EKG Interpretation and Dysrhythmias Chapter 36

Big wide qrs complex sinus block fall asleep then

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big wide QRS complex Sinus Block fall asleep then wake up Atrial Dysrhythmias focused on P wave Usually are rapid rhythms that take over from the sinus. Occasionally will be slow. Treatment aimed at returning to sinus rhythm. Impulse can originate in one or more irritable foci. Conduction of a Single Atrial Focus Beat SA node and send the impulse Conduction of Multiple Atrial Foci ablasion
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Premature Atrial Contraction Look normal but came early, comes from atrial area Causes Stimulants: Stress, Fatigue, Caffeine, Tobacco, Alcohol Hypoxia Electrolyte imbalance Disease states Premature Atrial Contraction Manifestations Palpitations Heart “skips a beat” Treatment Monitor for more serious dysrhythmias Withhold sources of stimulation β-adrenergic blockers- slow things down a little bit Antidysrhthmic meds Class 1 A (fast sodium channel blockers Procainamide, quinidine Class 1-B (decrease automaticity) lidocaine Class 1 C (decrease automatity) propafenone Class 2 (beta blockers) Class 3 (potassium channel locker) Amiodarone, ibutilide Class IV (calcium channel blockers) Other: adenosine Paroxysmal Atrial Tachycardia (PAT) Paroxysmal- coming and going QRS complex look normal o If coming from ventricle will be wide Reentrant phenomenon: PAC triggers a run of repeated premature beats Paroxysmal refers to an abrupt onset and termination Associated with overexertion, stress, deep inspiration, stimulants, disease, digitalis toxicity Manifestations HR is 150–220 beats/minute (add for clarification) HR > 180 leads to decreased cardiac output and stroke volume Hypotension Dyspnea , Angina Treatment Vagal stimulation IV adenosine IV β-adrenergic blockers
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Calcium channel blockers Amiodarone- atidysrhythmic, slow HR DC cardioversion- small heart shock Atrial Flutter Saw tooth pattern No identifiable P wave Typically associated with disease worried about clots before cardoversion Symptoms result from high ventricular rate and loss of atrial “kick” → decreased CO → heart failure Increases risk of stroke Fluttering and quivering- Treatment Pharmacologic agent Electrical cardioversion Radiofrequency ablation Atrial fibrillation No P wave o Fibrillulatory waves Can’t measure PR interval Paroxysmal or persistent Narrow waves Most common dysrhythmia Elderly Prevalence increases with age Usually occurs in patients with underlying heart disease Can also occur with other disease states Worried about clots before ardioversion As with atrial flutter – causes a decrease in CO and an increased risk of stroke Better to control ventricular rate Treatment Drugs to control ventricular rate and/or convert to sinus rhythm (amiodarone and ibutilide most common) Electrical cardioversion If it’s been 48 hours you shouldn’t shock someone unless you gave anticoagulnts Anticoagulation- @ risk for blood clots
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  • Fall '16
  • christiana
  • Cardiology, heart rate, Cardiac electrophysiology, pacemaker, QRS complexes

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