Atrial Dysrhythmias

TYPE OF DYSRHYTHMIA ECG CHARACTERISTICS CAUSES SIGNS & SYMPTOMS TREATMENT

1. Premature atrial contractions - Rate = normal  Emotional stress - Palpitations - Usually requires no
- Rhythm = irregular  Physical fatigue - Missed or skipped treatment
 Caffeine heartbeat - Pt. must avoid of alcohol,
- P wave = P wave may  Tobacco - Chest pain or
caffeine, smoking, stress
be seen or may be  Alcohol - Beta-blockers may help
hidden in the T wave shortness of breath in decreasing the
 Anxiety
- Lightheadedness, amount of PACs
 Inflammation
- QRS = normal dizziness, or feeling
 Infection
- ST = normal faint
 EI, meds, hypoxia
- PR = may be shorter but - Tiredness with
still WNL exercise or activity

2. Supraventricular Tachycardia - Rate = (atrial) 100-280  Substance abuse - Palpitations - Some are spontaneously
(AV node required) bpm (alcohol, nicotine, - Chest pain resolved
- Rhythm = regular caffeine) - Shortness of breath - Treatment varies with
 Meds - Dizziness
the severity of
- P wave = none (T wave  Stress, anxiety manifestations
takes over P wave)  CAD (Coronary - Valsalva maneuver
Artery Disease) - O2 if needed
- QRS = normal  MI - Carotid massage before
PSVT – paroxysmal SVT occurs - ST = may be hard to  Cardiomyopathy meds
intermittently; initiated with PAC and see  Cor pulmonale - May need cardioversion
terminated suddenly with or w/o - PR = not measurable (heart failure from to correct dysrhythmia
intervention lung disease) - Meds (adenosine,
 Hypokalemia verapamil, beta blocker)

3. Atrial flutter - Rate = atrial: 250-350 May be seen in pts. w/: - Chest pains - Synchronized
bpm; ventricular: 75-  Rheumatic or - Shortness of breath cardioversion
150 bpm ischemic heart dse. - Low BP - Beta blockers
- Rhythm = regular (can  CHF - Ca channel blockers
be irreg)  AV valve dse. - Anti-dysrhythmic
 Septal defects (amiodarone)
recurring, regular, sawtooth-shaped - P wave = Saw-toothed  Alcohol - Anticoagulants
flutter (F) waves that originate from a shape: these waves are  Thyrotoxicosis - Digitalis
single ectopic focus referred to as F waves;  Pulmonary
f waves 2 for every embolism
QRS (2:1 or 3:1)

- QRS = may be normal

or abnormal, or absent
- PR = not measurable
 4. Atrial fibrillation - Rate = atrial: 300-600  Thyrotoxicosis - palpitations - Ca channel blocker
bpm; ventricular: 100- (thyroid storm) - chest pain (diltiazem)
180 bpm  alcohol intoxication - fainting - Beta-blocker
- Rhythm = irregularly  caffeine use (not - cardiomyopathy - Digoxin
irregular directly causes a- - Cardioversion
fib) - Radiofrequency
- P wave = none due to  EI catheter ablation
chaotic atrial activity  stress - Maze procedure
{Fibrillatory (f) waves}  cardiac surgery - Anticoagulants

- QRS = WNL (may be

abnormal)
- PR = not measurable
- ST = slight depression
Junctional Arrhythmias
- Rate = 40-60 bpm  Idiopathic but it is - Usually without - Clients are usually
(impulse originating in due to abnormality significant loss of asymptomatic, and no
AV node) in depolarization cardiac output; interventions are
- Rhythm = regular or that arises from His however, clients with warranted
AV nodes in junctional area acts as an irreg purkinje system underlying diseases - Teach pt. to get up
escape pacemaker instead of SA node  Substance abuse may become slowly
- P wave = inverted or  Stress & anxiety symptomatic - Atropine or pacemaker
absent  Hyperthyroidism, depending upon the could help
CAD, hypoxia, MI, # of ectopic beats
- QRS = narrow heart failure - A racing or fluttering
- ST = normal  Digitalis toxicity heart
- PR = <.12 sec - Shortness of breath
- Sweating
- Headache
- Dizziness or
lightheadedness
- Fainting

Ventricular Arrhythmias
1. Premature ventricular contraction - Rate = depends on Maybe seen in pts. w/: - Most are often - Treat if asymptomatic in
underlying rhythm  MI asymptomatic presence of severe
(impulse originating in R  Chronic hypoxemia - Palpitations, heart dse
or L ventricle)  Chronic airway fluttering - Pt. must avoid alcohol,
- Rhythm = regular or limitation - Lightheadedness nicotine, caffeine
irreg  Hypokalemia or * rarely cause problems - Beta-blockers
hypomagnesemia unless they occur again - Class I or III
- P wave = ectopic beat  Administration of and again over a long antidysrhythmics
not preceded by P wave catecholamines period of time (amiodarone)
  Acidosis
- QRS = narrow or wide,  Anesthetic
bizzare  Infection
*occurs in repetitive rhythms (bigeminy,
- ST = can’t be evaluated  Trauma/surgery
PR = absent w/ PVC
trigemini or quadrigeminy); maybe
unifocal or multifocal

2. Ventricular Tachycardia - Rate = 100-250 bpm May be seen in pts. w/: - Hemodynamic - Treat if sustained,
- Rhythm = regular  MI compromise symptomatic or assoc.
 Cardiomyopathy - Low cardiac output w/ heart dse.
- P wave = not identifiable  Hypokal/hypomag - Shortened - O2 administration
 Valvular dse. ventricular filling time - Cardioversion
- QRS = wide & narrow  Drug toxicity resulting to - IV procainamide,
- ST = hard to determine  Ventricular decreased lidocaine, amiodarone,
- PR = not measurable aneurysm oxygenation sotalol if hemodynamic
(breathing problems, instability occurs
decreased LOC) - Surgical ablation
- May lead to v-fib if - Implanted cardioverter-
untreated defibrillator if repeated
episodes occur
3. Ventricular fibrillation - Rate = indistinguishable  Cardiac injury - Chest pain - Immediate
- Rhythm = chaotic (CAD, MI, valvular - ↓O2sat cardioversion/
dse) - Lethargy - Defibrillation
- P wave = none  Med toxicity - Loss of - CPR
(digoxin) consciousness - Airway management
- QRS = none, or wide &  Electrical - Anxiety - Oxygen
bizarre imbalances - Palpitations - Antidysrhythmics
*ventricles not pumping O2-rich blood to - PR = none (due to no  Unsuccessfully - Shortness of breath - Epinephrine
body due to no cardiac output atrial contraction) - Elevated HR - Emergency!!
treated V-tach,
acid-base, electric - Dizziness
shock
4. Ventricular Asystole - Complete absence of  May result from - No contraction - Goal: restore cardiac
any ventricular rhythm myocardial hypoxia - No cardiac output electrical activity
- No QRS w/c may be a - No pulse - CPR
- No P wave consequence of a - DO NOT shock asystole
- Pt. is in full cardiac more advanced - Airway management
arrest heart failure - Atropine and
 Severe epinephrine
hyperkalemia and administration
acidosis - Prognosis of asystole is
poor
- HCP could terminate
resuscitation efforts if
there’s no response