Exam (elaborations)
cardiac dysrhythmias AH 2 (1).
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cardiac dysrhythmias AH 2 (1).
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cardiac dysrhythmias AH 2•Located upper area of right atrium at junction of superior vena cava
•The normal pacemaker of the heart
•Normal rate: 60-100 beats/minute (bpm) - ANS-Sinoatrial (SA) Node
(40-60 beats per min)
•Located lower portion of right atrium above tricuspid valve
•Delays electrical impulse to allow atria to contract & complete filling of ventricles
•Receives an impulse & conducts it to ventricles - ANS-Atrioventricular (AV) Node
•Located upper portion of interventricular septum
•Connects AV node with the two bundle branches
•Intrinsic rate: 40-60 bpm - ANS-Bundle of His
•Divides into two bundles to supply left ventricle - ANS-Left Bundle Branch
•An elaborate web of fibers distributed throughout ventricular myocardium - ANS-Purkinje Fibers
White - RA
•Distal RIGHT clavicle
Black - LA
•Distal LRFT clavicle
Red - LL
•LEFT 5th intercostal
Brown - Central
•4th intercostal R Sternal border
Green - RL/Ground
•Right 5th Intercostal - ANS-Telemetry Lead Placement
Movement of ions across cell membrane causing inside of cell to become positive
Muscle contracts - ANS-Depolarization
Movement of ions causing inside of cell to become negative
Muscle relaxes - ANS-Repolarization
•Represents depolarization of right & left atria
•Usually smooth & rounded - ANS-P Wave
•Part of the PR interval
•Locater from end of P wave to beginning of QRS complex
•Normally isoelectric line - ANS-PR segment
,•Reflects ventricular depolarization
•Atrial repolarization usually takes place,
but the QRS complex overshadows it
•Normal QRS interval: 0.06-0.12 seconds - ANS-QRS complex
•The portion between the QRS complex & T wave
•Represents early part of repolarization of right & left ventricles - ANS-ST segment
•Ventricular repolarization
•Identified as the point where the slope of the ST segment appears to become abruptly or
gradually steeper & ends when it returns to baseline - ANS-T wave
0.04 sec - ANS-EKG Width of each small square
1 second - ANS-EKG 5 large boxes represent
6 seconds - ANS-EKG 30 large boxes represent
3 seconds - ANS-EKG 15 large boxes represent
Count number of QRS complexes in 6 seconds & multiply be 10 - ANS-how to count ventricular
rate with 6 second method
Count number of P waves in 6 seconds & multiply by 10 - ANS-how to count atrial rate with 6
second method
0.12-0.20 seconds - ANS-normal PR interval
smooth, rounded, upright in lead II, <0.12 seconds - ANS-P wave measurements
•Beginning of Q wave to end of S wave
Count the number of small squares
Multiply by .04 seconds - ANS-QRS complex measurements
Represents entire ventricular activity
Normal QT Interval: 0.36-0.44 seconds - ANS-QT interval
Normal Sinus Rhythm
Sinus Bradycardia
Sinus Tachycardia
Sinus Arrhythmia
Sinus Arrest(Pause) - ANS-Synus Rhythms
, •Originates in sinus node
•Reflects normal activity
•Normal intrinsic firing rate 60-100
•Rhythm - regular
•P Wave - normal
•PR interval - normal; may be prolonged
•QRS - normal; may be wide
•QT interval - normal; may be prolonged - ANS-normal sinus rhythm characteristics
•Originates in sinus node
•Rate below 59
•Rhythm regular
•P wave - normal
•PR interval - normal; may be prolonged
•QRS - normal; may be wide
•QT interval - may be prolonged - ANS-sinus bradycardia characteristics
•Good athletic conditioning
•Rest/sleep
•Increased vagal tone
•Medications -
Inderal, Digoxin, Verapamil
•MI
Hypothermia - ANS-sinus bradycardia causes
Usually asymptomatic
Symptoms if symptomatic:
Chest pain
SOB
Altered LOC
Hypotension
CHF
Pulmonary congestion
Fatigue
Syncope
Lightheadedness - ANS-sinus bradycardia symptoms
Treatment for symptoms:
O2
IV
Atropine IV
Transcutaneous pacing - ANS-sinus brady treatment
•Originates in SA node
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