Sinus Bradycardia
Characteristics
Physical Manifestations
May be asymptomatic
Lightheaded
Syncope
Chest pain
Hypotension
Atrial Fibrillation
Physical Manifestations
Irregular fast heart rate
Patients may feel like their
heart is racing, or chest pain
Normal sinus rhythm with a
heart rate <60 bpm
Consistent P wave
PR: 0.12-0.20
QRS: <0.12
QT: <1/2 R to R
Treatment
Treat symptomatic bradycardia:
Atropine
Epinephrine
External Pacemaker in an
emergency
Characteristics
A lot of ectopic cells in atria
causing it to be "irregularly
irregular."
Paroxysmal or persistent
Random QRS spacing
No clear P wave
Treatment
Because of the increased risk
of clots you want to give blood
thinners like heparin
Control HR: give CCBs
(Cardizem), amiodarone
Cardioversion in extreme cases
Sinus Tachycardia
Characteristics
Physical Manifestations
Subjective: feeling of anxiety,
racing heart, or chest pain
Objective: decreased BP,
Atrial Flutter
Physical Manifestations
LOC changes
Irregular fast heart rate
Patient may feel like their heart
is racing, chest pain
Normal sinus rhythm with a heart
rate of >100 bpm
Consistent P wave
PR: 0.12-0.20
QRS: <0.12
QT: <1/2 R to R
Treatment
Sinus tachycardia is always a
symptom of something else: treat
the underlying cause
Encourage rest
Administer CCBs like Cardizem or
diltiazem
Characteristics
A lot of ectopic foci synchronized
with each other. SA node firing
over and over again. No pause for
QRS
HR: <200, no P wave, skinny QRS
Regular saw tooth wave pattern
Treatment
Give Heparin and amiodarone
Cardiovert back into sinus rhythm
Long-term: Beta
blockers(metoprolol), CCBs
(Cardizem)
Supraventricular Tachycardia Ventricular Tachycardia
Characteristcs Characteristics
HR >100 (faster than sinus tach Fast PVCs, no atrial kick
Skinny QRS, lump in middle Paroxysmal
Paroxysmal HR: 150s, fast but not as fast
Sinus node is not getting a as SVT
chance to fire No P wave

Physical Manifestations Treatment Physical Manifestations Treatment

Pulseless: code, CPR, Defib
1: Vagal Maneuvers (like a deep
Fainting, dizziness Cardiac Arrest!! Unstable w/ pulse:
cough)
chest pain SOB, chest pain, dizzy, cardioversion (keep filling pulse)
2. Stable: give Adenosine rapid
Rapid pulse lightheaded, nausea Stable: Try vagal maneuver and
IV push (6-12-12)
diaphoretic Palpitations adenosine. Amiodarone,
3. Unstable: Cardioversion
cardioversion

Ventricular Fibrillation Idioventricular

Characteristics Characteristics
A lot of ectopic foci in HR: slow, 40-60
ventricles No P wave
No P, QRS, T QRS: abnormal wide shape (>.12)
Basically a wavy line SA node does not fire, AV node
Lethal takes over

Physical Manifestations Treatment Physical Manifestations Treatment

No pulse! CPR Syncope, dizziness, lightheaded Atropine
Cardiac arrest Defibrillation SOB Epinephrine
(No one is awake or has a Decreased LOC External pacemaker
pulse in Vfib) Cyanosis, dyspnea, poor perfusion Needs a permanent solution
Premature Ventricular Contractions Asystole
Characteristics Characteristics
Wide weird shaped QRS
Premature complexes, no P
Absence of rhythm or electrical
before it
activity
Ectopy- cell in ventricles
Can be caused by hypoxia,
stress, CAD

Physical Manifestations Treatment Physical manifestations Treatment

DO NOT SHOCK (Defibrillation
Decreased O2 sats Unconscious will not work)
Cardioversion
HR <60 Absent pulse Epinephrine IV push1 mg q 3-5
Avoid triggers like stimulants
Decreased LOC No respirations min or
Anxiety, stress Vasopressin 40 units IV
CPR!

1st Degree AV Block 3rd Degree AV Block

Characteristics Characteristics
Prolonged PR interval (intervals Atria and ventricles do not
are the same length >.20) communicate, so two conduction
AV node conduction time systems are happening at the same
time (P and QRS unrelated)
prolonged
Inconsistent P wave, QRS weird shape
Slow HR

Physical Manifestations Treatment Physical Manifestations Treatment

SOB Do not shock!
Usually Asymptomatic Usually no intervention required Dizzy, lightheaded Call code
Slow pulse rate Do not shock Chest pain Needs a pacemaker
Slow pulse, hypotension
2nd Degree AV Block Type I
Characteristics
PR interval gradually increases
overtime until one QRS gets
blocked
Only blocks one per cycle
AV node fatigue

Mobitz I or Wenckebach
Physical Manifestations Treatment
Fainting, dizzy, lightheaded
Chest pain Do not shock!
SOB Pacemaker
Slow HR Treat underlying issue
Usually asymptomatic

2nd Degree AV Block Type II

Characteristics
Occasional failure from SA node to
ventricles
P normal size, some not followed
by QRS, PRs are all equal
High grade block: more Ps than
QRS
Mobitz II
Physical Manifestations Treatment
Usually asymptomatic Do not shock
SOB, dyspnea, fatigue Has to be paced
Chest pain