Cardiac Dysrhythmia Review

Cardiac Dysrhythmia Review

by Ginny Bayes

​Sinus Rhythms

​Sinus rhythms originate from the SA node (sinoatrial node).

​The SA node is the intrinsic pacemaker of the heart.

​Normal rate for SR?

​Rate for sinus bradycardia?

​Rate for sinus tachycardia?

​Normal PR interval?

Multiple Choice

Name this rhythm (assume all cardiac strips are 6 second strips):

• Sinus arrythmia

• Sinus rhythm

• Sinus tachycardia

• Sinus bradycardia

​Atrial Arrythmias

​Originate from somewhere in the atrium but NOT the SA node.

​Most common: PACs, atrial fibrillation, atrial flutter

​PACs: come early in the cardiac cycle, make the rhythm irregular

​A-fib: atria are fibrillating, no discernable P-waves, always irregular

​Atrial flutter: flutter or saw tooth waves, tends to be more regular

Multiple Choice

Name this rhythm:

• Sinus rhythm with PACs

• Atrial flutter

• Atrial fibrillation

• Sinus tachycardia

Multiple Choice

Name this rhythm:

• Sinus rhythm with PACs

• Atrial flutter

• Atrial fibrillation

• Wandering atrial pacemaker

​Junctional Arrythmias

​Originate in the AV junction, aka junctional escape rhythm

​P wave can appear before the QRS, after the QRS or may be hidden in the QRS complex

​IF a p wave is present it will always be inverted

​Intrinsic rate is 40 - 60 bpm

​Accelerated junctional: 60 - 100 bpm

​Junctional tachycardia: >100 bpm

Multiple Choice

Name this rhythm:

• Junctional escape rhythm

• Accelerated junctional rhythm

• Junctional tachycardia

• Atrial tachycardia

Multiple Choice

Name this rhythm?

• Junctional escape rhythm

• Accelerated junctional rhythm

• Junctional tachycardia

• Idioventricular escape rhythm

​Ventricular Dysrhythmias

​Originate from the ventricles (below the atria and AV junction)

​*Remember all cardiac arrythmias are named for where they originate (expect AV blocks)

​Includes PVCs, ventricular tachycardia, ventricular fibrillation, idioventricular, ventricular standstill aka asystole

​QRS is wide and "bizarre"

​Never a P wave

​PVC Flavors

Multiple Choice

Name this rhythm:

• Sinus rhythm with a PAC

• Idioventricular escape rhythm

• Sinus tachycardia with a PVC

• Sinus rhythm with a PVC

Multiple Choice

Name this rhythm and the select the first line medication used for treatment:

• Ventricular tachycardia/

  epinephrine

• Ventricular tachycardia/

  atropine

• Ventricular fibrillation/

  amiodarone

• Ventricular fibrillation/

  lidocaine

Multiple Choice

Name this rhythm and the action the nurse should perform:

• Ventricular tachycardia/

  check a carotid pulse

• Sinus tachycardia/

  obtain a 12 lead ECG

• Ventricular fibrillation/

  start high quality BLS interventions

• Atrial fibrillation/

  place defibrillation pads on patient & prepare for cardioversion

Multiple Choice

Name this rhythm and the appropriate action:

• Idioventricular escape or agonal rhythm/check vitals signs & LOC

• Slow V-tach/

  defibrillate at 200 joules

• Junctional escape rhythm/call a rapid response

• Ventricular standstill/start

  CPR

Multiple Choice

The nurse walks into the client's room to find the client unresponsive. A cardiac monitor is placed immediately and a quick assessment is done. The nurse cannot palpate a pulse and the cardiac monitor reveals the following rhythm, choose the correct rhythm interpretation and nursing action.

• Sinus rhythm/call the provider immediately

• Sinus bradycardia/begin CPR and call for help

• Junctional escape/

  order a stat BMP and magnesium

• Pulseless electrical activity (PEA)/

  begin CPR and call for help

​Atrioventricular (AV) Blocks

​Conduction delay from the atria to ventricles somewhere in the cardiac conduction system

​Named for severity of block

​- 1st degree AV block: PR interval greater than 0.20 seconds

- ​2nd degree type 1 aka mobitz 1 aka wenckebach: PR interval gets successively longer until a QRS complete is dropped (short, long, longer, dropped)

​- 2nd degree type 2 aka mobitz 2: QRS complexes are dropped but the PR interval is always consistent when there is a P followed by a QRS

​- 3rd degree block aka complete heart block: no communication between the atria and ventricles, each is contracting independently to their own independent intrinsic pacemakers, roughly double the amount of P waves than QRS complexes

Multiple Choice

Name this rhythm:

• SR with 1st degree AV block

• Second degree Type I aka Mobitz 1 aka Wenckebach

• Second degree Type 2 aka Mobitz 2

• Third degree aka complete heart block

Multiple Choice

Name this rhythm and the appropriate action:

• SR with 1st degree AV block/monitor the patient's rhythm

• Second degree Type I aka Mobitz 1 aka Wenckebach/call a rapid response

• Second degree Type 2 aka Mobitz 2/prepare for synchronized cardioversion

• Third degree aka complete heart block/prepare the patient for the cath lab

Multiple Choice

Name this rhythm:

• SR with 1st degree AV block

• Second degree Type I aka Mobitz 1 aka Wenckebach

• Second degree Type 2 aka Mobitz 2

• Third degree aka complete heart block

Multiple Choice

Name this rhythm:

• SR with 1st degree AV block

• Second degree Type I aka Mobitz 1 aka Wenckebach

• Second degree Type 2 aka Mobitz 2

• Third degree aka complete heart block