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PET 4551: EKG Arrhythmias OutlineThere are a total of 21 Arrhythmias you will be responsible for identifying!Below they are grouped into the specific type of Arrhythmia, then they are listed in order with their individual characterisitics and pictures for each one. Enjoy!Sinus Arrhythmias:1. Normal Sinus Rhythm2. Sinus Bradycardia3. Sinus Tachycardia4. Sinus Arrhythmia5. Sinus Arrest6. Escape beata. Atrial b. Junctional c. Ventricular7. AsystoleEctopic Supraventricular Arrhythmias:- Non-sustained:1. Premature Atrial Contractions2. Junctional Premature Beat- Sustained:1. PSVT or PAT2. Atrial Flutter3. Atrial Fibrillation4. Multifocal Atrial Tachycardia5. Wandering PacemakerEctopic Ventricular Arrhythmias:1. Premature Ventricular Contractions2. Ventricular Tachycardia3. Ventricular Gibrillation4. Accelerated Idioventricular Rhythm5. Torsade De PointesSinus ArrythmiasSinus Arrythmias follow a usual SA node conduction pattern but the rhythm is either too fast, too slow, or irregular.Sinus Arrhythmia can also be seen during inhalation (R to R interval decreases; HR increases) and exhalation (R to R interval increases; HR decreases)SINUS ARRESTWhen the heart stops (beats followed by a prolonged isoelectric line). This occurs when theSA node stops firing. Shortly after, other “pacemakers” located in different parts of the myocardium will take over electrical activity and cause the heart to keep beating at different rates depending upon which pacemaker takes over, these are called an escape beats which originate outside the SA node. There are 3 types of escape beats that may follow Sinus Arrest:- Sinus Arrest + Atrial Escape Beat: HR (R to R interval of first and second beat after prolonged rest) is 60-75 bpmo With Atrial Escape you will see a P wave- Sinus Arrest + Junctional Escape Beat: HR is 40-60 bpm after prolonged resto With Junctional Escape, you will see a skinny QRS with NO P-wave- Sinus Arrest + Ventricular Escape Beat: HR is 30-45 bpm after prolonged resto With Ventricular Escape, you will see a wide QRS complex and NO P-waveEctopic Supraventricular ArrhythmiasEctopic Arrhythmias are abnormal rhythms that originate outside the SA node. Any outside myocardial pacemaker can accelerate it’s electrical activity to the point in which it exceeds the pace of the SA node and takes over the conduction of the myocardium. This physiological mechanism is called “Enhanced Automaticity”. This take over can also be caused by “Reentry” which represents disordered transmissions due to nerve impulses redirecting electrical impulses from the myocardium. We will now focus on the Ectopic Supraventricular Arrhythmias (Supra=above, ventricular=the ventricles), so this is dealing with parts of the atrium firing. There are 7 types (2 non-sustained & 5 sustained).To Determine Which Ectopic Supraventricular Arrhythmia it is, ask yourself:1. Is there a P wave? (P wave = atrial)2. What is the relationship of the P wave to the QRS complex?3. Is the QRS narrow?4. Is the rhythm regular or irregular?There are 2 Non-sustained Ectopic Supraventricular Arrhythmias:*Will have P wave (since it is an ATRIAL premature contraction). Another example of PAC: In the picture below, beats 2 and 6 are both Premature Atrial Contractions. Notice if these two beats were not premature, the rhythm would be regular. So, the rhythm is regular other than the PAC that is present.JUNCTIONAL PREMATURE BEATS Will NOT have P wave and the rate is slow. In the picture below, there is normal sinus rhythm until beat 7, in which there is no p wave and the beat is early.- Do not confuse a “Junctional Premature Beat” with a “Junctional Escape Beat”. They look similar except the JPB is early, while the JEB follows a prolonged rest or isoelectric line.There are 5 Sustained Ectopic Supraventricular Arrhythmias:PARAOXYSMAL SUPRAVENTRICULAR TACHYCARDIA (PVST)Regular rhythm, 150-250 bpm, QRS is narrow (sometimes P wave gets lost in T wave)Carotid massage may terminate the problem—baroreceptors in the carotid sense pressure due to high HR, light massage will stretch baroreceptors enough to trigger a vagal responsewhich will lower HR. ATRIAL FLUTTERRegular HR 250-300 bpm, Multiple P waves for every QRS (T waves may be hidden), Sawtooth appearance, Ratio of P to QRS may be 2:1, 3:1 or 4:1. The greater the ratio, the better. This allows for more filling of the ventricles before they contract.ATRIAL FIBRILLATIONThis is commonly referred to as “irregularly irregular”. Here, the atrium are firing all of the the place, atria are completely erratic which generates an irregular ventricular pattern.MULTIFOCAL ATRIAL TACHYCARDIAIrregular rhythm, 100-200 bpm, random firing of several different focal points within the atria. P waves will look different for every QRS. PR Intervals will also vary in length.If this occurs with a HR of less than 100 bpm, it is called “Wandering Pacemaker”:Ectopic Ventricular ArrhythmiasEctopic Ventricular Arrhythmias oritionate below the AV node since the AV node lies below the atria and above the ventricles. There are 5 types.PREMATURE VENTRICULAR CONTRACTION (PVC)PVC’s are very common, they will contain a beat in which there is a large and prolonged QRS complex. There are two types of PVC sustained rhythms:1. Bigeminy : every other beat is a PVC2. Trigeminy: 2 normal beats followed by a PVC (as seen in the middle of the picture)When do PVC’s become a problem? Rules of Malignancy:- When there are frequent PVC’s- Runs of consecutive PVC’s (3 in a row = tachycardia)- Multiform PVC’s (all PVC’s look different from eachother)- PVC falling on a T wave of previous beat (“R on T”)—can throw into Vtach- PVC’s in the setting of an MI—can throw into VtachVENTRICULAR TACHYCARDIA Ventricular Tachycardia results in 3 or more PVC’s in a row, HR is 120-200 bpm, the baselines remain symmetrical and every beat looks the same. Vtach still has cardiac output so this condition is not preterminal.VENTRICULAR FIBRILLATIONThis is a quivering of the ventricles. This condition normally follows Vtach. During Ventricular Fibrillation there is no cardiac output so this condition is preterminal and will progress to Asystole. Below is a picture of Ventricular Fibrillation going into Ventricular Tachycardia:ACCELERATED IDIOVENTRICULAR RHYTHMThis may be seen during an acute MI. Consists of regular rhythm occuring at 50-100 bpm (accelerated). This condition does not progress into ventricular


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FSU PET 4551 - Sinus Arrhythmias

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