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Basic Telemetry Course
Atrial Dysrhythmias Basic Telemetry Course
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Atrial Dysrhythmias Abnormal activity in the atria
P wave rate must be calculated and P wave must be analyzed Check the previous T wave for hidden P waves
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Include: Wandering Atrial Pacemaker Premature Atrial Complexes (PAC’s)
Atrial Tachycardia Atrial Flutter Atrial Fibrillation
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Wandering Atrial Pacemaker
At least 3 different shaped P waves PR intervals vary (irregular) Ventricular rate 60 – 100 QRS normal 1:1 conduction If ventricular rate goes above 100, name changes to Multifocal Atrial Tachycardia (MAT)
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Premature Atrial Contractions
Early P waves P wave looks slightly different from sinus P Conduction is usually down normal pathway QRS narrow (looks same as basic rhythm) Usually found in young or elderly otherwise healthy people Compensatory pause
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Compensatory Pause Definition:
The distance between the sinus beat before the Premature beat and the sinus beat that follows the Premature beat, is equal to the sum of two consecutive sinus intervals
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PACs
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Complete Compensatory Pause
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Complete Compensatory Pause
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Incomplete Compensatory Pause
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PAC
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PAC
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Atrial Bigeminy
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Significance of PAC’s Usually benign Can indicate presence of CHF
Can be precursors to more serious arrhythmias May be caused by pain, fever, fear, anxiety, excitement, exercise May be caused by drugs such as Digitalis, atropine, nicotine, caffeine, amphetamines Usually no treatment (have cardiac output with these beats)
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Atrial Tachycardia 3 or more PAC’s in a row
Impulse comes from an atrial pacemaker other than from the SA node Characterized by regular rates between /min Can appear and disappear suddenly (known as PAT – Paroxysmal Atrial Tachycardia) All P waves may not be conducted down to ventricle (Atrial Tach with Block)
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Atrial Tachycardia
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Paroxysmal Atrial Tachycardia
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SVT Term used for any tachycardia that has a narrow QRS, is regular with rate of and you are not sure whether the wave before the QRS is a P or a T wave General term indicating the tachycardia is originating somewhere above the ventricles
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SVT
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SVT
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SVT
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Treatment Stable SVT: Not a lethal dysrhythmia, but cannot be tolerated for long periods Vagal maneuvers Adenosine 6 mg IV push If recurs can treat with diltiazem, B-Blockers
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Treatment Unstable SVT
Signs include altered mental status, ongoing chest pain, hypotension, other signs of shock Perform immediate synchronized cardioversion Treat underlying cause (H’s, T’s)
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Atrial Flutter Atrial rate or P wave rate is 250-350
P waves sometimes appear as sawtooth’s Every P wave is not conducted to the ventricle Ventricular response can be regular or irregular Anytime ventricular rate is exactly 150 suspect atrial flutter Must slow down the rate to see for sure
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Atrial Flutter
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Atrial Flutter
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Atrial Flutter
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Atrial Flutter
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Atrial Flutter May be caused by heart disease, myocardial infarction, or drug toxicity Usually not lethal Treatment goal is to control rate: Diltiazem, B-Blockers
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Atrial Fibrillation P waves discharging from atria at 350-650/min
P wave shape deteriorates See no clear identifiable P waves Ventricular response ALWAYS irregular Called “Controlled” A Fib when ventricular rate is less than 100 Called “Uncontrolled” A Fib when ventricular rate is greater than 100
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Atrial Fibrillation
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Atrial Fibrillation
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Atrial Fibrillation
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Atrial Fibrillation May be caused by severe heart disease or MI
Also may occur with excessive use of alcohol or caffeine If rate rapid/unstable, immediate synchronized cardioversion Needs anticoagulation – at risk for cardioembolic event Can be treated with diltiazem, B-Blockers, Tikosyn, digoxin, amiodarone
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