Heart Dysrhythmias Cheat Sheet, Cheat Sheet of Cardiology

Download Heart Dysrhythmias Cheat Sheet and more Cheat Sheet Cardiology in PDF only on Docsity! Heart Dysrhythmias/Arrythmias Arrythmia s Description Causes Treatment Sinus Arrhythmi a  Irregular atrial and ventricular rhythms.  Normal P wave preceding each QRS complex.  Normal variation of normal sinus rhythm in athletes, children, and the elderly.  Can be seen in digoxin toxicity and inferior wall MI.  Atropine if rate decreases below 40 bpm. Sinus Tachycard ia  Atrial and ventricular rhythms are regular.  Rate > 100 bpm.  Normal P wave preceding each QRS complex.  Normal physiologic response to fever, exercise, anxiety, dehydration, or pain.  May accompany shock, left- sided heart failure, cardiac tamponade, hyperthyroidis m, and anemia.  Atropine, epinephrine, quinidine, caffeine, nicotine, and alcohol use.  Correction of underlying cause.  Beta- adrenergic blockers or calcium channel blockers for symptoma tic patients. Arrythmia s Description Causes Treatment Sinus Bradycard ia  Regular atrial and ventricular rhythms.  Rate < 60 bpm.  Normal P wave preceding each QRS complex.  Normal in a well- conditioned heart (e.g., athletes).  Increased intracranial pressure; increased vagal tone due to straining during defecation, vomiting, intubation, mechanical ventilation.  Follow ACLS protocol for administra tion of atropine for symptoms of low cardiac output, dizziness, weakness, altered LOC, or low blood pressure.  Pacemake r Sinoatrial (SA) arrest or block  Atrial and ventricular rhythms normal except for missing complex.  Normal P wave preceding each QRS complex.  Pause not equal to multiple of the previous rhythm.  Infection  Coronary artery disease, degenerative heart disease, acute inferior wall MI.  Vagal stimulation, Valsalva’s maneuver, carotid sinus massage.  Treat symptoms with atropine I.V.  Temporary pacemake r or permanent pacemake r if considered for repeated episodes. Arrythmia s Description Causes Treatment present, it’s called paroxysmal atrial tachycardia; when a normal P wave isn’t present, it’s called paroxysmal junctional tachycardia. fraction, consider calcium channel blockers, beta- adrenergic blocks or amiodaron e.  If patient has an ejection fraction less than 40%, consider amiodaron e. Atrial flutter  Atrial rhythm regular, rate, 250 to 400 bpm  Ventricular rate variable, depending on degree of AV block  Saw-tooth s hape P wave configuration.  QRS complexes uniform in shape but often irregular in rate.  Heart failure, tricuspid or mitral valve disease, pulmonary embolism, cor pulmonale, inferior wall MI, carditis.  Digoxin toxicity.  If patient is unstable with ventricular rate > 150bpm, prepare for immediate cardioversi on.  If patient is stable, drug therapy may include calcium channel blockers, Arrythmia s Description Causes Treatment beta- adrenergic blocks, or antiarrhyt hmics.  Anticoagul ation therapy may be necessary. Atrial Fibrillation  Atrial rhythm grossly irregular rate > 300 to 600 bpm.  Ventricular rhythm grossly irregular, rate 160 to 180 bpm.  PR interval indiscernible.  No P waves, or P waves that appear as erratic, irregular base-line fibrillatory waves  Heart failure, COPD, thyrotoxicosis, constrictive pericarditis, ischemic heart disease, sepsis, pulmonary embolus, rheumatic heart disease, hypertension, mitral stenosis, atrial irritation, complication of coronary bypass or valve replacement surgery  If patient is unstable with ventricular rate > 150bpm, prepare for immediate cardioversi on.  If stable, drug therapy may include calcium channel blockers, beta- adrenergic blockers, digoxin, procainam ide, quinidine, ibutilide, or amiodaron Arrythmia s Description Causes Treatment e.  Anticoagul ation therapy to prevent emboli.  Dual chamber atrial pacing, implantabl e atrial pacemake r, or surgical maze procedure may also be used. Junctional Rhythm  Atrial and ventricular rhythms are regular.  Atrial rate 40 to 60 bpm.  Ventricular rate usually 40 to 60 bpm.  P waves preceding, hidden within (absent), or after QRS complex; usually inverted if visible.  Inferior wall MI, or ischemia, hypoxia, vagal stimulation, sick sinus syndrome.  Acute rheumatic fever.  Valve surgery  Digoxin toxicity  Correction of underlying cause.  Atropine for symptoma tic slow rate  Pacemake r insertion if patient is refractory to drugs  Discontinu ation of digoxin if Arrythmia s Description Causes Treatment block (complex heart block) regular.  Ventricular rhythm regular and rate slower than atrial rate.  No relation between P waves and QRS complexes.  No constant PR interval.  QRS interval normal (nodal pacemaker) or wide and bizarre (ventricular pacemaker). anterior wall MI, congenital abnormality, rheumatic fever. epinephrin e, and dopamine for symptoma tic bradycardi a.  Temporary or permanent pacemake r for symptoma tic bradycardi a. Premature ventricula r contractio n (PVC)  Atrial rhythm regular  Ventricular rhythm irregular  QRS complex premature, usually followed by a complete compensator y pause  QRS complex wide and  Heart failure; old or acute myocardial ischemia, infarction, or contusion.  Myocardial irritation by ventricular catheters such as a pacemaker.  Hypercapnia, hypokalemia, hypocalcemia.  If warranted, procainam ide, lidocaine, or amiodaron e I.V.  Treatment of underlying cause.  Discontinu ation of drug Arrythmia s Description Causes Treatment distorted, usually >0.14 second.  Premature QRS complexes occurring singly, in pairs, or in threes; alternating with normal beats; focus from one or more sites.  Ominous when clustered, multifocal, with R wave on T pattern.  Drug toxicity by cardiac glycosides, aminophylline, tricyclic antidepressant s, beta- adrenergic.  Caffeine, tobacco, or alcohol use.  Psychological stress, anxiety, pain causing toxicity.  Potassium chloride IV if PVC induced by hypokalem ia.  Magnesiu m sulfate IV if PVC induced by hypomagn esaemia. Ventricula r Tachycard ia  Ventricular rate 140 to 220 bpm, regular or irregular.  QRS complexes wide, bizarre, and independent of P waves  P waves no discernible  May start and stop suddenly  Myocardial ischemia, infarction, or aneurysm  Coronary artery disease  Rheumatic heart disease  Mitral valve prolapse, heart failure, cardiomyopath y  Ventricular catheters.  If pulseless : initiate CPR; follow ACLS protocol for defibrillati on.  If with pulse: If hemodyna mically stable, follow ACLS protocol Arrythmia s Description Causes Treatment  Hypokalemia, Hypercalcemia .  Pulmonary embolism.  Digoxin, procainamide, epinephrine, quinidine toxicity, anxiety. for administra tion of amiodaron e; if ineffective initiate synchroniz ed cardioversi on. Ventricula r Fibrillation  Ventricular rhythm and rate are rapid and chaotic.  QRS complexes wide and irregular, no visible P waves  Myocardial ischemia or infarction, R- on-T phenomenon, untreated ventricular tachycardia,  Hypokalemia, hyperkalemia, Hypercalcemia , alkalosis, electric shock, hypothermia.  Digoxin, epinephrine, or quinidine toxicity.  If pulseless : start CPR, follow ACLS protocol for defibrillati on, ET intubation, and administra tion f epinephrin e or vasopressi n, lidocaine, or amiodaron e; ineffective consider magnesiu m sulfate. Asystole  No atrial or  Myocardial  Start CPR.