EKG Rhythms

Created by bennyben1 

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Sinus Bradycardia
1. Slowing of SA Node
2. Rate <60
3. Tx. Atropine (0.5 mg/max 3 mg), TCP

Sinus Tachycardia
1. Increased Rate of SA Node Discharge
2. Rate >100
3. Tx. Underlying Cause

Sinus Dysrhythmia
1. Variation of R-R Interval
2. Rate Varies w/Respirations
3. Rhythm Irregular
4. Tx. None Typically Required

Sinus Arrest
1. Sinus Node Fails to Discharge for Brief Periods
2. Rate Normal - Slow, Depending on Frequency/ Duration of Arrest
3. Rhythm Irregular, R-R I Varies After Dropped Beat (Node Failed to Fire)
4. Tx. Atropine (0.5 mg/max 3 mg), TCP

Sinus Block
1. Sinus Node Discharge Blocked
2. Rate Normal - Slow, Depending on Frequency/ Duration of Arrest
3. R-R I After Dropped Beat Constant (Node Fired)
4. Tx. Atropine (0.5 mg/max 3 mg), TCP

Sinus Pause
1. Sinus Node Fails to Discharge for Brief Periods, Single Dropped PQRST Complex
2. Rate Normal - Slow, Depending on Frequency/ Duration of Arrest
3. Rhythm Irregular, R-R I Varies After Dropped Beat (Node Failed to Fire)
4. Tx. Atropine (0.5 mg/max 3 mg), TCP

Sick Sinus Syndrome
1. Combination of Dysrhythmias: Profound Bradycardia-Profound Tachycardia, Sinus Blocks
2. Rate Extremely Variable
3. Rhythm Irregular, Block Drops Single PQRST Complex
4. Tx. TCP

Wandering Atrial Pacemaker
1. Transfer of Pacemaker Site to Atria & AV Junction
2. Rhythm Slightly Irregular
3. Pacemaker Site Varies Among SA Node, Atrial Tissue, AV Junction
4. P Waves Morphology Changes Beat to Beat, May Disappear Entirely
5. PRI Varies, May be <0.12 secs, >0.2 secs
6. Tx. Adenosine, Verapamil

Multifocal Atrial Tachycardia
1. Wandering Pacemaker w/100< Rate
2. Rhythm Irregular
3. Pacemaker Sites Ectopic in Atria
4. P Waves Organized, Discrete Nonsinus w/3 Different Forms
5. PRI Varies
6. QRS Complex May be <0.12 secs, >0.2 secs
7. Tx. Underlying Disease

Premature Atrial Contractions (PAC's)
1. Single Impulse from Atria Outside SA Node, Premature Depolarization of Heart
2. Rate & Rhythm Depends On Underlying Rhythm
3. Pacemaker Site Ectopic Focus in Atria
4. P Waves of PAC Differs Occurring Earlier Than Expected, May Be Hidden in T Wave
5. PRI Usually Normal, May Vary w/Ectopic Foci Near AV Node (<0.12 secs)
6. QRS Complex Usually Normal, May be Absent
7. Tx. Oxygen, IV, Medical Direction

Paroxysmal SVT
1. Rapid Atrial Depolarization Overrides SA Node, Sudden Onset & Terminates Abruptly
2. Rate 150-250
3. Rhythm Regular Except During Onset
4. Pacemaker Site in Atria Outside SA Node
5. P Waves from Atria Differ, Often Buried in T Wave (Especially w/Tachycardia)
6. PRI Usually Normal, Ectopic Pacemaker Near AV Node <0.12 secs
7. Tx. 12 Lead EKG, IV, Vagal Maneuvers, Adenosine if Stable and Cardiovert w/Sedative

...

SVT
1. Tachycardias Originating Above Ventricles
2. Rate 150-250
3. Rhythm Regular Except During Onset
4. Pacemaker Site in Atria Outside SA Node
5. P Waves Indiscernible, Often Buried in T Wave (Especially w/Tachycardia)
6. PRI Usually Normal, Ectopic Pacemaker Near AV Node <0.12 secs
7. Tx. 12 Lead EKG, IV, Vagal Maneuvers, Adenosine if Stable and Cardiovert w/Sedative

Atrial Flutter
1. Rapid Atrial Reentry Circuit & AV Node Not Conducting All Impulses to Ventricles
2. Atrial Rate is 250-350, Ventricular Rate Varies w/Ratio of AV Node Conduction
3. Rhythm is Normal for Atria & Ventricles Unless AV Node Block is Variable
4. P Waves - Flutter Waves are Present, Saw Tooth or Picket Fence Pattern
5. PRI May Vary
6. Tx. 12 Lead EKG, IV, Diltiazem or Beta Blockers if Stable, Cardioversion w/Sedative if Unstable

Atrial Fibrillation
1. Multiple Areas of Atrial Reentry or Multiple Actopic Foci Bombarding AV Node (AV Conduction Random & Highly Variable)
2. Atrial Rate is 350-750, Ventricular Rate Varies w/Ratio of AV Node Conduction
3. Rhythm Irregularly Irregular
4. Pacemaker Site Numerous Ectopic Foci in Atria
5. P Waves Nondiscernible, Fibrillation Waves Indicate Chaotic Atrial Activity
6. PRI None
7. Tx. Lead EKG, IV, Diltiazem or Beta Blockers if Stable, Cardioversion w/Sedative if Unstable

First Degree AV Block
1. Delay in Conduction at AV Node, Condition Imposed on a Rhythm
2. Rate Depends on Rhythm
3. Usually Regular, Can be Slightly Irregular
4. Pacemaker Site SA Node or Atria
5. PRI >0.20 secs (Diagnostic)
6. Tx. Avoid Drugs that Slow AV Conduction (Lidocaine, Procainamide)

Type I Second Degree AV Block
1. Intermittent Block at AV Node
2. Rate at Ventricles May Be Slowed
3. Rythm at Ventricles Irregular
4. Pacemaker Site SA Node or Atria
5. P Waves Occasionally Not Followed by QRS Complex
6. PRI Progressively Longer Until QRS Dropped
7. Tx. Avoid Drugs that Slow AV Conduction (Lidocaine, Procainamide), w/Bradycardia Atropine & TCP

Type II Second Degree AV Block
1. Intermittent Block at AV Node
2. Rate at Ventricles Usually Bradycardic
3. Rythm Irregular if Conduction Varied
4. Pacemaker Site SA Node or Atria
5. P Waves Occasionally Not Followed by QRS Complex
6. PRI Constant for Conducted Beats
7. QRS Complex Often >0.12 secs, Abnormal Ventricular Depolarization
8. Tx. Atropine (0.5 mg/max 3 mg), TCP

2:1 AV Block
1. Type of Second Degree Block w/(2) P Waves/QRS Complex (1st of Pair Blocked)
2. Rate at Ventricles Usually Bradycardic
3. Pacemaker Site SA Node or Atria
4. P Waves (2)/QRS Complex
5. PRI Constant for Conducted Beats
6. QRS Complex Often >0.12 secs, Abnormal Ventricular Depolarization
7. Tx. Atropine (0.5 mg/max 3 mg), TCP

Third Degree AV Block/ Complete Block
1. Absence of Conduction Between Atria & Ventricles
2. Rate at Ventricles 40-60 w/Junctional Pacemaker, <40 if in Ventricles
3. Pacemaker Site SA Node for Atria, AV Junction of Ventricles for Ventricles
4. P Waves Normal w/o Relationship to QRS Complex
5. PRI w/o Relationship
6. QRS Complex >0.12 w/ventricular pacemaker
7. Tx. Atropine (0.5 mg/max 3 mg), TCP

Premature Junctional Contractions
1. Single AV Node Impulse Occuring Prior to Next Sinus Beat
2. Rate & Rhythm Depend on Underlying Rythm, Usually Regular Except for PJC
3. Pacemaker Site Ectopic Focus in AV Junction
4. P Waves Inverted, Before, After, Masked by QRS Complex
5. PRI May Occur After QRS Complex, R-P Interval
6. Observation w/o s/s

Junctional Escape Complex and Rhythm
1. SA Node Slower than AV Node
2. Rate is AV Node Standard 40-60
3. Either Irregular or Regular
4. Pacemaker Site AV Junction
5. P Waves Inverted,Before, After, Masked by QRS Complex
6. PRI May Occur After QRS Complex, R-P Interval
7. Tx. Atropine (0.5 mg/max 3 mg), TCP

Junctional Bradycardia
1. Junctional Dysrhythmia w/Rate <40
2. Rate is <40
3. Either Irregular or Regular
4. Pacemaker Site AV Junction
5. P Waves Inverted,Before, After, Masked by QRS Complex
6. PRI May Occur After QRS Complex, R-P Interval
7. Tx. Atropine (0.5 mg/max 3 mg), TCP

Accelerated Junctional Rhythm
1. Increased Automaticity in AV Junction, May Override SA Node
2. Rate is > Av Node Intrinsic 40-60
3. Regular
4. Pacemaker Site AV Junction
5. P Waves Inverted,Before, After, Masked by QRS Complex
6. PRI May Occur After QRS Complex, R-P Interval
7. Tx. Generally Unnecessary

Ventricular Escape/Idioventricular Rhythm
1. Higher Pacemakers Fail to Reach Ventricles or Ventricular Rate Becomes Higher
2. Rate is 15-40
3. Regular or Irregular
4. Pacemaker Site Ventricle
5. P Waves None
6. PRI None
7. QRS Complex >0.12 secs w/ Bizarre Morphology
8. Tx. Atropine (0.5 mg/max 3 mg), TCP or w/Bradycardia Follow Pulseless Arrest Protocol

Accelerated Idioventricular Rhythm
1. Abnormally Wide, Subtype Ventricular Dysrhythmia
2. Rate 60-110

PVC's
1. Single Ectopic Impulse From Ventricular Irritable Focus, Increased Automaticity or Reentry
2. Rate Depends on Under. Rhythm & Rate of PVC's
3. Rhythm Interrupts Regularity of Under. Rhythm
4. Pacemaker Site Ventricles
5. P Waves None, Normal Sinus P Wave may Appear Before PVC
6. PRI None
7. QRS Complex >0.12 secs & Bizarre Morphology
8. Tx. Lidocaine, IV, Oxygen, Lidocaine Drip (Procainamide)

Ventricular Tachycardia
1. 3+ Ventricular Complexes in Succession w/Rate of 100+, Atria & Ventricles not in Sync
2. Rate 100-250
3. Usually Regular
4. Pacemaker Site Ventricle
5. P Waves if Present not Associated w/QRS Complexes
6. PRI None
7. QRS Complex >0.12 secs & Bizarre Morphology
8. Tx. Perfusing, Amiodarone & Cardioversion, Non-Perfusing Pulseless Arrest Algorithm

Torsades de Pointes
1. Polymorphic Tachycardia, Different in Appearance & Cause (Antidysrhythmic Drugs)
2. Rate 166-300
3. Rhythm Irregularly Irregular
4. P Waves None
5. PRI None
6. QRS Complex Wide & Varied
7. Tx. Magnesium Sulfate in D5W, Overdrive Pacing, Correct Electrolyte Problems

Ventricular Fibrillation
1. Chaotic Ventricular Rhythm, Many Reentry Circuits Within Ventricles (No Ventricular Depolarization or Contraction)
2. Rate None Organized
3. Rhythm None Organized
4. Pacemaker Site Numerous Ectopic Foci in Ventricles
5. P Waves None
6. PRI None
7. QRS Complex None
8. Pulseless Arrest Algorithm, Uninterrupted Chest Compressions Extremely Important

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