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NORMAL SINUS RHYTHM

ECG: Rate: 60-100; Rhythm: regular; QRS shape: normal; P:QRS ratio: 1:1 (p always in front of QRS)

SINUS BRDYCARDIA

Sinus node creates an impulse at a slower than normal rate Causes: o Athlete, sleep, ICP, MI o Vagal stimulation vomiting, straining, suctioning, sever pain o Meds bb, ccb, amiodarone o The Hs and Ts hypovolemia, hypoxia, hydrogen ion (acidosis), hypo/hyperkalemia, hypoglycemia, hypothermia; toxins, tamponade, tension pneumothorax, thrombosis, trauma Management: IV atropine blocks vagal stimulation; Pacemaker ECG: Same as those for normal sinus rhythm, except for the Rate: less than 60

SINUS TACHYCARDIA

Sinus node creates an impulse at a faster than normal rate Causes: o Stress, blood loss, anemia, shock, hypo/hypervolemia, HF, fever, exercise, anxiety o Meds/ stimulants/ illicit drugs catecholamines, aminophylline, atropine, caffeine, ETOH, nicotine Management: BB, CCB; catheter ablation, pacemaker if unresponsive to meds ECG: Same as those of normal sinus rhythm, except for Rate: greater than 100

ATRIAL FLUTTER

Conduction defect in the atrium causing rapid, regular, atrial rate (250-400/min) Because the atrial rate is faster than the AV node can conduct not all impulses reach the ventricle causing a therapeutic block which helps prevent ventricular fibrillation. S/S: SOB, low BP, chest pain Causes : COPD, valvular disease, open heart surgery Management: monitoring, cardioversion, ablation; meds to slow ventricular response BB, CCB, digitalis ECG: Rhythm: regular; QRS shape: normal; P:QRS ratio: 2-4:1 (p-waves have saw tooth appearance)

ATRIAL FIBRILLATION

Uncoordinated atrial electrical activity that causes rapid, disorganized and uncoordinated twitiching of atrium; atrial rate: 300-600, vent rate: 120-200; can be transient or persistent A-fib causes an increased risk of stroke b/c erratic atrial contractions promote thrombi formation Due to smaller stroke volume, loss in AV synchrony, and atrial kick (= c/o) S/S may include: SOB, fatigue, hypotension, CP, Pulm edema, altered LOC, syncope, palpitations, pulse deficit Cause: age, heart disease, HF, CAD, HTN, DM, obesity, hyperparathyroidism, pulm HTN/emboli, heavy ingestion of ETOH (holiday heart), pulmonary or open heart surgery Management: o Self limiting; return to normal sinus rhythm within 24 hrs o Cardioversion, Amiodarone, BB, CCB, ablation o Coumadin to prevent thrombi formation ECG: Rhythm: highly irregular; QRS shape: normal; P:QRS ratio: many:1; no discernible p-waves

VENTRICULAR TACHYCARDIA

Abnormal impulses within the ventricles causing the heart to beat more than 160 bpm causing inadequate filling of the ventricles = less systemic circulation; ventricle rate: 100-200 Causes: MI, CAD, heart disease Management: Cardioversion, defibrillation if pt is pulse less, implantable cardioverter defibrillator ECG: Rate: +100; Rhythm; regular; QRS shape: bizarre, abnormal; p-waves are very difficult to detect

VENTRICULAR FIBRILLATION

Rapid disorganized ventricular rhythm that causes ineffective quivering of the ventricles; ventricular rate greater than 300 bpm V-fib is always characterized the absence of an audible HB, palpable pulse, and respirations. Cause: MI, CAD, untreated VT, Heart disease, electrolyte imbalances, electrical shock Treatment: Defibrillation, if more than 4 min response CPR then defibrillation, epinephrine ECG: No p-waves; rhythm extremely irregular without a specific pattern; unrecognizable QRS

ASYSTOYLE

No cardiac electrical activity

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