition or sympatheticstimulation-Sinus rate is 101-200 bpm-Exercise, fever, pain, hypotension,hypovolemia, anemia, hypoxia,hypoglycemia, MI, HF,hyperthyroidism, anxiety, fear-Drugs: epinephrine,norepinephrine, atropine, caffeine,theophylline, Procardia, hydralazine
-HR:
101-200 bpm-
Rhythm:
regular-
P wave:
normal, before eachQRS-
PR Int:
normal-
QRS:
normal shape/duration-Depends on pt tolerance of 
↑ HR
 -Sx: dizziness, dyspnea, hypotensiondue to decreased cardiac output-
↑ myocardial o2 consumptionassociated with ↑HR
 -
Angina or ↑infarction size may
accompany in pt w CAD or acute MI-Treat the underlying cause-Pain: effective pain management-Hypovolemia: treat hypovolemia-If stable: vagal maneuvers, IV betablockers given to reduce HR andmyocardial o2 demand
Premature Atrial Contraction
-Originates at site other than SA-Starts L/R atrium travels acrossatrium by abnormal path creatingdistorted P wave-At AV it may be stopped, delayed(long PR interval) or go normally-Normal Heart: emotional stress,physical fatigue, caffeine, tobacco,alcohol-Electrolyte imbalance,hyperthyroidism, COPD,-Heart disease: CAD, valvulardisease
-HR:
varies with underlyingrate and frequency of PAC-
Rhythm:
irregular-
P wave:
different shape(notched, downward, hiddenin T wave)-
PR Int:
longer or shorter butWNL-
QRS:
usually normal, if >0.12abnormal conduction via vents-Not significant if isolated PAC inhealthy heart-
Pt report “palpitations” “skip a beat”
 -Heart disease: freq PAC- enhancedautomaticity of atria, or reentry (maywarn of more serious dysrhythmias-supraventricular tachycardia)-Depends on sx-Withdrawal of caffeine orsympathomimetic drugs-B-blockers may decrease PACs
SupraventricularTachycardia
-Originates in ectopic focus abovebundle of His-Occurs d/t reexcitation of atria
when there’s a one
-way block-Abrupt onset and terminationfollowed by brief asystole-Some degree AV block possible-Normal Heart: overexertion,emotional stress, deep inspiration,stimulants (caffeine and tobacco)-Rheumatic heart disease, digitalistoxicity, CAD, cor pulmonale
-HR:
150-220 bpm-
Rhythm:
regular/slightlyirregular-
P wave:
hidden in T wave orirregular shape-
PR Int:
shortened or normal-
QRS:
usually normal-Depends on associated symptoms-Prolonged episode and HR >180 mayprecipitate decreased CO d/t reducedstroke volume-Sx often include hypotension,dyspnea, angina-Vegal stimulation: Vasalva maneuverand coughing-Drug tx: IV adenosine (1
st
),IV b-blocker, CCB, amiodarone-If pt remains unstable, cardioversionis used-Radiofrequency catheter ablation(burn foci generating ectopic rhythm)
Atrial Flutter
-Atrial tachydysrhythmia-ID by recurring, regular, sawtoothshaped flutter waves-Originate from single ectopic focusin R atrium (or L but uncommon)-Rarely occurs in healthy heart-Diseased states: CAD, HTN, mitralvalve disorders, PE, chronic lungdisease, cor pulmonale,cardiomyopathy, hyperthyroidism-Drugs: digoxin, quinidine,epinephrine
-HR:
Atrial: 200-350 bpm;Vent: varies r/t conductionratio-
Rhythm:
Regular (A and V)-
P wave:
None (F waves- moreF waves than QRS complexes)-
PR Int:
Variable/notmeasurable-
QRS:
usually Normal-High ventricular rates and loss of 
atrial “kick” (sinus P wave) decrease
CO and cause serious consequencessuch as HF, esp if heart disease hx-
↑ Stroke risk d/t risk thrombus
formation in atria from stasis of blood-Warfarin given to prevent stroke-Primary goal: slow ventricularresponse by increasing AV block-Cardioversion if an emergency-Antidysrhythmia drugs: Amiodarone,propafenone, ibutilide, flecanide-Radiofreq catheter ablation
Atrial Fibrillation
-Total disorganization of atrialelectrical activity due to multipleectopic foci resulting in loss of effective atrial contraction-Paroxysmal or persistent (>7 Days)-Sometimes, atrial flutter and atrialfibrillation may coexist-Primarily in pts w/ underlying heartdisease (CAD, rheumatic heart dx,cardiomyopathy, HTN, HF,pericarditis)-Often develops acutely w/thyrotoxicosis, ETOH intox, caffeineuse, electrolyte imbalances, stress,cardiac surgery
-HR:
Atrial: up to 600 bpm;Vent: varies 60-100 controlled,>100 Rapid, <60 slow ventresponse-
Rhythm:
Irregular-
P wave:
Replaced byfibrillatory waves-
PR Int:
Not measurable-
QRS:
normal shape/duration-
Results in ↓CO d/t ineffective atrial
contractions and/or rapid ventricularresponse-Thrombi form in atria d/t blood stasis-Thrombi may embolize and causestroke (A Fib responsible for 20% all)-
Goal: ↓vent response (<100),
prevent cerebral embolism, convert toNSR if possible-Drugs (rate control): CCB, B-blockers,digoxin, dronedarone-Antidysrhythmia drugs: Amiodarone,ibutilide-Cardioversion or Ablation
 
Rhythm Clinical Associations ECG Characteristics Clinical Significance Treatment Strip
1⁰ AV Block
 
-Every impulse conducted toventricles but AV conduction is long-After through AV, ventriclesrespond normally-MI, CAD, rheumatic fever,hyperthyroidism, vagal stimulation-Drugs: digoxin, B-blockers, CCB,flecainide
-HR:
Normal-
Rhythm:
Regular-
P wave:
Normal-
PR Int:
Prolonged (>0.20seconds)-
QRS:
normal shape/duration-usually not serious but can beprecursor of higher degrees of AVblock-asx-No treatment-Modifications to potentially causativemeds may be considered-Monitor pts for new changes inrhythm (more serious AV block)
2⁰ AV Block Type 1
(Wenckebach/Mobitz I)
-Gradual lengthening of PR intervald/t prolonged AV conduction timeuntil an atrial impulse isnonconducted and a QRS is blocked-Most common in AV but can occurin His-purkinje system-Once beat is blocked, cycle repeatsw progressive lengthening of PRinterval until another QRS drops-Digoxin-Beta-blockers-CAD-Other dx that slow AV conduction
-HR:
Atrial: normal; vent:possibly slower d/t blockedQRS leading to bradycardia-
Rhythm:
Pattern of groupedbeats-
P wave:
Normal shape-
PR Int:
Gradual lengthening-
QRS:
normal shape/duration
 
-Usually d/t myocardial ischemia orinfarction-Generally transient and well tolerated-In some pts may be warning sign of amore serious conduction disturbancesuch as complete heart block-If sx: at
ropine to ↑HR or temporary
pacemaker (especially if hx MI)-If asx: rhythm observed withtranscutaneous pacemaker on standby-Bradycardia more likely to becomesymptomatic when hypotension, HF orshock is present
2⁰ AV Block Type 2
 (Mobitz II)
-P wave nonconducted w/oprogressive PR lengthening-Usually occurs when block in oneof the bundle branches is present-More serious type of block-Certain # of impulses are notconducted into the ventricles-Occur in ratios 2:1, 3:1, etc (2 Pwaves for 1 QRS complex)-May occur with varying ratios-Rheumatic heart disease-CAD-Anterior MI-Drug toxicity
-HR:
Atrial: NormalVent: depends on intrinsicconduction/degree of block-
Rhythm:
Atrial: RegularVent: may be irregular-
P wave:
Normal shape-
PR Int:
Normal or prolonged,constant on conducted beats-
QRS:
Usually >0.12 sec d/tbundle branch block
 
-
Often progresses to 3⁰ block
 -Associated with poor prognosis-
↓HR frequently results in ↓CO with
hypotension and myocardial ischemia-Indication for therapy withpermanent pacemaker-Temporary pacemaker may benecessary if pt becomes symptomaticprior to insertion of permanentpacemaker (e.g., hypotension, angina)
3⁰ AV Block
 
-Complete Heart Block-No impulses from atria conducted-Atria stimulated and contractindependently of ventricles-Vent rhythm is escape rhythm,ectopic pacemaker may be above orbelow the bundle of HisSevere heartdx-CAD-MI-Myocarditis-
Cardiomyopathy
 Systemic dx-Amyloidosis-SclerodermaDrugs-Digoxin-Beta-blockers-CCB
-HR:
Atrial: sinus 60-100 bpmVent: r/t block site (AV 60-40,etc)-
Rhythm:
Regular (unrelated)-
P wave:
Normal shape-
PR Int:
Variable-
QRS:
Normal or Widened**No time relationship b/t Pwave and QRS complex**
 
-
↓CO→ ischemia, HF, and shock
 -Syncope d/t severe bradycardia orperiods of asystoleSymptomatic pts-Transcutaneous pacemaker used untiltemporary transvenous pacemakercan be inserted-Drugs: Atropine, Epinephrine,Isoproterenol, Dopamine are
temporary to ↑HR and BP
 -If d/t CCB tox, tx w calcium chloride
Premature Vent Contraction
-Contractions from ectopic focuswithin ventricles-Premature wide/distorted QRS-Diff foci: diff shape (multifocal)-Same foci: same shape (unifocal)-Couplet, trigeminy, bigeminy-VTach if 3+ consecutive PVCs-Can initiate VTach or VFibStimulants-Caffeine-ETOH-Nicotine-Aminophylline-Epinephrine-Isoproterenol-Digoxin-ElectrolyteImb-Hypoxia-Fever-Exercise-Emotion stressDisease States-MI-Mitral prolapse-HF-CAD
-HR:
Varies r/t intrinsic rate, #PVCs-
Rhythm:
Irregular d/t prebeats-
P wave:
Usually lost in QRS of PVC-
PR Int:
Not measurable-
QRS:
Wide, Distorted, >0.12sec
-T wave:
Large, Oppositedirection to direction of QRS-Usually benign in pt w/ normal heart-If hx he
art dx: may ↓CO and
precipitate angina and HF (depends onfrequency)-Monitor apical pulse b/c PVCs usually
aren’t strong enough to illicit
peripheral pulses possibly leading topulse deficit-Relates to cause PVCs-Assess hemodynamics r/t need fordrug tx-Drug tx: Beta-blockers, Procainamide,Amiodarone, Xylocaine-PVCs in CAD or acute MI indicate ventirritability so monitor pt response

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