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Santos, Gail Lian B.



Sinus node
1. Sinus arrest Is a sinus rhythm interrupted -side effects of beta -P waves: Sinus P waves -atropine -treat the underlying
by an occasional, prolonged blockers, digitalis, present when sinus node is -CPR causes
failure of the SA node to calcium blockers firing and absent during -artificial - if hemodynamic
initiate an impulse. Because -vagal stimulation periods of sinus arrest. pacemaker compromise, atropine
the atria are not stimulated to - myocardial -PR interval: Normal (0.12 0.5 to 1.0mg IV
contract, an entire P-QRS-T infarction to 0.20 seconds) with
complex is dropped. underlying rhythm; PR
absent during pause.
-Rhythm: Irregular during
-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.
2. Sinus Is a sinus dysrhythmia with an -vagal effect of -P waves: Normal in -none -none
arrhythmia irregular rhythm. 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
-QRS complex : Normal
(0.04 to 0.10 seconds)
3. Sinus Is a sinus rhythm of less than -normal variant in -P waves: Normal in --if symptomatic: -Document
Bradycardia 60 beats per minute. 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
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
-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 -Rhythm: Atrial rhythm is
been implicated. 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
-QRS complex: Normal
(0.04 to 0.10 seconds)
3. Paroxysmal It is originating in an ectopic -Sepsis -P waves: Abnormal (often -Cardioversion -Detect and document a
atrial atrial focus. They start and stop -Hyperthyroidism pointed); may precede the -Verapamil and rapid, regular pulse
tachycardia suddenly, a result of the very -Myocarditis QRS, frequently obscured in digitalis -Assess for signs /
rapid firing of an atrial ectopic preceding T wave or may be symptoms of
focus. It usually is preceded by hidden in QRS complex. diminished cardiac
frequent atrial ectopic -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
4. Premature Are atrial beats that arise -stimulants such as -P waves: Abnormal in size, -Medications such -usually no treatment if
atrial earlier than expected. It occurs caffeine, tobacco, shape, or direction. P wave as beta blockers or asymptomatic
contraction in addition to the patients and alcohol is usually upright (often calcium blockers -Treat underlying
underlying rhythm -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
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).
4. Third-degree There is no conduction of -Ischemia of AV -P waves: Normal - Cardiac pacing -Detect and document
heart block stimuli from the atria to the node or -PR interval: Varies greatly, dysrhythmia
ventricles. Instead, the atria compression of AV no constant relationship
and ventricles beat bundle between P waves and QRS.
independently of each other. -Acute inferior and -Rhythm:
The atria usually continue to be anterior MI Regular atrial rhythm;
paced by the sinus node while -Drug toxicity regular ventricular rhythm.
the ventricles are paced by an (digitalis, beta- -Rate: Ventricular rate is
escape pacemaker located in blockers, calcium between 40 to 60
the AV node or in the channel blockers) beats/minute if paced by AV
ventricles. -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).
1. Junctional Is a dysrhythmia originating in - Digitalis toxicity -P waves: Before (inverted), - Atropine to - Treatment is rarely
Rhythm the AV junctional tissue at a - Following during, or after QRS. increase the heart required
rate of its inherent pacemaker. inferior myocardial -PR interval: Short, usually beat
Occurs as an escape or safety infarction due to 0.10 second or less.
mechanism when higher disruption of blood -Rhythm: Regular
pacemakers are not functioning supply to the AV -Rate: 40 to 60 beats/minute
or if their impulses are not node -QRS complex: Normal
getting through the AV node. - Heart failure (0.04 to 0.10 seconds)
2. Accelerated It is an arrhythmia originating - Digitalis toxicity -P waves: Before (inverted), -Artificial -Monitored with EKGs
Junctional in AV junction. The term - Following during, or after QRS. pacemaker -give oxygen
Rhythm accelerated denotes a inferior myocardial -PR interval: Short, usually -give drugs like -monitor blood
Rhythm that occurs at a rate infarction due to 0.10 second or less. atropine, Digibind pressure.
that exceeds the inherent disruption of blood -Rhythm: Regular (removes digoxin), -Treat underlying cause
junctional escape rate of 40 supply to the AV -Rate: 60 to 100 or the seizure drug
60, but is not fast enough to be node beats/minute phenytoin.
junctional tachycardia. - 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
-Rate: Variable; usually
-QRS complex: Normal
(0.04 to 0.10 seconds)
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
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
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

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