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Questions and Answers
What is the typical heart rate for atrial tachycardia?
What is the typical heart rate for atrial tachycardia?
Which of the following can be a cause of sinus pauses?
Which of the following can be a cause of sinus pauses?
In atrial flutter, what is the characteristic appearance of P waves?
In atrial flutter, what is the characteristic appearance of P waves?
What treatment is commonly used for atrial tachycardia?
What treatment is commonly used for atrial tachycardia?
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What is the typical response of a patient during frequent sinus pauses?
What is the typical response of a patient during frequent sinus pauses?
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What is the characteristic QRS duration in atrial tachycardia?
What is the characteristic QRS duration in atrial tachycardia?
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In atrial flutter, how is the P:QRS ratio expressed?
In atrial flutter, how is the P:QRS ratio expressed?
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Which of the following medications may be considered for treating atrial tachycardia?
Which of the following medications may be considered for treating atrial tachycardia?
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What is the primary cause of atrial flutter?
What is the primary cause of atrial flutter?
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Which patient response can occur with atrial fibrillation?
Which patient response can occur with atrial fibrillation?
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Which of the following treatments is commonly recommended for atrial flutter?
Which of the following treatments is commonly recommended for atrial flutter?
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What is characteristic of junctional escape rhythm when the AV node impulse moves forward?
What is characteristic of junctional escape rhythm when the AV node impulse moves forward?
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What is the typical heart rate range for atrial fibrillation?
What is the typical heart rate range for atrial fibrillation?
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What important step should be taken before performing cardioversion for atrial fibrillation?
What important step should be taken before performing cardioversion for atrial fibrillation?
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Which of the following conditions is NOT a cause of atrial flutter?
Which of the following conditions is NOT a cause of atrial flutter?
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What is an expected finding in the PR interval of atrial fibrillation?
What is an expected finding in the PR interval of atrial fibrillation?
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What is a common cause of junctional escape rhythm?
What is a common cause of junctional escape rhythm?
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What is the main characteristic of multifocal PVCs?
What is the main characteristic of multifocal PVCs?
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Which condition is considered more dangerous when dealing with PVCs?
Which condition is considered more dangerous when dealing with PVCs?
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What treatment option is commonly used for symptomatic bradycardia in junctional escape rhythm?
What treatment option is commonly used for symptomatic bradycardia in junctional escape rhythm?
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Which of the following is NOT a common cause of PVCs?
Which of the following is NOT a common cause of PVCs?
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What waveform is absent or altered in junctional escape rhythm?
What waveform is absent or altered in junctional escape rhythm?
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What describes ventricular tachycardia?
What describes ventricular tachycardia?
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What is the characteristic PR interval range in junctional escape rhythm?
What is the characteristic PR interval range in junctional escape rhythm?
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Which dysrhythmia is characterized by a heart rate greater than 100 bpm?
Which dysrhythmia is characterized by a heart rate greater than 100 bpm?
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What is the normal heart rate range for Sinus Rhythm?
What is the normal heart rate range for Sinus Rhythm?
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Which step is NOT part of the systematic ECG rhythm analysis?
Which step is NOT part of the systematic ECG rhythm analysis?
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Which of the following is NOT a common cause of Sinus Tachycardia?
Which of the following is NOT a common cause of Sinus Tachycardia?
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In the context of ECG interpretation, what does a normal PR interval indicate?
In the context of ECG interpretation, what does a normal PR interval indicate?
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What is the P:QRS ratio in a normal Sinus Rhythm?
What is the P:QRS ratio in a normal Sinus Rhythm?
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Which type of dysrhythmia originates from the atria?
Which type of dysrhythmia originates from the atria?
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Which of the following is an accurate description of Sinus Pauses?
Which of the following is an accurate description of Sinus Pauses?
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Which of the following is a common cause of sinus bradycardia?
Which of the following is a common cause of sinus bradycardia?
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What is a potential patient response to decreased cardiac output?
What is a potential patient response to decreased cardiac output?
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Which treatment is recommended for symptomatic sinus bradycardia?
Which treatment is recommended for symptomatic sinus bradycardia?
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In sinus arrhythmia, how is the heart rate typically affected?
In sinus arrhythmia, how is the heart rate typically affected?
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What is the expected regularity of sinus pauses during the period of the pause?
What is the expected regularity of sinus pauses during the period of the pause?
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Which of the following medications may cause bradycardia?
Which of the following medications may cause bradycardia?
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What is the P:QRS ratio typically observed in sinus bradycardia?
What is the P:QRS ratio typically observed in sinus bradycardia?
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Which symptom is NOT typically associated with decreased coronary artery perfusion?
Which symptom is NOT typically associated with decreased coronary artery perfusion?
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Study Notes
Dysrhythmia of the SA Node
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Sinus Tachycardia
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Rate: >100 bpm
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Regularity: regular
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P waves: normal
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PR interval: normal/less
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QRS duration: normal
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ST segment: isoelectric
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P:QRS ratio: 1:1
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Causes: stimulation of the sympathetic nervous system, response to fear, pain, or anxiety, hyperthyroidism, heart failure, anemia, exercise, stimulants (caffeine, decongestants, stress, and pain), high temperature (fever), and alterations in fluid status (hypovolemia)
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Patient response: Decreased ventricular filling time -> Low cardiac output, Decrease coronary filling during diastole
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Treatment: Treat the underlying cause, for example, pain medications are administered to treat pain or antipyretics are given to treat fever, no medication is given to slow down the heart rate.
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Sinus Bradycardia
- Rate: <60 bpm
- Regularity: regular
- P waves: normal
- PR interval: normal
- QRS duration: normal
- ST segment: isoelectric
- P:QRS ratio: 1:1
- Causes: athletes, increased vagal stimulation (parasympathetic nervous system), drug effects e.g., digoxin, or AV nodal blocking agents, including calcium channel blockers and beta-blockers; or (sometimes, a desired result), myocardial infarction (MI), SA node diseases, hypoxemia and hypothermia, and increased intracranial pressure
- Patient response: Decreased cardiac output -> hypotension -> decrease organ perfusion
- Treatment: Treat the underlying cause, assess for hemodynamic instability related to the bradycardia. If the patient is symptomatic, administer atropine and/ or TCP (transcutaneous pacing) when symptomatic bradycardia.
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Sinus Arrhythmia
- Rate: May be normal
- Regularity: irregular
- P waves: normal
- PR interval: normal/abnormal
- QRS duration: normal
- ST segment: isoelectric
- P:QRS ratio: 1:1
- Patient response: This rhythm is tolerated well.
- Treatment: No treatment is required.
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Sinus Pauses
- Rate: May be normal
- Regularity: Irregular for the period of the pause, but regular when sinus rhythm resumes.
Dysrhythmia of the Atria
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Atrial Tachycardia
- Rate: 150 - 250 bpm
- Regularity: regular
- P waves: merged with the T wave if present
- PR interval: not measurable
- QRS duration: normal/less
- Causes: Patients with cardiac diseases, could occur in healthy patients, electrolyte imbalance, digitalis toxicity, ischemic heart disease, valvular abnormalities, lung disease.
- Patient response: Low cardiac output, life-threatening.
- Treatment: Assessing patient tolerance to tachycardia, cardioversion, medications include adenosine, beta-blockers, calcium channel blockers, and amiodarone.
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Atrial Flutter
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Rate: Atrial rate (250 to 350 bpm), Ventricular rate (varies)
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Regularity: Regular
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P waves: Classic saw-tooth in leads II, III, and a VF
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PR interval: Unmeasurable
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QRS duration: Normal to wide
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P:QRS ratio: No. of P waves: 1
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Arises from a single irritable focus in the atria.
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Causes: hyperthyroidism, hypoxemia, ischemic heart disease, heart failure, lung disease, alcoholism.
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Patient response: Asymptomatic, fast ventricular rate could result in low cardiac output.
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Treatment: Anticoagulation therapy, cardioversion done after receiving anticoagulation for 6 weeks, electrophysiological treatment (ablation of the irritable focus).
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Atrial fibrillation
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Rate: Atrial (indiscernible from 350 to 500 bpm), Ventricular (varies)
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Regularity: Irregular
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P waves: Absent (fine waves)
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PR interval: Unmeasurable
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QRS duration: Normal/wide
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Arises from multiple ectopic foci in the atria, causing chaotic quivering of the atria and ineffectual atrial contraction.
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Most common rhythm with clinical importance
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Erratic impulses formation throughout the atria.
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Causes: Hyperthyroidism, valvular disease, ischemic heart disease, heart failure, lung disease.
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Patient response: Patient may or may not be aware of atrial fibrillation, fast ventricular rate could result in low cardiac output.
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Treatment: Anticoagulation therapy, cardioversion done after receiving anticoagulation for 4 to 6 weeks, emergent cardioversion is done if hemodynamically unstable, electrophysiological treatment (ablation of the irritable focus).
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Dysrhythmia of the AV node
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Junctional Escape Rhythm
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Rate: 40 to 60 bpm.
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Regularity: Regular.
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P wave: Absent/inverted/following QRS.
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PR interval: Normal to short.
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QRS: Normal.
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ST segment: Isoelectric.
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Occurs when the dominant pacemaker (SA node) fails to fire.
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Causes: Loss of SA node activity.
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Patient response: Assessed for tolerating bradycardia
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Treatment: Administer atropine and/ or TCP (transcutaneous pacing), dopamine infusion, or epinephrine when symptomatic bradycardia.
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Dysrhythmia of the Ventricles
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PVCs (Premature Ventricular Contractions)
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Early beats that interrupt the underlying rhythm.
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They can arise from a single ectopic focus or from multiple foci within the ventricles.
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Unifocal PVCs: Arise from a single irritable focus.
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Multifocal PVCs: Arise from multiple irritable foci.
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PVC Patterns:
- Bigeminy: Every other beat is a PVC
- Trigeminy: Every third beat is a PVC
- Quadrigeminy: Every fourth beat is a PVC
- Couplet: Two consecutive PVCs
- Pairs: Two or more consecutive PVCs
- Triplet: Three consecutive PVCs
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Causes: Hypokalemia, hypomagnesemia, hypoxemia, acid-base imbalance, ischemic heart disease.
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Patient response: May be experienced as palpitations. Patients may become symptomatic if the PVCs occur frequently.
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Treatment: Treat the underlying cause.
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When are PVCs Dangerous?
- Frequent
- Multifocal
- Two or more in a row
- R on T: PVC falls into the vulnerable period of the T wave, ventricular tachycardia, or fibrillation can result.
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Ventricular Tachycardia (VT)
- Rapid, life-threatening dysrhythmia originating from a single ectopic focus in the ventricles.
- Rate: Usually > 100 bpm.
- Patient response: Reduced cardiac output, decreased BP, palpitations, syncope or sudden death
- Treatment:
- For stable VT: Medications (amiodarone, lidocaine, procainamide), electrical cardioversion
- For unstable VT: Immediate defibrillation
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Description
This quiz covers the key aspects of dysrhythmia related to the SA node, focusing on sinus tachycardia and sinus bradycardia. Understand the characteristics, causes, patient responses, and treatments for these conditions. Test your knowledge and enhance your understanding of cardiac rhythm disorders.
