Download Heart Dysrhythmias Cheat Sheet and more Cheat Sheet Cardiology in PDF only on Docsity!
Heart Dysrhythmias/Arrythmias
Arrythmia s Description Causes Treatment Sinus Arrhythmi a Irregular atrial and ventricular rhythms. Normal P wave preceding each QRS complex. Normal variation of normal sinus rhythm in athletes, children, and the elderly. Can be seen in digoxin toxicity and inferior wall MI. Atropine if rate decreases below 40 bpm. Sinus Tachycard ia Atrial and ventricular rhythms are regular. Rate > 100 bpm. Normal P wave preceding each QRS complex. Normal physiologic response to fever, exercise, anxiety, dehydration, or pain. May accompany shock, left- sided heart failure, cardiac tamponade, hyperthyroidis m, and anemia. Atropine, epinephrine, quinidine, caffeine, nicotine, and alcohol use. Correction of underlying cause. Beta- adrenergic blockers or calcium channel blockers for symptoma tic patients.
s Description Causes Treatment Sinus Bradycard ia Regular atrial and ventricular rhythms. Rate < 60 bpm. Normal P wave preceding each QRS complex. Normal in a well- conditioned heart (e.g., athletes). Increased intracranial pressure; increased vagal tone due to straining during defecation, vomiting, intubation, mechanical ventilation. Follow ACLS protocol for administra tion of atropine for symptoms of low cardiac output, dizziness, weakness, altered LOC, or low blood pressure. Pacemake r Sinoatrial (SA) arrest or block Atrial and ventricular rhythms normal except for missing complex. Normal P wave preceding each QRS complex. Pause not equal to multiple of the previous rhythm. Infection Coronary artery disease, degenerative heart disease, acute inferior wall MI. Vagal stimulation, Valsalva’s maneuver, carotid sinus massage. Treat symptoms with atropine I.V. Temporary pacemake r or permanent pacemake r if considered for repeated episodes.
s Description Causes Treatment very early or blocked PACs. P wave often buried in the preceding T wave or identified in the preceding T wave. sinus massage. Paroxysm al Supravent ricular Tachycard ia Atrial and ventricular rhythms are regular. Heart rate > 160 bpm; rarely exceeds 250 bpm. P waves regular but aberrant; difficult to differentiate from preceding T wave. P wave preceding each QRS complex. Sudden onset and termination of arrhythmia When a normal P wave is Physical exertion, emotion, stimulants, rheumatic heart diseases. Intrinsic abnormality of AV conduction system. Digoxin toxicity. Use of caffeine, marijuana, or central nervous system stimulants. If patient is unstable prepare for immediate cardioversi on. If patient is stable, vagal stimulatio n, or Valsalva’s maneuver, carotid sinus massage. Adenosine by rapid I.V. bolus injection to rapidly convert arrhythmia . If patient has normal ejection
s Description Causes Treatment present, it’s called paroxysmal atrial tachycardia; when a normal P wave isn’t present, it’s called paroxysmal junctional tachycardia. fraction, consider calcium channel blockers, beta- adrenergic blocks or amiodaron e. If patient has an ejection fraction less than 40%, consider amiodaron e. Atrial flutter Atrial rhythm regular, rate, 250 to 400 bpm Ventricular rate variable, depending on degree of AV block Saw-tooth s hape P wave configuration. QRS complexes uniform in shape but often irregular in rate. Heart failure, tricuspid or mitral valve disease, pulmonary embolism, cor pulmonale, inferior wall MI, carditis. Digoxin toxicity. If patient is unstable with ventricular rate > 150bpm, prepare for immediate cardioversi on. If patient is stable, drug therapy may include calcium channel blockers,
s Description Causes Treatment e. Anticoagul ation therapy to prevent emboli. Dual chamber atrial pacing, implantabl e atrial pacemake r, or surgical maze procedure may also be used. Junctional Rhythm Atrial and ventricular rhythms are regular. Atrial rate 40 to 60 bpm. Ventricular rate usually 40 to 60 bpm. P waves preceding, hidden within (absent), or after QRS complex; usually inverted if visible. Inferior wall MI, or ischemia, hypoxia, vagal stimulation, sick sinus syndrome. Acute rheumatic fever. Valve surgery Digoxin toxicity Correction of underlying cause. Atropine for symptoma tic slow rate Pacemake r insertion if patient is refractory to drugs Discontinu ation of digoxin if
s Description Causes Treatment PR interval (when present) < 0.12 second QRS complex configuration and duration normal, except in aberrant conduction. appropriat e. Premature Junctional Conjunctio ns Atrial and ventricular rhythms are irregular. P waves inverted; may precede be hidden within, or follow QRS complex. QRS complex configuration and duration normal. MI or ischemia Digoxin toxicity and excessive caffeine or amphetamine use Correction of underlying cause. Discontinu ation of digoxin if appropriat e. First- degree AV block Atrial and ventricular rhythms regular PR interval > 0.20 second. P wave preceding each QRS complex. Inferior wall MI or ischemia or infarction, hypothyroidis m, hypokalemia, hyperkalemia. Digoxin toxicity. Use of Correction of the underlying cause. Possibly atropine if PR interval exceeds
second or symptoma
s Description Causes Treatment block (complex heart block) regular. Ventricular rhythm regular and rate slower than atrial rate. No relation between P waves and QRS complexes. No constant PR interval. QRS interval normal (nodal pacemaker) or wide and bizarre (ventricular pacemaker). anterior wall MI, congenital abnormality, rheumatic fever. epinephrin e, and dopamine for symptoma tic bradycardi a. Temporary or permanent pacemake r for symptoma tic bradycardi a. Premature ventricula r contractio n (PVC) Atrial rhythm regular Ventricular rhythm irregular QRS complex premature, usually followed by a complete compensator y pause QRS complex wide and Heart failure; old or acute myocardial ischemia, infarction, or contusion. Myocardial irritation by ventricular catheters such as a pacemaker. Hypercapnia, hypokalemia, hypocalcemia. If warranted, procainam ide, lidocaine, or amiodaron e I.V. Treatment of underlying cause. Discontinu ation of drug
s Description Causes Treatment distorted, usually >0. second. Premature QRS complexes occurring singly, in pairs, or in threes; alternating with normal beats; focus from one or more sites. Ominous when clustered, multifocal, with R wave on T pattern. Drug toxicity by cardiac glycosides, aminophylline, tricyclic antidepressant s, beta- adrenergic. Caffeine, tobacco, or alcohol use. Psychological stress, anxiety, pain causing toxicity. Potassium chloride IV if PVC induced by hypokalem ia. Magnesiu m sulfate IV if PVC induced by hypomagn esaemia. Ventricula r Tachycard ia Ventricular rate 140 to 220 bpm, regular or irregular. QRS complexes wide, bizarre, and independent of P waves P waves no discernible May start and stop suddenly Myocardial ischemia, infarction, or aneurysm Coronary artery disease Rheumatic heart disease Mitral valve prolapse, heart failure, cardiomyopath y Ventricular catheters. If pulseless : initiate CPR; follow ACLS protocol for defibrillati on. If with pulse : If hemodyna mically stable, follow ACLS protocol
s Description Causes Treatment ventricular rate or rhythm. No discernible P waves, QRS complexes, or T waves ischemia or infarction, aortic valve disease, heart failure, hypoxemia, hypokalemia, severe acidosis, electric shock, ventricular arrhythmias, AV block, pulmonary embolism, heart rupture, cardiac tamponade, hyperkalemia, electromechan ical dissociation. Cocaine overdose.
