Causes:

*exercise, hypovolemia, medications, fever,

*hypoxia, substances, anxiety, fear, acute MI,

fight or flight, congestive heart failure (CHF)

Causes:

*intrinsic sinus node disease

*increased parasympathetic tone

*drug effect

Premature Atrial Contraction

(PAC)

Causes:

*normal

*excessive use of caffeine, tobacco, or alcohol

*congestive heart failure (CHF)

*Myocardial ischemia or injury

*Hypokalemia, digoxin toxicity

*COPD

Rate:  usually <100, dependant

Rhythm:  irregular

P waves:  early & upright, different from Sinus

PR:  0.12-0.20 second; different from Sinus

qRs:  0.04-0.10 second

P:qRs: 1 to 1

Atrial Flutter

Causes:

*ischemic heart disease

*hypoxia

*acute MI

*Digoxin toxicity

*Mitral or Tricuspid valve disease

*Pulmonary embolism

Rate:  Atrial 250-350; ventricular 150 common

Rhythm:  atrial=regular; vent=regular or irregular

P waves:  not identifiable

F waves:  uniform (sawtooth or picket fence)

PRI:  not measurable

qRs:  0.04-0.10

Causes:

*Ischemic heart disease

*hypoxia

*acute MI

*digoxin toxicity

*mitral or tricuspid disease

Rate:  Atrial=400-700; vent=160-180

Rhythm:  Atrial & vent = irregular

P waves:  No identifiable P's

F waves:  may be seen

PRI:  unable to measure (no identifiable P)

Paroxymal Atrial Tachycardia

(PAC)

also known as reentry supraventricular tachycardia

Rate:  usually 160-220

Rhythm:  regular

P waves:  differ in shape from Sinus P's; usually difficult to identify (rate related)

PRI:  normal when the P's can be identified; short if WPW present

qRs:  0.04-0.10

Other:  onset sudden, often initiated by a PAC

Premature Junctional Contraction

(PJC)

Rate:  usually <100, dependant on the underling rhythm

Rhythm:  irregular

P waves:  inverted before or after qRs or not visible

PRI:  <0.12 second when inverted P is before

qRs:  0.04-0.10 second

P:qRs:  1 to 1 if P's are visible

Causes:

*healthy athlete at rest

*related to medication-Beta blockers, Ca++ channel blockers, digoxin toxicity

*increased parasympathetic tone

*Acute inferior wall MI

*Rheumatic Heart Disease

*Post-cardiac surgery

*Valvular disease

*SA node disease

*Hypoxia

Rate:  40-60

61-100 (accelerated)

Rhythm:  regular

P waves:  inverted before or after qRs or not visible

PRI:  <0.12 second when inverted P is before

qRs:  0.04-0.10

P:qRs:  1 to 1 if P's are visible

Supraventricular Tachycardia(SVT)

An umbrella term used when unable to distinguish which

rhythm is present

Causes:

same as sinus, atrial, and junctional tachycardia, and atrial flutter

Rhythm:  absolutely regular

Rate:  >150 per minute

P waves:  not visible(PRI not measurable)

qRs:  normal 0.04-0.10

Causes:

*gastric overload, stress, caffeine, alcohol, nicotine

*heart disease, acid-base imbalance, hypoxia

*electrolyte imbalance, cyclic antidepressants

*acidosis, acute MI

Rate:  dependant upon underlying rhythm

Rhythm:  R to R is unequal

P waves:  usually absent, if present, not associated with PVC

qRs:  0.12 second or greater; bizarre and notched

ST/T:  often opposite in direction to the qRs

Timing: 

one on a strip=rare

one in a row=isolated

two in a row=pair, couplet

three in a row=v-tach

Pattern:

every other=bigeminy

every third=trigeminy

Morphology:

similar shape=uniformed

different shape=multiformed

Location:

R-on-T=PVC falls on the T wave of the complex before the PVC

Ventricular Tachycardia

(V-Tach)

Causes:

Same as PVC's

R on T Phenomenon

Rate:  >100/min and usually not >220

Rhythm:  usually regular

P waves:  no P waves or if present, not associated with qRs

qRs:  wide (> or = 0.12 seconds), bizarre

ST/T wave:  opposite direction of qRs

Causes:

*Acute myocardial infarction

*untreated ventricular tachycardia

*hypothermia

*R-on-T PVC's

*electrolyte imbalance

*electrical shock

Rate:  0

Rhythm:  0 regularity, chaotic undulating waves

P waves:  0

qRs:  0

ST/T wave:  0

Organized activity:  0

no cardiac output or pulse

Causes:

*myocardial infarction

*digoxin toxicity

*metabolic imbalances

*post resuscitation rhythm

Rate:  20-40/minute

Rhythm:  R to R is equal

P waves:  no P waves associated to qRs

qRs:  >0.12 second, notched, bizarre appearance

ST/T:  opposite direction of qRs

**rate >40 to 100 = accelerated

Causes:

*extensive myocardial damage

*acute respiratory failure

*ischemia or infarction

*traumatic cardiac arrest

*ventricular aneurysm

*countershock

*hypoxia, hypothermia, hyper or hypokalemia

*preexisting acidosis

*drug overdose

2nd degree AV Block

Type 1 (Wenkeback)

More P waves than qRs

PRI progressively increases in a cycle until P appears w/o qRs

cyclic pattern reoccurs

R to R is unequal

2nd degree AV Block

Type 2

More P waves than qRs

PRI consistent

qRs normal or wide(bundle branch block)

R to R is equal or unequal

More P waves than qRs

P not r/t qRs( P too close, P too far)

PRI varies greatly

qRs normal or wide

R to R is equal