Sinus bradycardia
-ECG: HR <60 bpm, rhythm regular
-S/sx: pale, cool skin; hypotension, weakness, angina, dizziness or syncope; confusion or
... [Show More] disorientation; and shortness of breath
Treat: atropine. if that's ineffective, transcutaneous pacing, or a dopamine or epi infusion
Sinus tachycardia
-ECG: HR 101-200 bpm, rhythm regular
-Treat: depends on underlying cause (treat pain if caused by pain)
-S/sx: dizziness, dyspnea, hypotension
-Associations: exercise, fever, pain, hypotension, hypovolemia, anemia, hypoxia, hypoglycemia, myocardia ischemia, heart failure, hyperthyrodism, anxiety, and fear
Premature atrial contraction (PAC)
-Contraction starting from an ectopic focus in the atrium and coming sooner than the next expected sinus beat
-ECG: HR varies, rhythm irregular. P wave has a different shape, or it may be hidden in the T wave
-S/sx: may report palpations or that heart "skipped a beat"
-Treat: b-blockers
-Associations: emotional stress, physical fatigue, tobacco, caffeine, or alcohol. Hypoxia, electrolyte imbalances, hyperthyroidism, COPD, heart disease
Paroxysmal supraventricular tachycardia (PSVT)
a dysrhythmia starting in an ectopic focus anywhere above the split of the bundle of His
-S/sx: prolonged episode and HR >180 bpm will cause decreased CO b/c of reduced stroke volume. Hypotension, palpations, dyspnea, and angina
Treat: vagal stimulation and drugs
-Associations: overexertion, emotional stress, deep inspiration, caffeine, and tobacco. Rheumatic heart disease, CAD, cor pulmonale
Atrial flutter
-Atrial tachydysrhythmia identified by recurring, regular, sawtooth-shaped flutter waves that originate from a single ectopic focus in teh right atrium
-ECG: atrial rate 200-300 bpm, regular. Ventricular rate ~150, regular
-Treat: b blockers and Ca channel blockers. radiofrequency catheter ablation.
-Associations: CAD, HTN, mitral valve disorders, pulmonary embolus, chronic lung disease, cor pulmonale, cardiomyopathy, hyperthyroidism, and the use of drugs like digoxin, quinidine, and epi
** these pts have increased risk for stroke
Atrial fibrillation
-Total disorganization of atrial electrical activity b/c of multiple ectopic foci, resulting in loss of effective atrial contraction
-ECG: atrial rate 350-600. P waves replaced by chaotic fibrillatory waves. Ventricular rhythm irregular
-Treat: Ca channel blockers, b-blockers, dronedarone, digoxin. Electrical cardioversion. If drugs or cardioversion doesn't work, long term Warfarin.
-Associations: usually develops in pt with underlying heart disease. Acutely develops with alcohol intoxication, caffeine use, electrolyte disturbances, cardiac surgery, and stress.
**results in decrease in CO. Thrombi form in the atria because of blood stasis. An embolized clot may develop and move to the brain, causing a stroke
Junctional dysrhythmia
-Start in the area of the AV node, they result because the SA node fails to fire or the signal is blocked
ECG: HR 40-60 (junctional escape) HR 61-100 (accelerated junctional). 101-180 (junctional tachycardia). Rhythm regular. P wave abnormal in shape and inverted, or may be hidden by QRS complex
-Treat: atropine
-Associations: CAD, heart failure, cardiomyopathy, electrolyte imbalances, inferior MI, and rheumatic heart disease
**they serve as a safety mechanism when the SA node hasn't been effective. accelerated junctional rhythm is due to sympathetic stimulation to improve CO
Ventricular fibrillation
-ECG: HR not measurable. Rhythm irregular and chaotic. P wave not visible, and the PR interval and QRS interval aren't measurable.
-Treat: immediate initiation of CPR and advanced cardiac life support with the use of efibrillation and definitive drug therapy
-Associations: occurs in acute MI and myocardial ischemia and in heart failure and cardiomyopathy. can occur in cardiac pacing or cardiac catheterization procedures. also electric shock, hyperkalemia, hypoxemia, acidosis, and drug toxicity
**results in unresponsive, pulseless and apneic state, if not rapidly treated, patient won't recover
Asystole
-The total absence of ventricular activity
-Treat: CPR with initiation of ACLS measures. These include definitive drug therapy with epi and/or vasopressin and intubation
-Associations: usually a result of advanced cardiac disease, a severe cardiac conduction system disturbance, or end-stage heart failure
**usually they have end-stage heart disease or has prolonged arrest and can't be resuscitated [Show Less]