Santos, Gail Lian B.
BSN III-C
DYSRRYTHMIAS DESCRIPTION
Sinus node
arrhythmias
1. Sinus arrest Is a sinus rhythm interrupted
by an occasional, prolonged
failure of the SA node to
initiate an impulse. Because
the atria are not stimulated to
contract, an entire P-QRS-T
complex is dropped.
2. Sinus Is a sinus dysrhythmia with an
arrhythmia irregular rhythm.
3. Sinus Is a sinus rhythm of less than
Bradycardia 60 beats per minute.
CAUSES ECG CHANGES TREATMENT NURSING
INTERVENTIONS
-side effects of beta -P waves: Sinus P waves -atropine -treat the underlying
blockers, digitalis, present when sinus node is -CPR causes
calcium blockers firing and absent during -artificial - if hemodynamic
-vagal stimulation periods of sinus arrest. pacemaker compromise, atropine
- myocardial -PR interval: Normal (0.12 0.5 to 1.0mg IV
infarction to 0.20 seconds) with
underlying rhythm; PR
absent during pause.
-Rhythm: Irregular during
pause
-Rate: Usually within
normal range, but may be in
the bradycardia range
-QRS complex: Normal
(0.04 to 0.10 seconds); QRS
absent during pause.
-vagal effect of -P waves: Normal in -none -none
certain medication configuration and direction;
such as one P wave precedes each
digoxin/morphine QRS complex.
- normal in healthy -PR interval :Normal (0.12
person to 0.20 seconds)
-Rhythm: Irregular
-Rate : Greater than 100
beats/minute
-QRS complex : Normal
(0.04 to 0.10 seconds)
-normal variant in -P waves: Normal in --if symptomatic: -Document
athletes configuration and direction; Atropine 0.5 to 1.0 dysrhythmia
one P wave precedes each mg IV
QRS complex.
 -PR interval : Normal (0.12 - Monitor
- increased vagal to 0.20 seconds) hemodynamic
tone -Rhythm: Regular parameters
-Rate : Less than 60 -if asymptomatic: no
-responses to beats/minute treatment
digitalis, beta -QRS complex : Normal
blockers and (0.04 to 0.10 seconds)
calcium channel
blockers
4. Sinus Is a sinus rhythm of more than -normal response -P waves: Normal in -beta blockers and -document dysrhythmia
tachycardia 100 beats per minute. to exercise and configuration and direction; calcium blockers - monitor hemodynamic
emotion one P wave precedes each parameter
-pain QRS complex. - treat underlying
-fever -PR interval : Normal (0.12 causes
-hyperthyroidism to 0.20 seconds)
-anemia -Rhythm: Regular 2
-Rate : Greater than 100
beats/minute
-QRS complex : Normal
(0.04 to 0.10 seconds)
Atrial arrhythmias
1. Atrial Atrial rhythm characterized by -Rheumatic heart -P waves: Not present; -Beta blocker -Detect and document
fibrillation disorganized atrial activity disease irregular P waves are often medication and dysrhythmia
without discernible P waves. -Heart failure seen, and vary in size from correct low -Monitor for
-Myocardial course to very fine. Potassium and diminished cardiac
infarction -PR interval: Not Calcium blood output
measurable since there are levels.
no P waves. -blood thinner
-Rhythm: Irregular (Coumadin)
-Rate: Atrial rate is too rapid -Cardioversion
to determine; ventricular may be necessary
rate varies depending on the if the patient is
amount of block at the AV hemodynamically
node. 7 unstable.
-QRS complex: Normal
(0.04 to 0.10 seconds)
2. Atrial flutter Is an atrial rhythm -Rheumatic heart -P waves: Characterized by -Cardioversion -Detect and document
characterized by a rapid atrial disease a very regular, sawtooth -Verapamil and dysrhythmia
rate. The rhythm is the result of -Myocardial pattern. beta blockers -Monitor for signs of
a circus movement pathway ischemia or -PR interval: Not -Quinidine and decreased cardiac
(also called reentry), although infarction measurable procainamide output
 enhanced automaticity has also
been implicated.
3. Paroxysmal It is originating in an ectopic
atrial atrial focus. They start and stop -Hyperthyroidism
tachycardia suddenly, a result of the very
rapid firing of an atrial ectopic
focus. It usually is preceded by
frequent atrial ectopic
4. Premature Are atrial beats that arise
atrial earlier than expected. It occurs
contraction in addition to the patients
underlying rhythm
-Rhythm: Atrial rhythm is
regular, ventricular rhythm
may be regular or irregular
due to varying AV block.
-Rate: Atrial rate varies
between 250 to 350
beats/minute, most
commonly 300; ventricular
rate varies depending on the
amount of block at the AV
node, most commonly 150
beats/minute and rarely 300
beats/minute.
-QRS complex: Normal
(0.04 to 0.10 seconds)
-Sepsis -P waves: Abnormal (often -Cardioversion -Detect and document a
pointed); may precede the -Verapamil and rapid, regular pulse
-Myocarditis QRS, frequently obscured in digitalis -Assess for signs /
preceding T wave or may be symptoms of
hidden in QRS complex. diminished cardiac
-PR interval: Not output
measurable -Carotid sinus massage
-Rhythm: Regular Rate: 170
to 250 beats/minute
-QRS complex: Normal
(0.04 to 0.10 seconds)
-Onset and termination are
abrupt
-stimulants such as -P waves: Abnormal in size, -Medications such -usually no treatment if
caffeine, tobacco, shape, or direction. P wave as beta blockers or asymptomatic
and alcohol is usually upright (often calcium blockers -Treat underlying
-congestive heart pointed), or it may be causes.
failure inverted. In faster rhythm, -Detect and document
-hypermetabolic the P wave is superimposed irregular pulse; frequent
states on the preceding T wave, PACs may precede
hidden in the QRS complex. more serious
-PR interval: Normal or arrhythmias such as
prolonged - usually differs atrial fibrillation.
from that of underlying -If increasing in
rhythm. frequency (5-6 BPM),
Digitalis, quinidine, or
 -Rhythm: Regular except propranolol may be
when atrial ectopic occur, indicated.
resulting in early beats.
-Rate: Normal
-QRS complex: QRS
complex: Normal (0.04 to
0.10 seconds)
AV block
1. First-degree the sinus impulse is conducted -Inflammation of -P waves: Normal -artificial -Continue monitoring
heart block normally to the AV node, AV bundles -PR interval: Prolonged pacemaker -Treat the underlying
where it is delayed longer than - Acute myocardial (greater than 0.20 seconds); causes
usual before being conducted infarction remains constant
to the ventricles. - Hyperkalemia -Rhythm: Regular
-Rheumatic fever -Rate: Normal
-QRS complex: Normal
2. Second- It is characterized by a failure -Acute infections -P waves: Normal -none -none
degree heart of some of the sinus impulses (rheumatic fever -PR interval: Progressively
block to be conducted to the and myocarditis) lengthens until a P wave
(Mobitz Type ventricles. In this rhythm the -Normal variant occurs without a
1) sinus impulse is conducted QRS. A pause follows the
normally to the AV node but dropped QRS.
each successive impulse has -Rhythm: Regular atrial
more and more difficulty rhythm; irregular ventricular
passing through the AV node, rhythm.
until finally an impulse does -Rate: Ventricular rate will
not pass through. depend on number of
impulses conducted through
AV node - will be less than
the atrial rate.
-QRS complex: Normal
3. Second- It is characterized by a failure -Acute MI -P waves: Normal - Cardiac pacing - Detect and document
degree heart of some of the sinus impulses -Cardiomyopathy -PR interval: May be normal dysrhythmia
block to be conducted to the -Severe coronary or prolonged - remains
(Mobitz Type ventricles. artery disease constant.
2) -Degeneration of -Rhythm: Regular atrial
the electrical rhythm; regular ventricular
conduction system rhythm unless the AV
conduction ratio varies.
-Rate: Ventricular rate will
depend on number of
impulses conducted through

4. Third-degree There is no conduction of
heart block stimuli from the atria to the
ventricles. Instead, the atria
and ventricles beat
independently of each other.
The atria usually continue to be anterior MI
paced by the sinus node while
the ventricles are paced by an
escape pacemaker located in
the AV node or in the
ventricles.
Junctional
arrhythmias
1. Junctional Is a dysrhythmia originating in
Rhythm the AV junctional tissue at a
rate of its inherent pacemaker.
Occurs as an escape or safety
mechanism when higher
pacemakers are not functioning
or if their impulses are not
getting through the AV node.
2. Accelerated It is an arrhythmia originating
Junctional in AV junction. The term
Rhythm accelerated denotes a
Rhythm that occurs at a rate
that exceeds the inherent
junctional escape rate of 40
60, but is not fast enough to be
junctional tachycardia.
AV node - will be less than
the atrial rate.
-QRS complex: Normal (if
block located in bundle of
His); wide (if block located
in bundle branches).
-Ischemia of AV -P waves: Normal - Cardiac pacing -Detect and document
node or -PR interval: Varies greatly, dysrhythmia
compression of AV no constant relationship
bundle between P waves and QRS.
-Acute inferior and -Rhythm:
Regular atrial rhythm;
-Drug toxicity regular ventricular rhythm.
(digitalis, beta- -Rate: Ventricular rate is
blockers, calcium between 40 to 60
channel blockers) beats/minute if paced by AV
-Following cardiac node; 30 to 40 beats/minute
surgery if paced by ventricles.
-QRS complex: Normal (if
block located at level of AV
node or bundle of His); wide
(if block located at level of
bundle branches).
- Digitalis toxicity -P waves: Before (inverted), - Atropine to - Treatment is rarely
- Following during, or after QRS. increase the heart required
inferior myocardial -PR interval: Short, usually beat
infarction due to 0.10 second or less.
disruption of blood -Rhythm: Regular
supply to the AV -Rate: 40 to 60 beats/minute
node -QRS complex: Normal
- Heart failure (0.04 to 0.10 seconds)
- Digitalis toxicity -P waves: Before (inverted), -Artificial -Monitored with EKGs
- Following during, or after QRS. pacemaker -give oxygen
inferior myocardial -PR interval: Short, usually -give drugs like -monitor blood
infarction due to 0.10 second or less. atropine, Digibind pressure.
disruption of blood -Rhythm: Regular (removes digoxin), -Treat underlying cause
supply to the AV -Rate: 60 to 100 or the seizure drug
node beats/minute phenytoin.
- Heart failure -QRS complex: Normal -ablation
(0.04 to 0.10 seconds)
 3. Premature A premature junctional -Myocardial -P waves: May occur before, -permanent -Elimination of stress
junctional contraction is a junctional beat infarction during, or after the QRS pacemaker factors and stimulants.
complex that occurs prematurely. They -Digitalis toxicity complex of the premature implantation -Administer oxygen.
appear before the next beat and are usually -Detect and document
normally expected complex inverted. dysrhythmia
-PR interval: Short, usually -Treat underlying cause
0.10 second or less.
-Rhythm: Regular except for
occurrence of premature
beats.
-Rate: Variable; usually
normal
-QRS complex: Normal
(0.04 to 0.10 seconds)
Ventricular
arrhythmias
1. Idioventricul It is an arrhythmia originating -heart failure -P waves: Absent -atropine - Monitor
ar rhythm in an escape pacemaker site in -PR interval: Not -Transcutaneous hemodynamic
the ventricles, with a heart rate measurable. pacing parameters
between 30 40 per minutes. -Rhythm: Regular
-Rate: 30 40 beats per
minute (sometimes slower)
-QRS complex: Wide,
greater than 0.12 second in
duration.
2. Asystole Also known as flat line. It is a - Acute respiratory -P waves: May be present if -CPR -CPR
state of cardiac standstill with failure the sinus node is -Endotracheal (ET)
no cardiac output and no - Myocardial functioning. intubation
ventricular depolarization infarction -PR interval: Not
- Hyperkalemia measurable.
-Rhythm: None
-Rate: None
-QRS complex: Absent
3. Premature A less serious type of -Hypoxia -P waves: VEs not preceded -Lidocaine IV -Detect and document
Ventricular ventricular arrhythmia. The -Myocardial by P wave. frequency of the
Contraction condition happens when the ischemia -PR interval: Not present premature beats and
ventricles contract too soon, -Hypokalemia before most VEs. any patterns of
out of sequence with the -Acidosis -Rhythm: Irregular because occurrence
normal heartbeat. of the early beats. -Monitor hemodynamic
-Rate: May be any rate. parameters
-QRS complex: Wide, -Monitor serum
greater than 0.12 second in electrolytes
 duration; may vary in, -Treat underlying cause
morphology (size, shape) if
they originate from more
than one focus in the
ventricles.
4. Ventricular Ventricular fibrillation is rapid, - Myocardial -P waves: None seen. -CPR -CPR
Fibrillation disorganized depolarization of infarction -PR interval: Not -automatic external
the ventricles. Individual - Electrolyte measurable. defibrillator (AED)
muscle fibers in the ventricles imbalance -Rhythm: Irregular -Implantable
depolarize, but in a - Metabolic -Rate: Rapid, uncoordinated, Cardioverter
disorganized manner. acidosis ineffective. Defibrillators
- Hypothermia -QRS complex: Not formed (ICD)
- Ventricular QRS complexes seen; rapid,
tachycardia irregular undulations
without any specific pattern.
5. Ventricular Is a condition in which the SA -Cardiomyopathy -P waves: Usually not -CPR -Administer anti
Tachycardia node no longer controls the -ischemic heart present. -Electrical arrhythmic drugs if
beating of the ventricles. disease -PR interval: Not defibrillation or prescribed.
Ventricular tachycardia refers -heart failure measurable. cardioversion -Monitor V/S.
to a paroxysm, or sustained -Rhythm: Regular (electric shock) -Detect and document
rhythm, of three or more PVCs -Rate: Ventricular rate is -Medications (such dysrhythmia
in a row. faster than 100 beats/minute. as lidocaine, - Monitor
-QRS complex: Wide, sotalol, or hemodynamic
greater than 0.12 second in amiodarone) given parameters
duration. intravenously. - Monitor serum
-Implantable electrolytes
Cardioverter
Defibrillators
(ICD)

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New Health Advisor. Retrieved from: http://www.newhealthadvisor.com/Accelerated-Junctional-Rhythm.html
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