Relias Dysrhythmia Basic Test Answers

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normal sinus rhythm
normal sinus rhythm
heart rhythm originating in the sinoatrial node with a rate in patients at rest of 60 to 100 beats per minute
Sinus Arrhythmia
Sinus Arrhythmia
Appearance is ALMOST NORMAL:
Respiratory – Circulatory interaction
Rate INCREASES with INSPIRATION (IN=IN)
Sinus Bradycardia
Sinus Bradycardia
<60
normal sinus rhythm
Sinus Tachycardia
Sinus Tachycardia
>100 (100-150)
normal sinus rhythm
Premature Atrial Contraction (PAC)
Premature Atrial Contraction (PAC)
Heart Rate: Depends on underlying rhythm
Regularity: Interrupts the regularity of underlying rhythm
P-Wave: can be flattened, notched, or unusual. May be hidden within the T wave
PRI: measures between .12-.20 seconds and can be prolonged; can be different from other complexes
QRS: <.12 seconds
Sinus Arrest/Pause
Sinus Arrest/Pause
– SA node doesn’t fire
– notice absence of P-wave for a complete cycle (a missed cycle)
length of pause ≠ multiple of normal rate (block)
Atrial Fibrillation (A-Fib)
Atrial Fibrillation (A-Fib)
an irregular and often very fast heart rate originating from abnormal conduction in the atria
Atrial Flutter
Atrial Flutter
irregular beating of the atria; often described as “a-flutter with 2 to 1 block or 3 to 1 block”
Junctional Rhythm
Junctional Rhythm
40-60 Regular!
-impulse from AV node w/ retro/antegrade transmission
– P wave often inverted/buried/follow QRS
– slow rate
– narrow QRS (not wide like ventricular)
Junctional Tachycardia
Junctional Tachycardia
>60 bpm (ms. K; 150-250)
– KEY: will be regular (consistent)
– AV junction produces a rapid sequence of QRS-T cycles
– p-wave often inverted/buried/follow QRS
Premature Junctional Contraction
Premature Junctional Contraction
Inverted p wave or hidden p wave
PRI<0.12 or none
Normal QRS
Supraventricular Tachycardia (SVT)
Supraventricular Tachycardia (SVT)
an abnormal heart rhythm arising from aberrant electrical activity in the heart; originates at or above the AV node
First degree heart block
First degree heart block
atrioventricular (AV) block in which the atrial electrical impulses are delayed by a fraction of a second before being conducted to the ventricles
2nd degree heart block type 1 (Wenkebach)
2nd degree heart block type 1 (Wenkebach)
Progressively longer PR interval until the P wave is not followed by a QPR
2nd Degree Heart Block (Mobitz II)
2nd Degree Heart Block (Mobitz II)
Rare, but more serious
Sudden appearance of a nonconducted P-wave
P-waves are nl, but some aren’t followed by a QRS complex
PR & RR intervals are constant
3rd degree heart block
3rd degree heart block
no obvious correlation between p and qrs, need pace maker
premature ventricular contraction (PVC)
premature ventricular contraction (PVC)
a ventricular contraction preceding the normal impulse initiated by the SA node (pacemaker)
Bigeminy PVC
Bigeminy PVC
every other beat is a PVC
PVC couplets
PVC couplets
PVC occurring in pairs, no adequate C.O. when this occurs
monomorphic ventricular tachycardia
monomorphic ventricular tachycardia
presents with wide QRS complexes of a common shape.
Torsades de pointes
Torsades de pointes
Rate: 120 – 200 usually
P wave: Obscured by ventricular waves
QRS: Wide QRS – “Twisting of the Points”
Conduction: Ventricular only
Rhythm: Slightly irregular
Ventricular fibrillation (V-fib)
Ventricular fibrillation (V-fib)
abnormal heart rhythm which results in quivering of ventricles
Idioventricular Rhythm
Idioventricular Rhythm
<40
*looks like vtach but slow*
– no P waves (from vent foci)
– Wide QRS
(serious, death like rhythm)
– called “dying heart” rhythm…occasional ventric beat b4 death (asystole)
Accelerated Idioventricular Rhythm
Accelerated Idioventricular Rhythm
Rate: 50 – 100 usually (usually slow)
P wave: Obscured by ventricular waves (occur during ventricular contraction) – SA node slower than faster ventricular pacing than should be
QRS: Wide QRS
Conduction: Ventricular only
Rhythm: Regular- benign rhythm that is sometimes seen during acute MI or early after reperfusion. – Rarely sustained, does not progress to vfib, rarely requires treatment
asystole
asystole
absence of contractions of the heart
Failure to capture (pacemaker)
Failure to capture (pacemaker)
failure to sense (pacemaker)
failure to sense (pacemaker)
Atrial paced rhythm
Atrial paced rhythm
spike before P wave
Ventricular paced rhythm
Ventricular paced rhythm
ventricular contractions which occur in cases of complete heart block.
Normal sinus rhythm
Normal sinus rhythm
Regular
Rate: 60-100
P Wave: Present, upright
PR Interval: 0.12-0.20 sec
QRS: <0.12 sec
Sinus Bradycardia
Sinus Bradycardia
Regular
Rate: <60
P Wave: Present, upright
PR Interval: 0.12-0.20 sec
QRS: <0.12 sec
Sinus Tachycardia
Sinus Tachycardia
Regular
Rate: 100-150
P Wave: Present, upright
PR Interval: 0.12-0.20 sec
QRS: <0.12 sec
Premature Atrial Contraction
Premature Atrial Contraction
IRREGULAR
Rate: depends on underlying rhythm
P wave: Present or hidden in T wave
PR Interval: 0.12-0.20 sec
QRS: <0.12 sec
Atrial Fibrillation
Atrial Fibrillation
IRREGULAR
Atrial rate: UNMEASURABLE
Ventricular rate: variable
P wave: unable to see
PR Interval: N/A
QRS: <0.12 sec
A fib RVR
A fib RVR
IRREGULAR
Ventricular rate: 100-175
P wave: unable to see
PR Interval: N/A
QRS <0.12 sec
Atrial Flutter
Atrial Flutter
Usually REGULAR can be irregular
Atrial rate: 250-350
Ventricular rate: variable BUT < atrial rate
P Wave: Flutter
PR Interval: N/A
QRS: <0.12 sec
Supraventricular Tachycardia
Supraventricular Tachycardia
Regular
Rate: 150-350
P wave: Hidden in QRS or T wave
PR: unable to determine
QRS: <0.12 sec
Junctional Rhythm
Junctional Rhythm
Regular
Rate: 40-60
P Wave: ABSENT or INVERTED
PR Interval: None or <0.12
QRS: <0.12 sec
Accelerated Junctional Rhythm
Accelerated Junctional Rhythm
Regular
Rate: 60-100
P Wave: NONE or INVERTED
PR Interval: None or <0.12
QRS: <0.12 sec
Junctional Tachycardia
Junctional Tachycardia
Regular
Rate: >100
P Wave: NONE or INVERTED
PR Interval: None or <0.12
QRS: <0.12 sec
Premature Ventricular Contraction
Premature Ventricular Contraction
IRREGULAR
Rate: refer to underlying rhythm
P Wave: NONE
PR Interval: N/A
QRS: WIDE and BIZARRE , >0.12 sec
Ventricular Tachycardia
Ventricular Tachycardia
Regular
Rate: >100
P Wave: NONE
PR Interval: N/A
QRS: WIDE and BIZARRE, >0.12 sec
Ventricular Fibrillation
Ventricular Fibrillation
Chaotic
Coarse: big waves
Fine: small waves
Rate: unmeasurable
P Wave: NONE
PR Interval: N/A
QRS: N/A
Idioventricular
Idioventricular
Regular
Rate: 20-50
P wave: NONE
PR Interval: N/A
QRS: WIDE, >0.12 sec
Accelerated Idoventricular Rhythm
Accelerated Idoventricular Rhythm
Regular
Rate: 50-100
P wave: NONE
PR Interval: N/A
QRS: WIDE, >0.12 sec
1st Degree AV Block
1st Degree AV Block
Regular
Rate: 60-100
P Wave: Present, upright
PR interval: >0.20 sec CONSISTENTLY LONG
QRS: <0.12 secHusband stays late till 9 consistently
2nd Degree AV Block Type I Mobitz, Wenckebach
2nd Degree AV Block Type I Mobitz, Wenckebach
IRREGULAR
Rate: 60-100
P wave: Present, upright
PR Interval: Progressively longer until drop (PR interval longer and longer until drop)
QRS: <0.12 secHusband stays late till 9, then 11, then 1, then doesn’t come home at all
2nd Degree AV Block Type II
2nd Degree AV Block Type II
Irregular or regular
Rate: <60
P wave: Present, upright
PR Interval: PR interval consistently LONGER like type 1 but then a QRS will drop
QRS: <0.12 secHusband stays late till 9 consistently, then wife goes out and doesn’t come home
3rd Degree AV Block
3rd Degree AV Block
Atrials and ventricles don’t communicate
Rate: regular atrial
P wave: Present, upright
No relationship between P waves and QRS
PR Interval: VARIABLE
QRS: variableP-P ad R-R consistent but NO correlationHusband and wife live separate lives and don’t communicate
SA Node
1st
60-100
AV Node
2nd
40-60
Bundle of His
3rd
40-45
Right and Left Bundle Branches
4th
40-45
Purkinje Fibers
5th
20-50
1 Small Box
0.04 sec
1 Big Box
0.20 sec
Junctional Rhythms
SA Node DID NOT FIRE
AV Node fired
NO P WAVE bc SA node didn’t fire
Narrow QRS
P Wave
Amplitude 0.5-2.5 mm
Will be shorter than T wave
Shows firing of SA node
QRS

0.06-0.10 sec SHOULD BE <0.12 sec

Wide QRS: delay in ventricular contraction, delay of conduction through bundle branches or purkinje fibers
BUNDLE BRANCH BLOCK or BLOCK IN PURKINJE FIBERS (idioventricular)

Calculate Regular Rate
1500/ # boxes R-R
Calculate Irregular Rate
# of Rs in 6 sec strip X 10
Unifocal PVCs
Unifocal PVCs
Only 1 shape PVC
Bigeminy
PVC occurs every OTHER beat
Trigeminy
PVC occurs every THIRD beat
Couplet
2 PVCs together
Triplet
3 PVCs together
Multifocal
Multiple shapes
Monomorphic V Tach
Monomorphic V Tach
Same Shapes V Tach
Polymorphic V Tach
Polymorphic V Tach
Different Shapes V tach
Coarse V Fib
Coarse V Fib
Chopy but not as high as polymorphic V tach
Fine V Fib
Fine V Fib
Fine and fibrillatory
Idioventricular Rhythms
Only purkinje fibers firing
WIDE QRS always
Atrially Paced
Spike comes before P
Ventricularly Paced
Spike comes before QRS and QRS will be wide
AV Paced
Spike before P and before QR
Failure to Capture
Failure to Capture
Spikes with no QRS
Failure to Sense
Failure to Sense
Spikes happen regardless of QRS on their own
How to determine the rhythm
Regular or irregular?
Rate?
P before every QRS? QRS for every P?
QRS wide or narrow?
QT Interval
0.34-0.43
P Wave
0.06-0.12 sec
PR Interval
0.12-0.20 sec
SA Node Firing Rhythms
*Fires normally @ 60-100*
-SR 60-100
-SB <60
-ST 100-150
-SVT 150-350
AV Node Firing, SA Node Failed Rhythms
*Fires normally @ 40-60*
-Junctional rhythm 40-60
-Accelerated junctional rhythm 60-100
-Junctional tachycardia 100-150
Only Purkinje Fibers Firing Rhythms (Everything else has failed)
*Fires normally @ 20-50*
-Idioventricular 20-50
-Accelerated idioventricular 50-100

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