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Sinus arrhythmia
- Irregular rhythm
- Coincides with phases of resperation
- Common in kids and athletes
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Sinus Tachycardia
- Rate= 100-160
- Tx=none unless symptomatic - tx cause; carotid sinus massage (allows you to see Pwaves); Drugs= adenosine, verapamil, digoxin
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Sinus Bradycardia
- Rate=<60
- Tx: if pt is symptomatic tx cause; Drug of choice is Atropine IVP (.5-1mg); Transcutaneous pacing
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First Degree Heart Block (A-V block)
- PR intv= >.20
- Cause: impulse delayed in atria - MI, digoxin toxicity, ischemia, BB, CCB, CAD, hyperkalemia, rheumatic fever
- Tx: Monitor, correct underlying cause
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Third degree Heart Block- Complete Heart Block (CHB)
- Atrial rate exceed Ventricular rate; QRS wide and bizzare ; PR variable
- Cause: digoxin, inderal, CAD, increase vagal tone, inferior MI, acute myocarditis, electrolyte imbalance
- Tx: Pacemaker; Atropine IVP or Isuprel drip
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Atrial Flutter
- Rate=240-360 (usually 300)
- P wave= abnormal with saw-tooth appearance
- Cause: rheumatic or ischemic disease, HF, AV valve disease, pre-excitation syndrome, septal defects, pulmonary emboli, thyrotoxicosis, alcoholism, pericarditis
- Tx: Admin 02; Digoxin, amiodarone, cardizem to slow rapid vent response, anticoag
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Atrial fibrillation
- Rhythm= grossly irregular
- Rate=400-600
- Pwave= NONE, fibrillatory waves
- Cause: HTN, DM, male, CHF, valve disease, alcohol, cardiac surgery, MI, pericarditis, myocarditis, pulm embolism
- Tx: Antidysrhythmic (CCB-cardizem, amiodarone); Anticoag (Lovanox, Coumadin); Cardioversion
- **Observe for clot formation
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Premature Atrial Contraction (PAC)
- Rhythym= reg except PAC
- P wave= may be hidden in preceding T wave
- (looks like beat comes too soon)
- Cause: rheumatic heart disease, mitral stenosis, early sign of CHF, MI, stimualants
- Tx: Usually none. Pronestyl or Quinidine to increase refractoriness of atrium
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Premature Ventricular Contraction (PVC)
- Rhythym=irregular d/t premature beat
- QRS= wide and bizzare!
- MCLI best lead to see
- Cause: hypoxia, hypokalemia, ischemia, mi, stimulants, proarrhytmic meds
- Tx: when seen with bradycardia as escape beats/ >6bpm, multifocal, couplet or R on T- lidocaine (bolus 1-1.5mg/kg repeat in 30 mins w 1/2 as much); lidocaine drip (1-4mg/min); Pronestyl and amiodarone
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Ventricular Tachycardia (V-tach)
- Rate= >100
- QRS = >.12 +bizarre
- Cause: same as PVC+cardiomyopathy, vent aneurysm
- Tx: unconcious- electrically cardioverted, defib, pacemaker, amiodarone 150mg over 10 min, lidocaine, pronestyl
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Ventricular fibrillation
- Rhythym= chaotic electrical activity
- Rate, Pwave, PR, QRS= NONE
- Cause: same as PVC
- Tx: CPR/Defibrillation-200,300,360; epinephrine 1mg ivp Q3-5min or Vasopressin 40 units IVP x1; defibrillate again
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Asystole
- AKA Standstill
- Absence of rhythym may see little p waves
- Cause: adv cardiac disease, electrical cardioversion, defibrillation, antiarrhythmic meds
- Tx: cpr and acls protocol DO NOT SHOCK- check ABCs, check leads, transcutaneous pacing, epi 1 mg ivp Q3-5min, atropine 1mg ivp
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