EKG Interpretation Cheat Sheet for Heart Arrhythmias Nurseslabs 2

EKG Interpretation Cheat Sheet Arrhythmias Paroxysmal Supraventricular Tachycardia (PSVT) Description: Atrial and ventricular rhythms regular. Ventricular rate: 150-250 bpm; atrial rate usually same. P waves superimposed on T waves; difficult to discern from T waves. P waves preceding each QRS complex. Sudden onset and termination. If abnormal P wave is present, it is called paroxysmal atrial tachycardia (PAT). If abnormal P wave is not seen, it is called paroxysmal junctional tachycardia (PJT). Causes: Physical exertion, emotion, stimulants, rheumatic heart disease. Infectious inflammation of AV conduction system. Digoxin toxicity. Disturbance of rhythm, particularly in cases of nervous system stimulation. Treatment: If the patient is unstable, prepare for immediate synchronized cardioversion. If the patient is stable, vagal stimulation or adenosine. Adenosine to rapidly IVP, flush saline bolus to rapidly convert rhythm. Additional options: beta-blockers, calcium channel blockers, and/or amiodarone. Assess hemodynamic response and conduction delays. Atrial Flutter Description: Atrial rhythm regular; rate: 250-400 bpm. Ventricular rhythm regular or irregular depending on degree of AV block. Sawtooth shape F wave configuration. QRS complex normal in shape but often irregular in rate. Causes: Heart failure, tricuspid or mitral valve diseases, pulmonary embolism, cor pulmonale, inferior wall MI, carditis. Digoxin toxicity. Treatment: If the patient is unstable, synchronized cardioversion. If the patient is stable, calcium channel blockers, beta-blockers, or antiarrhythmics. Antithrombotic therapy may include anticoagulants. Ablation therapy may be necessary. Atrial Fibrillation Description: Atrial rhythm grossly irregular. Rate: >300 bpm. Ventricular rhythm irregular; rate varies from 60 to 180 bpm. P waves: not present. PR interval: not measurable. QRS complex: normal. T waves: not present. Irregular baseline fibrillatory waves. Causes: Heart failure, COPD, thyrotoxicosis, rheumatic heart disease, atrial septal defect, cardiomyopathy, hypertension, mitral stenosis, ischemic heart disease, myocardial infarction, myocarditis, and recent cardiac or valve replacement surgery. Treatment: If patient is unstable, prepare for immediate synchronized cardioversion. If patient is stable, medications to control rate, rhythm, and anticoagulant therapy. Anticoagulation therapy if A-fib is >48 hours. Rate control: beta-blockers, calcium channel blockers, or digoxin. Junctional Rhythm Description: Atrial and ventricular rhythms regular. Ventricular rate is usually 40 to 60 bpm. P waves: may precede, be hidden, or follow QRS complex. PR interval (if present): <0.12 seconds. QRS complex normal duration and configuration. Causes: Inferior wall MI, ischemia, rheumatic heart disease, surgery, increased vagal tone, valvular heart disease. Acute inflammatory conditions, digitalis toxicity. Treatment: Correction of underlying cause. Atropine for symptomatic patients. Temporary pacing if bradycardia is unresponsive to atropine. Discontinuation of digoxin if toxicity is suspected. Premature Junctional Contractions (PJCs) Description: Atrial and ventricular rhythms are irregular. P waves inverted; may precede, be hidden, or follow QRS complex. QRS complex configuration and duration normal. Causes: Myocardial ischemia. Digitalis toxicity and excessive caffeine or amphetamine use. Treatment: Correction of underlying cause. Discontinuation of digoxin if appropriate. First-Degree AV Block Description: Atrial and ventricular rhythms regular. Rate: normal. P waves: precede each QRS complex. PR interval prolonged. QRS complex normal. Causes: Inferior wall MI, ischemia, myocarditis, rheumatic fever. Hyperkalemia, hyperthyroidism, use of beta-blockers, calcium channel blockers, or digitalis. Treatment: Correction of underlying cause. Discontinue medications causing block. Monitor for progression to more severe AV block.