THERE ARE 3 RHYTHMS THAT ORIGINATE IN THE SA NODE, WHICH IS THE PRIMARY PACEMAKER OF THE HEART.

Arrhythmia Rule S/S Causes Treatments

Normal Sinus Regularity: Regular
Rhythm Rate: 60-100bpm
P wave: Uniform shape
PRI: 0.12-0.20 sec
QRS: < 0.12 sec
Sinus Regularity: Regular -May be asymptomatic -↑ demand for O2 Treat the cause
Tachycardia Rate: >100-<150 bpm -May have chest discomfort -Anxiety,
P wave: Uniform shape -Palpitations -Atropine/Epinephrine
PRI: 0.12-0.20 sec -↓ BP or syncope -Caffeine, Smoking
QRS: <0.12 sec. -fatigue, -Anemia,
-weakness -Fever
-SOB, -Pain,
-Restlessness -Blood loss
-Pale cool skin -Exercise,
-Hypoxia,
*Can be dangerous in CAD pt b/c ST -Stress,
inc. the myocardial o2 demand in an -PE
already ailing heart. Can lead to heart
failure

Sinus Regularity: Regular Usually asymptomatic but may cause: -MI, -1st drug to give: OXYGEN
Bradycardia Rate: < 60 bpm -Syncope, -Hypoxia -HR <60 bpm and pt is symptomatic:
P wave: Uniform shape -Confusion, -Inferior wall MI Atropine IV push
PRI: 0.12-0.20 sec -Hypotension, -Sleeping *inc. SA node automaticity and
QRS: < 0.12 sec -SOB -Drugs such as: Mgso4, AV node conductivity
Dig, Ca**Blockers -Hold drugs that may be the cause:
-Athletes Morphine, Digoxin
-Prolonged suctioning of Pt may need pacemaker if the SB is Long
intubated pt. standing and symptomatic.
-Valsalva maneuver.
(colace)
Arrhythmia Rule S/S Causes Treatments
Atrial Flutter Regularity: Regular Pt can be asymptomatic is venticular -CAD, O2 1st
Rate: 250-350 bpm rate is WNL -Hypotension -CHF, Stable: meds will slow ventricle rate
*Single irritable P wave: Saw tooth pattern -Syncope, -MI, -Ibutilide (corvert)
focus within the PRI: Cannot measure -weakness, -Valve dz, -amiodarone (coradarone),
atria initiates QRS: <0.12 seconds -fatigue, -Alcoholism, -diltiazem (cardizem), digoxin (lanoxin)
rapid, repetitive -SOB, -PE,
impulses. -may have evidence of heart failure -Long term treatment- Digoxin (lanoxin)
HR >60 & Dig Level
-Monitor K, CA & Mg if dec. can cause digoxin
toxicity

Unstable:
synchronized cardioversion is the treatment of
choice, if detected early

Atrial Fibrillation Regularity: Atrial rate is not -↓BP, -MI, Stable: -Verapamil-Cardize
Rate: >350 bpm (atrial) -syncope, -HTN, *Meds do not treat A-fib keeps ventricle rate
P wave: to many to count -fatigue -CAD, decreased or WNL
*Many irritable PRI: Cannot measure -SOB, -Heart failure,
sites within atria QRS: < 0.12 sec. -Thyrotoxicosis, Amiodarone (cordarone) for difficult to control A-
fire repetitively, Can lead to CHF b/c heart is not -COPD, fib
causing pumping effectively, main concern -Rheumatic heart
ineffective atrial is thrombi formation which can disease Unstable: valsalva maneuver,
depolarization. lead to stroke or PE. that causes Mitral anticoagulate, Heparin
valve stenosis
Stroke S/S: synchronized cardioversion start w/ 100j
-Change in metation or LOC Risk factors for 4-6 wk anticoagulation therapy
AV node tries to
-Change in speech, AF: ECHO or TEE to rule out atrial clots
block most
-Sensory function -Long term HTN Hold Dig for 48hr bf CV.
impulses, so
-Motor function -Diabetes -dig inc. vent irritability and risk for v-fib
ventricle rate can
-Male
be slower or can
Pt. with Valve disease and A-fib are -CHF last resort:
be rapid b/c AV
esp. at risk for thromboemboli!!! -Valve disease Radiofrequency catheter ablation (burning)
node cannot
Either ablation of the pulmonary vein or the AV
block effectively
node, Zaps these sites, form scar tissue that
“blocks” the electrical impulse.

If AV node gets zapped then Pt would need

Permanent ventricle pacemaker
Arrhythmia Rule S/S Causes Treatments
PVC's Regularity Except for the PVC's -Dim Peripheral pulses -AMI, CHF, Treat the underlying cause
: Do not count PVC's -Decreased CO -Hypokalemia, May use:
Rate: Cannot see or measure -May c/o palpitations, -exercise, Lidocaine
P: Cannot see or measure -Decreased BP, -caffeine, Amiodarone
PRI: Wide and bizarre, -Syncope, -smoking, Potassium replacement if low K+ is cause
QRS: >.12sec -alcohol, Procainamide (Pronestyl)
T: Opposite direction, -COPD, What major side effect will you monitor?
-trauma,
-pacemaker wire irritation. Three or more PVC's in a row is a run or
Unifocal: Look the same ventricular tachycardia
Multifocal: Look different >Post menopausal women find that
Couplets: 2 PVC's together caffeine causes palpitations and > If >7PVC's, give Lidocaine bolus, followed
PVC's by a drip

Ventricular Regularity: Can be Decr. In CO, thus BP, -MI, Stable V-tach:
Tachycardia Rate: 150-250 bpm -Organic heart disease, -O2,
P: Cannot see *Eventually patient will -Drug overdose, -Amiodarone,
PVC's run PRI: Cannot measure become unresponsive -Hypokalemia, -Cardiomyopathy, -lidocaine
together QRS: >0.12 sec Wide & Bizarre -Can be triggered by PVC's -synchronized cardioversion.
T: Cannot see, or in opposite (if V tach on monitor)
*a single direction from R wave
irritable focus Unstable V-tach: (pt is unresponsive)
within the -O2,
ventricles fires -CPR,
very rapidly, -d-fib
thus overriding -Epinephrine
higher sites for -Amiodarone
control of the -Procainamide (Pronestyl)
heart
Treatment Must be immediate.
-Vtach can progress quickly to V-fib.
-Give Amiodarone (early)
-Synchronized cardioversion (early)
-Prepare for a “CODE”
*If pulseless, begin CPR and give Epinephrine
Epinephrine primes the heart and increases HR
and contractility
Arrhythmia Rule S/S Causes Treatments
Ventricular Regularity: Irregular chaotic -Unresponsiveness, -Untreated V tach, Start CPR, call code,
Fibrillation Rate: Cannot measure -No pulses -AMI, PRIORITY TREATMENT
P: -No breathing -hypokalemia, hypomagnesia d-fib (unsynchronized defibrillation)
Life Threatening PRI: -No heart sounds -massive hemorrhage, Shock once then CPR if no change
“a dying heart” QRS: -trauma,
CO falls to 0 -electrical shock, Drugs for V-fib
*Multiple foci in Just hanging on!! -cardioversion gone bad Vasopressin (One time Shot in the pants)
the ventricles Epinephrine
become irritable *R on T phenomenon Amiodarone
and generate (R wave hits on the T wave) Pronestyl
uncoordinated, Lidocaine
chaotic
impulses that
cause the heart
to fibrillate
rather than
contract.

Asystole Flat Line No electrical activity AMI, PEAT

from the heart at all massive cardiac hypoxia, Pacer
Full cardiac severe hyperkalemia, Epinepherine (1st line drug)
arrest cardiac tamonade, Atropine
massive trauma, Terminate
hemorrhage,
PE,
electric shock,
cocaine overdose
Arrhythmia Rule S/S Causes Treatments