Term
| 12 Lead EKG indicated when: |
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Definition
Chest pain or discomfort
SOB
Syncope
Diaphoresis unexplaiend by temp; generalize dweakness, unexplained nausea
HR less than 50, greater than 150
palpitations
drug overdose
DKA
unconscious patient |
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Term
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Definition
Detects cardiac abnormality: enlargement of heart muscle, electrical conduction issues, insufficient blood flow, and death of coroncary muscle due to an occlusion in the coronary arteries
Can identify the location of the occlusion prior to complete muscle damage
Is used to determine the existence of problems with heart rate and regularity
Is the essential evaluation tool used for all pts with chest pain
Uses 10 electrodes |
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Term
| Describe 12 Lead electrode placement |
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Definition
RA: right
LA: left arm
LL: left leg
RL: right leg
V1: 4th ICS RSB
V2: 4th ICS LSB
V3: midway between V2 and V4
V4: 5th ICS at midclavicular line
V5: midway between V4 and V6 in the horizontal plan of V4
V6: In the horizontal of V4 at midaxillary line |
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Term
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Definition
Right sided EKG
Gets a better view of the right side of the heart, shows an inferior MI
After 12 lead is incomplete, move the precordial leads (V1-V6) to the right chest and perform the EKG a second time to produce an 18 Lead EKG
12 Lead EKG and the six relocated precordial leads (now on right side) = 18 leads
Infarctions inolving the right ventricle wall are not as easily seen on standard 12 Lead EKGs
Approximately 40% of patients wth inferior wall infarctions have right ventricular and/or posterior wall involvement which predisposes them to more complications and increased mortality |
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Term
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Definition
Obtain a 15 lead EKG when 12 lead shows a Posterior MI, to get a better view of the posterior heart
Ater 12 lead EKG is done, move V4-V6 to specific locations on the patient's back adn perform EKG a second time to produce the 15 lead EKG
12 lead EKG plus 3 relocated V leads (now on posterior) = 15 leads
The diagnostic 15 lead EKG captures a more accurate view of the posterior wall fo the heart
Important to detect right ventricular and posterior wall infarction, as 40% of patient with inferior wall infartctions have right ventricular and posterior wall involvement, predisposing them to more complications and increased mortality |
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Term
| 18 lead electrode placement |
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Definition
RA right arm
LA left arm
LL left leg
RL right leg
V1 4ICS LSB
V2 4ICS RSB
V3 Midway between V2R and V4R
V4 5ICS at midclavicular line
V5 Midway between V4R and V6R in horizontal plan of V4
V6 Horizontal plane of V4R at the midaxillary line |
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Term
| 15 lead electrode placement |
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Definition
RA
LA
RL
LL
V1: 4ICS at RSB
V2: 4ICS LSB
V3: Midway between V2 and V4
V7: Horizontal to V6 at the posterior axillary line
V8: Horizontal to V6 below the scapula
V9: Horizontal to V6 at the paravertebral border |
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Term
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Definition
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Term
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Definition
Generally used for transport or procedire monitoring
3 leads attached to the patient's torso
Provides multiple views of the heart since lead I looks at the lateral wall, while II and III look at inferior wall |
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Term
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Definition
Typically used in ICU and Telemetry, supports continuous cardiac monitoring
Multiple views of heart; lateral, inferior, adn anterior walls of the heart
Four leads attached to torso and fifth is precordial or V lead
Allows for monitoring I, II, III, AVR, AVF, and V1
up to 95% of ischemic events captured |
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Term
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Definition
ICU and Telly, continuous
lateral, inferior, and anterior walls of the heart
FOur leads on torso and two V leads on chest
-lead V1 for arrhythmia monitoring
-V3 and lead III for ST segment monitoring
Allows monitoring of I, II, III, AVR, AVF, V1 and V3 |
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Term
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Definition
RA: upper right chest
LA: upper left chest
LL: Lower left abdomen |
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Term
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Definition
RA: upper right chest
LA: upper left chest
LL: Lower left abdomen
RL: right lower abdomen
V1: 4ICS RSB |
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Term
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Definition
RA: upper right chest
LA: upper left chest
LL: Lower left abdomen
RL: right lower abdomen
V1: 4ICS RSB
V3: Midway between V2 and V4 |
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Term
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Definition
Artifact: minimize patietn movement, separate EKG cable from all other cables and equipment
Large patients: care for correct anatomical location adn to note alterations
Large breasts: lifted, electrodes placed on chest wall, and not on the rbeat tissue
Lead placement: inorrect V1 can make SVT look like VT |
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Term
| Sinus Rhythms (from SA node) |
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Definition
Normal Sinus
Sinus Bradycardia
Sinus Tach
Sinus Arrhythmia
Sinus Arrest
Sinoatrial Block
Sick Sinus Syndrome |
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Term
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Definition
Rate: 60 - 100
Rhythm regular and originates in teh SA node
P waves: regular, preceding each QRS
PR: 0.12 -0.20
QRS: <0.12 |
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Term
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Definition
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Term
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Definition
Rate: less than 60
Rhythm: regular, SA node
P waves: upright, regular
PR: lengthens are the rate decreases
QRS: normal, <0.12
May reflect increased parasympathetic tone, or in response to conditioning or sleep
Causes:
Hypoxemia, MI, SSS, ICP, Hypothyroidism, hyperkalemia, drug effect (BB, Dig, CCB), sleeping, increased vagal tone (vomiting, BM, ET intubation), CHF, angina, syncope, hypertension
If symptomatic:
Atropine (first choice, may be beneficial for AV block)
transcutaneous pacing
dopamine
epinephrine
isoproterenol |
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Term
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Definition
Rate: 100-160
Rhythm: regular, SA node
P waves: reular, before each QRS
PR: shortens as rate increases
QRS: <0.12 seconds
Implies a rapid heart rate from an increase in the automatiity of the sinus node in response to stimuli.
Causes:
Hypoxemia, stress, pain, fever, dehydration, anemia, pulm embolism, CHF, Hypovolemia, shock, hypotension, MI, hyperthyroidism, drugs effects (atropone, epi, dig, caffeine, cocaine)
TX: identify cause; if CO poor, tachycardia may be helping and compensatory
Provide O2 is oxygenation is poor |
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Term
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Definition
Rate: 60-100 per minute
Rhythm: irregular and originates in teh SA node
P waves: regular, before each QRS
PR: Normal
QRS: normal
impulses from teh SA node are generated at irregular intervals due to the effecr of respiration on the vagus nerve. The longest P-P interval must be >0.12 longer than the shortest P-P interval for diagnosis
Causes:
MI
SSS
ICP
Chronic lung disease
Dig
Children, athletes, and some adults
If tx needed and patient symptomatic, treat as bradycardia; pace and atropine
Ischemic Heart disease
Posterior MI
Myocardial diesase
Digitalis toxicity |
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Term
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Definition
Rate: 60-100
Rhythm: irregular, originate in SA
P waves: regular, preceding each QRS when complexes are present
PR: regular
QRS: regular
Failure of an impulse to form in the SA node
Symptomatic sinus arrest is seen with:
elderly
TX: ventricular pacing and atropine. Reasons to pace include symptomatic syncope, CHF< angina, ventricular ectopy |
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Term
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Definition
Rate determined by frequency of block
Rhythm irregular when block occurs
P waves: normal except in areas of droped beats
PR: may be greater than 0.20
QRS: normal
Characterized by a blocked beat in some multiple of the P-P interval. Usually after the dropped beat the cycle continues in regular time
Seen in SSS, Dig toxicity, increased vagal tone (athletes)
TX: not needed if infrequent; if frequent, follow bradycardia protocol. |
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Term
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Definition
Rate: less than 60 with short bursts of over 100
Rhythm: irregular
P waves: intermittant conduction
PR: usually consistent for conducted beats
QRS: normal
marked bradycardia with intermittant escape beats and may exhbit short burst or runs of atrial tachycardia, flutter or fibrillation. May require a pacemaker.
Causes: inflammatory diseases, cardiomyopathy, surgical unjury, structural heart disease, MI, congenital heart disease, idiopathic
TX: Pacemaker may be indicated |
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Term
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Definition
Wandering Atrial pacemaker
Premature Atrial Complex
Atrial Tachycardia
Paroxysmal Atrial Tach
Multifocal Atrial Tach
Atrial FLutter
Atrial Fibrillation |
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Term
| Wandering Atrial Pacemaker |
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Definition
Rate: 60-100
Rhythm: irregularly irregular
P waves: varying P waves according to the pacemaker site, upright, or inverted
PR: changing PR and R-R
QRS: Normal
Atrial dysrhythmia is where teh site of the pacemaker changed with each beat. The rate is dependent upon the different pacemaker sites. If the rate becomes greater than 100 is is classified as multifocal atrial tachycardia. TO be correctly identified, three or more different P waves must be seen
Causes:
Lung disease, Cor pulmonale, DM, dig toxicity. May be seen in nromal heartbeats.
Presence of P waves distinguish WAC from a Fib
Tx: No interventions unless pt is symptomatic |
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Term
| Premature Atrial Pacemaker |
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Definition
Rate: 60 - 100
Rhythm: irregular
P waves: upright
PR: Normal
QRS: normal
PACs are beats of non sinus origin, and the shape of the P wave is dependent ont eh location or origin
PACs from the atrium that ocur before the expected beat, may occur randomly or in a pattern.
Causes:
Caffeine, tobacco, dig tox, theophylline, hypokalemia, hypomagnesemia, COPD, Heart failure
TX: PACs are not noticed by patient normally; if troublesome, see causes |
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Term
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Definition
Rate: 160-240
Rhythm: Regular
P waves: P waves originating in the atria, appear differnt from sinus P waves
PR: Regular
QRS: Regular
A run of six or more consecutive atrial premature beats that results from an ectopic focus where the atria take over from the SA node
Atrial tachycardia is typically a narrow stable QRS tachycardia
Causes: hypoxmia, dig toxicity, excess catecholamines
TX: For persistant and hemodynamically unstable, prepare for synchronized cardioversion, especially if drug interventions ineffecive
COnsider:
O2
Vagal maneuvers
Adenosine
CCB (Diltiazem, Verapamil)
Adenosine: first drug for most forms of stable forms of SVT. Effective in terminating tachycardias due to reentry involving AV node or SA node.
-IV rapid push, patient in mild trendelenburg, given over 1-3 seconds
-bradycardia and ventricular ectopy are common after SVT are common |
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Term
| Paroxysmal Atrial Tacycardia |
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Definition
Rate: 160 - 240
Rhythm: irregular
P waves: ectopic P waves have abnormal configuration
PR: variable PR interval 0.12 - 0.20
QRS: normal
PAT is considered atrial tacycardia with a sudden onset and an abrupt ending and is usually preceded by an atrial premature beat
Causes:
hypoxemia, enalrged atrium, chronic lung disease, CHF, electrolyte imbalance, acid-base imbalance
TX:
O2 poor, provide supplementaryoxygen, vagal maneuvers, adenosine, CCB, BB |
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Term
| Multifocal Atrial Tachycardia |
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Definition
Rate: 100-200
Rhythm: irregular
P waves: early ectopic P waves or non conducted P waves may occur
PR: irregular
QRS: normal
Multifocal atrial tachycardia can also be referred to as chaotic atrial tachycardia, adn will consist of a run of six or more multifocal APBs from different locations in the atria. To be correctly identified, three or more different P wave configurations must be seen.
Causes:
Hypoxemia
COPD
Cor Pulmonale
TX:
Goal is to control HR and treat underlying cause
Oxygenation is poor, provide O2 support
Vagal maneuvers
Adenosine
CCB |
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Term
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Definition
Rate: Atrial rate of 220 to 250
Rhythm: usually regular
P waves: P waves replaced by flutter (F) waves
PR: not discernable
QRS: Normal
Atrial flutter is caused by rapid firing of atrial impulses. Beacause the rate is so rapid, the resulting wave is called an F wave or flutter wave. The ventricles may oly contract on every second, thir, or fourth beat causing an irregular rhythm. This finding results in 2:1, 3:1, or 4:1 conduction ratios.
Causes:
Hypoxemia
Pulm emb.
Valve disease
atrial enlargement
atrial septal defects
Pericarditis
Chronic lung disease
Cor pulmonale
Hyperthyroidism
THyrotoxicosis
Dig toxicity
Beri-beri
May also be caused by consuming substances that change the way electrical impulses are trasmitted through the heart. Occurs after open heart surgery. Produces HR of appx. 150
TX:
CCB
Synchronized cardioversion
BB
Antiarrythmics |
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Term
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Definition
Rate atrial: > 400 beats
Rhythm: ireegularly irregular
P waves: replaced by fibrillation line
PR: No measurable PR interval
QRS: Normal
A Fib occurs when mulitplefoci in the atria fire at repetitive rates and the contractions are weak and incomplete. The F wave can be classified as coarse or fine and may be seen best in Lead V1. The ventricular response is irregular and may result in heart rates greater than 100 beats per minute
CAUSES:
Hypoxemia
Mitral Valve disease
Iscemic heart disease
Cardiomyopathy
CHF
HTN
RHD
COPD
Thyrotoxicosis
TX:
Oxygenate
Synchronized cardiversion
CCB
BB
Ablation when warranted
Antiarrythmics
Antithrombotic therapy |
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Term
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Definition
| Junctional Tachycardia, accelerataed junctional, Premature Junctional COmplex, AV Nodal Tachycardia, Paroxysmal Junctional Tachycardia, SA block Junctional Escape, Junctional Escape |
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Term
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Definition
Rate: 100-160
Rhythm: regular
P waves: inverted, absent, or after the QRS
PR: Present <0.10 seconds
QRS: Normal
Occurs when the SA node fails to send out impulses or if there is a blockage in teh conduction system, and typically is initiated by a premature junctional beat. This rhythm consists of a run of 6 or more escape beats. P waves may precede or follow QRS.
Causes:
Hypoxemia
Decreased CO
AMI
Myocarditis
Open heart surgery
Dig tox
Nonparoxysmal junctional tach is caused by abnormal automaticity in the AV node or adjacent tissue
Heart rate is 100-160, thus symptoms are usually absent. |
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Term
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Definition
Rate: 61-100
Rhythm: regular
P waves: inverted, buried, absent, retrograd
PR: if present, short or retrograde.
QRS: normal
TX: often a comensatory mechanism to maintain CO. Requires no treatment. TX aimed at reversing the underling auses of a junctional rhythm which can cause low CO due to loss of atrial kick. |
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Term
| Premature Junctional Complexes (PJC) |
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Definition
Rate: dependent on underlying rhythm
Rhythm: irregular
P waves: may be absent, inverted, preceding or following QRS
PR: <0.12 seconds
QRS: Normal
Ectopic impulses that originate from the area around the AV node, or from the node itself. The QRS may be preceded by an inverted P wave, due to retrograde conduction. THe P wave may follow the QRS, or may not be seen at all.
Causes
Hypoxemia
DIg TOxicity
Excess caffeine or amphetamine
MI
CHF
Hypoxia
TX:
SUppressive treatment is rearely needed. TX is directed at reversing the underlying causes. If PJCs are a source of concern to the patient, correct any underlying factors listed as Possible Causes |
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Term
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Definition
Rate: 150 - 250
Rhythm: Regular
P waves: frequently buried in QRS
PR: usually not possible to measure
QRS: Normal
Most ommon regular SVT and least likely to be life-threatening. Occurs when a re-entry circuit forms within or just next to the AV node. The circuit usually involves two anatomical pathways; the fast and the slow, which are both in the right atrium
Possible causes:
Caffein
alcohol
Sleep deprivation
Stressful situations
anxiety
It can occur in people of any age, most commonly in young adults and elderly, more common in women.
The main symptom is sudden developement of rapid, regular palpitations
TX:
Supplement O2
Vagal maneuvers
Adenosine
CCB
BB |
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Term
| Paroxysmal Junctional Tachycaria |
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Definition
Rate: 140-200
Rhythm: irregular
P waves: inverted, absent, or after the ORS
PR: Short if present
QRS: <0.12
Rapid rate, narrow complexes and absent or abnormal wave caused y a very irritable automaticity focus in the AV junction. S/S of decreased CO or may result from teh rapid rate.
Causes:
CAD, RHD, HTN, Dig, tox. This irritable focus depolarizes the left ventricle before the right, to produce somewhat widened QRS during the tachycardia
TX:
O2
Vagal maneuvers
ADenosine
CCB
BB
Synchronized Cardioversion |
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Term
| SA Block Junctional Escape |
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Definition
Rate: dependent on underlying rhythm
Rhythm: irregular
P waves: inverted, absent, or seen after the QR
PR: underlying normal
QRS: normal
Usually produced by the AV node when th eSA node does not fire and a pause occurs. The escape beat may be preceded by a retograde P wave or it may have no P wave, and will have s shortened PR interval
Causes:
SSS
Dig tox
Potassium abnrmality
increased vagal tone
TX: none, observe and monitor |
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Term
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Definition
Rate 40-60
Rhythm regular
P waves inverted, absent or Carson
PR: Normal
QRS: Normal
Causes:
Hypoxemia, dig tox, potassium imbalance.
Most commonly junctional escape caomplexes and rhythms are benign events of automaticity
TX:
O2
Potassium
If symptomatic, follow protocol for sinus bradycardia |
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Term
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Definition
SA Block Ventricular Escape
V Tach
V Fib
IVR
Accelerated IVR
Torsadess
Capture Beats |
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Term
| SA Block Ventricular Escape |
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Definition
Rate: Dependent on underlying rhythm
Rhythm: irregular
P waves: absent with the escape beat
PR: Underlying normal
QRS: wide and bizzare
Ventricular escape beats are usually produced by the ventricles when the SA node and the AV node do not fire and a longer pause occurs. The QRS is usually wide and is not preceded by a P wave
Causes:
Ischemia, MI, myocarditis, dig tox
TX:
Transcutaneous pacing (in unstable bradycardia with s/s)
Be ready to pace in setting of AMI |
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Term
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Definition
Rate: 100-220
Rhythm: regular
P waves: no discernable P waves
PR: no PR interval
QRS: wide and bizzare
Consists of three or more PVCs in a row and can be classified by the duration as either non-sustained (less than 30 seconds) or sustaied (more than 30 secconds). Most patients ar enot able to sustain an adequate BP at rapid rate and rapidly can degenerate int oventricular fibrillation
Causes:
Hypoxemia
MI
ischemia
Cardiomyopathy
Mitral valve prolapse
Dig Tox
TX:
If pulse is asbent, pt is treated using the ventricular fibrillation algorim
If pulse is present, cosider:
O2 inadequate
Sychrnized cardioversion
Adenosine
Lidocained |
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Term
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Definition
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