Rate= 60-100 bpm

P waves present/normal

PR interval = 0.12-0.20

QRS Duration= 0.04-0.12

Monitor for symptomatic characteristics

Rate = <60bpm           P waves present/normal

PRI= 0.12-0.20                      QRS= 0.04-0.12 S/S: cool, pale skin/weakness/confusion/SOB / Dizziness/ hypotension

Etiology: vagal stimulation, dig toxicity, MI, athletes, sleep, suctioning, vomiting

Rx: ATROPINE, O2, rest, dopamine, epinephrine

ONLY IF SYMPTOMATIC!!!

Rate= >100bpm           P waves present/normal

PRI= 0.12-0.20                      QRS= 0.04-0.12

Etiology: stressors, fever, exercise, pain, hypotension, hypovolemia, drugs, anemia, fear

S/S: dizziness/dyspnea/hypotension

Rx: Lopressor(Beta), Inderal(Beta), Cardizem(Ca), Calan(Ca),

Digoxin(Inotropic)

PSVT

Paroxysmal Supraventricular Tachycardia

Rate= >150bpm       P waves hidden in T waves

PRI= 0.12-0.20                      QRS= 0.04-0.12

Etiology: Overexertion, stress, caffiene, tobacco, RHD, hypotension, cor pulmonale

S/S: hypotension, dyspnea, angina,

Rx: vagal stimulation(valsalva), IV Adenosine,

Lopressor, Cardizem, Digoxin, Amiodarone

Cardioversion if not improving

Atrial Rate= 350-600 bpm

Ventricular Rate= 50-180 bpm (increased to compensate)

P waves are fibriulatory

PRI is not measurable

QRS is normal

Etiology: HTN, MI, CHF, Hyperthyroidism

S/S: weakness, JVD, anxiety, syncope, hypotension

*At risk for pulmonary thrombi b/c of blood pooling in atrium*

Rx: to control VR -Digoxin, Calan, Cardizem, Tenormin, Lopressor

to control Rhythm (in atrium & ventricles)- Quinagiute, Tambacor

to control clotting- Coumadin

If not improving- Cardioversion, Radio Fequency Catheterization

Atrial Flutter

(tachydysrhythmia, with an increased VR, increased AR)

Atrial Rate= 240-400 bpm

Ventricular Rate= >100

QRS complex is normal

PRI can not be measured

Etiology: CAD, HTN, MVP, pulmonary embolus, drugs, hyperthyroidism

Rx: to control VR- Cardizem(Ca), Calan(Ca)

Beta Blockers (Tenormin, Lopressor, Betapace)

to control AR- Amiodarone(K+), Rythmol(Na), Corvert, Tambacor(Na)Norpace(Na)

Premature Ventricular Contraction (PVC)

(Dysrhythmia with normal, increased, or decreased VR)

Rate depends on # of PVC's

Rhythm is irregular

P wave is usually lost in the QRS complex

PRI is not measurable

Etiology: MI, hypoxia, acidosis, drug toxicity, electrolyte imbalance

Rx: O2, K+ or Mg supplementation if needed, LIDOCAINE BOLUS, Beta Blockers, Amiodarone

Ventricular Tachycardia

Ventricular Rate= 150-250 bpm      

Rhythm may be regular or irregular

P waves are usually lost in QRS complex

No PRI

 QRS is wide >0.12 sec

Etiology: MI, CAD, electrolyte imbalance, drug intoxication

*LIFE THREATENING*

S/S: hypotension, pulmonary edema, cardia arrest

Rx: O2, IV Amiodarone, Lidocaine, or Betapace. Cough CPR

If has a pulse- Cardioversion

If no pulse- defibrilation

Rate is not measurable

Rhythm is irregular and chaotic

P wave, PRI, and QRS interval are not measurable

*NO PULSE, NO CO = LIFE THREATENING*

Etiology: MI, CAD, electrolyte imbalance, acid-base balance, trauma

Rx: Immediate initiation of CPR and defibrilation, O2, epinephrine, amiodarone, lidocaine, Mg sulfate 

Rate and Rhythm are normal/regular

PRI= >0.20

QRS is normal (0.04-0.12)

Etiology: drugs, excessive vagal tone, ishemia, MI, RHD

Most are asymptomatic

 Rx: monitor patient for s/s or changes

Third Degree AV Block

(complete heart block)

Atria and Ventricles contract independently

AR= 60-100                                     VR= 20-60 bpm

P wave is normal but has no corelation with the QRS complex

Etiology: MI, CAD, Dig toxicity, Beta-blockers, Ca-Channel blockers,

S/S: severe fatigue, dyspnea, changes in LOC, hypotension

Rx: for symptomatic patients- transcutaneous pacemaker to monitor

to increase HR- Atropine, Epinephrine, Dopamine, Isoproterenol

Permanent pacemaker

Sodium Channel Blockers

Decrease conduction velocity in the atria, ventricles, and HIS-Purkinje system)

disopyramide-Norpace, procainamide- Pronestyl

lidocaine- Xylocaine, mexiletine- Mexitil, phenytoin- Dilantin, tocainide- Tonocard

flecainide- Tambacor, propafenone- Rythmol

Beta Adrenergic Blockers

(decrease automaticity of the SA node, decrease conduction velocity in the AV node)

acebutolol- Sectral

atenolol- Tenormin

esmolol- Brevibloc

metoprolol- Lopressor

sotalol- Betapace

Potassium Channel Blockers

(delay repolarization)

amiodarone- Coradarone

bretylium- Bretylol

dofetilide- Tikosyn

sotalol- Betapace

Calcium Channel Blockers

(decrease automaticity of SA node, delay AV node conduction)

diliatzem- Cardizem

verapamil-Calan

adenosine- Adenocard

digoxin- Lanoxin

ibutilide- Corvert

magnesium

Report any s/s of infection at incision site

Keep incision site dry for 4 days after insertion

Avoid lifting arm on ICD side above shoulder until approved

Discuss sexual activity( safe once site is healed)

Avoid driving until cleared

Avoid direct blows to ICD site

Avoid large magents/electromagnetic fields

NO MRI's

If ICD fires, report to provider immediately

If ICD fires more than once, contact EMS

Wear identification bracelet and carry card with meds

Family members should learn CPR

Definition and Source of Disturbance:

P Wave

Begins with the firing og the SA node and represents the contractions of the atria

Duration- 0.06-0.12 sec

Disturbance is in conduction within the atria

(PSVT, Atrial Flutter, Atrial Fibrillation, Junctional Dysrhythmias)

Definition and Source of Disturbance of

PR interval

Measured from beginning of P wave to beginning of QRS complex; represents time taken for impulse to spread through the atria, AV node and bundle of His, the bundle branches, and Purkinje fibers, to a point immediately preceding ventricular contraction.

Duration- 0.12-0.20 sec

Disturbance in conduction usually in AV node, bundle of his, or bundle branches but can be in atria as well

Definition and Source of Disturbance of

QRS Interval

Measured from beginning to end of QRS complex; represents contraction of the ventricles from the AV node 

Duration- 0.04-0.12

Disturbance in conduction in bundle brnaches or in ventricles

(PVC, Ventricular Tachycardia, Ventricular Fibrillation)

Definition and Source of Disturbance of

T wave

Represents the relaxation/filling of the ventricles

Duration- 0.16 sec

Disturbances usually caused by electrolyte imbalances, ischemia, or infarction

CAD

HTN

Advanced Age

Diabetes

Smoking

Elevated total cholesterol

Anemia-Abnormally high or low Hct (male=40-54%; female=38-47%)

Cor Pulmonale

RHD

Normal Lab Values;

Potassium

Magnesium

LDL Cholesterol

Potassium- 3.5-5.0 mEq/L

Magnesium- 1.5-2.5 mEq/L

LDL Cholesterol- <130 mg/dl