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Heart Rhythms - Coggle Diagram
Heart Rhythms
Supraventricular Tachycardia
Rhythm: regular
Rate: 150- 250 bpm
P waves: abnormal often pointed, usually found in T wave
PR: Not measurable
QRS: 0.12 seconds or less
Causes: emotional stress, valve disease, acute MI, alcohol ingestion, caffeine, nicotine
Stable Tx: Sedation, vagal maneuvers, adenosine, calcium channel blocker, beta blocker, digitalis, electrical cardioversion, amiodarone, procainamide
Unstable Tx: Electrical cardioversion, radiofrequency catheter ablation
6mg IV over 1-3 min followed by 10-20cc saline
Ventricular Tachycardia
V-Tach is considered a lethal dysrhythmia
Rhythm: Regular
Rate: > 100BPM
P wave: Absent
PRI: Not measurable
QRS: Wide, Greater than 0.12
Causes
CHF, Acute MI, Hypoxia, Cocaine overdose, electrolyte imbalance, valvular disease, Chronic Ischemic heart disease
TX
Check for a carotid pulse!
If carotid pulse is present, vagal maneuvers and cardiovert
If no carotid pulse then defibrillate
Ventricular Fibrillation
Rhythm: Chaotic
Rate: Not measurable
P wave: Absent
PRI: Not measurable
QRS: Not measurable
Causes
Metabolic acidosis
Hypoxia
Hyperkalemia
Hypokalemia
Hypothermia
Drug overdose
TX:
Defibrillation
CPR
Atrial Fibrillation
Rhythm: Grossly irregular/ irregularly irregular
Rate: Atrial 400 or more not measurable
Ventricular varies with the number of impulses conducted
P waves: Irregular wavy deflections called fibrillation waves (F waves)
PR: Not measurable
QRS: 0.12 seconds or less
5 Step Rhythm Interpretation Method
1) Examine P Wave
Present of absent
Appearance
Consistency
Relationship to QRS
2) Examine the QRS
Presence: are the complexes easily identified?
Appearance
Consistency
duration
3) Determine the regularity of the atrial and ventricular rhythms
4) Calculate the atrial and ventricular rates
5) Measure the Intervals: PRI, QRS, and QT
Normal Sinus Rhythm
Rhythm: regular
Rate: 60 – 100
P waves: Normal in configuration; precede each QRS
PRI: Normal (0.12-0.20 seconds)
QRS: Normal (0.04 - <0.12 seconds
Sinus Bradycardia
have all the normal ekg parts just slow
Causes
Vagal response
Drug effect
Chronic ischemic heart disease
MI
TX
Atropine
0.5mg IV, may be repeated max q3-5min for a max of 3mg
Pacing
Temporary Pacing-Transcutaneous pacing & Transvenous. Perm.-Single or Dual Chamber, BiV
What Symptoms would a patient with symptomatic bradycardia experience?
Syncope, dizziness, weakness, confusion, alter LOC, hypotension, diaphoresis, SOB, chest pain
Symptomatic bradycardia exists when the following 3 criteria are present: 1.) The heart rate is slow; 2.) The patient has symptoms, and 3.) The symptoms are due to the slow heart rate.
What are considerations for a patient with a perm. pacer? Patient education:
Obtain ECG-look for pacer spikes, ensures working correctly
Asses for bleeding, swelling, redness, tenderness….infection
Dressing, clean, dry and intact
Activity restrictions: avoid lifting arm over hear or lifting more than 10 lbs for 4 weeks-could dislodge the pacer leads
Do regular arm/shoulder activity to prevent Frozen Shoulder
Do NOT pick at pacer site
Do NOT operate electrical appliances directly over pacer site
Keep cell phones 6inches away
NO MRI
Carry the given Pacer card: Pacer card will say what type of pacer and setting, as well as date placed.
Can go through metal detector, but need to let personal know and show card
Do pace maker batteries die? Yes
Atrial Flutter
Rhythm: Regular or irregular
Rate: atrial 250 -400
P waves: V shaped waveforms with saw-toothed appearance called flutter waves (F waves)
PR: Not measurable
QRS: 0.12 seconds or less
Sinus Tachycardia
Sinus Sinus tachycardia occurs when the sinus node discharges impulses at a rate greater than 100 beats per minute tachycardia occurs when the sinus node discharges impulses at a rate greater than 100 beats per minute
Characteristics
Rhythm: regular
Rate: 100-150
P waves: Normal in configuration; precede each QRS
PRI: Normal (0.12-0.20 seconds)
QRS: Normal (0.04 - <0.12 seconds)
Causes
Anxiety
fright
Anemia
anger
Hypotension
hypoxia
Caffeine
pain
Nicotine
cocaine
TX: Symptomatic-Treat underlying cause