1. Cardiovascular Monitoring Cardiac Dysrhythmia
Dr.noha elsayed

2. Sinoatrial Node (Sinus) Dysrhythmias
Sinus bradycardia: the SA node fires electrical impulses at a rate that is slower than normal (that is, less than 60 impulses per minute)
Sinus tachycardia: the SA node fires electrical impulses at a rate that is faster than normal (that is, greater than 100 impulses per minute)

3. Sinus Bradycardia - SB Regularity – regular Rate – less than 60 / min
P waves – 1:1
PRI
QRS or less

4. Sinus Tachycardia - ST Regularity – regular Rate - > 100 / min
P waves = 1:1
PRI =
QRS = .12 or <

5. Sinus Arrhythmia - SA
Caused by a variety of factors: anxiety, stimulants, fever, exercise, medical conditions
Regularity – irregular
Rate – anything; freq. in normal rate of 60 – 100 / min
P waves – 1:1
PRI
QRS or <

6. Sinus Rhythms SR SB ST SA Regularity Regular Irregular Rate
Interpretation SR SB ST SA
Regularity
Regular
Irregular
Rate
60 – 100/ min
< 60 min
> 100 min
Could be any rate, usually between
P waves
1:1
PRI
QRS
.12 or <

7. Atrial Dysrhythmias
Atrial flutter: Atrial contraction (represented by the P waves on the ECG) is regular but faster than normal (250 to 400 times per minute)
Atrial fibrillation: is caused by rapid, uncoordinated twitching of the myocardium of the atria; in atrial fibrillation, the P waves are irregular and small, and they occur at a rapid rate all along the ECG

8. Atrial Fibrillation : A Fib

9. Atrial Flutter : A Flutter

10. Atrioventricular Junction Dysrhythmias
Junctional rhythm: occurs if the SA node fails to fire and send an electrical impulse through to the AV node or if the SA node fires the impulse too slowly

11. Junctional rhythms

12. P wave after QRS - junctional

13. Ventricular Dysrhythmias
Premature ventricular contraction
Ventricular tachycardia
Ventricular fibrillation

14. Premature Ventricular Contraction: PVC
Ectopic beat – dangerous if occurs often
Regularity – may interrupt the regularity of underlying rhythm
Rate – depends on underlying rhythm
P wave – will not be one before ectopic beat
PRI – none in ectopic beat – measure underlying rhythm
QRS – ectopic beat – wide and bizarre, also look at underlying rhythm

16. Ventricular Tachycardia - VT
Medical Emergency – most pts will be unconscious & can’t feel pulse
Regularity – usually regular, can be slightly irregular
Rate – 150 – 250 / min
P waves – none
PRI – none
QRS - >.12

18. Ventricular Fibrillation - VF
Start CPR!!
Regularity – baseline totally chaotic
Rate – can’t determine
P waves - ?
PRI - ?
QRS - ?

20. Asystole
No electrical activity
Start CPR

21. Cheat Sheet – Ventricular Dysrhythmias
Interpretation
PVC – premature ventricular contraction
VT – Ventricular Tachycardia
VF – Ventricular Fibrillation
Asystole
Regularity
The underlying rhythm can be regular or irregular
Usually regular, can be irregular
Baseline totally chaotic
No electrical activity, only a flat line
Rate
Determined by underlying rhythm
150 – 250
Per min.
Can’t be determined
P waves
Ectopic not preceded by a P wave
none
No discernible P waves
PRI
Ectopic comes from lower focus, no PRI
QRS
Wide and bizarre >.12
No discernible QRS complex

22. Atrioventricular Blocks
First-degree atrioventricular block
Second-degree atrioventricular block
* Type I - Wenckebach rhythm
* Type II - Mobitz type I rhythm
Third-degree atrioventricular block (Mobitz type II rhythm)

23. Observations to Report to the Nurse Immediately
The PR interval is longer than earlier
The QRS complex changed shape or widened
The ECG shows a new dysrhythmia that was not there before
C/O chest pain or discomfort
C/O shortness of breath
C/O dizziness
Person unconscious

24. Artifacts Can Be Caused by:
Electrical interference from other electrical equipment (such as an electric razor) or monitoring devices in the area
Loose electrodes, especially if the person is diaphoretic (sweating) or recently repositioned
Electrodes dried out
Electrodes placed over an excessively hairy area
Defective monitor or lead wires
Patient movement (for example, from shivering or brushing the teeth)

25. Artifact:

26. 12 Lead EKG: Prepare equipment Bed at comfortable working height
Adjust patient’s clothing to expose chest; provide privacy
Determine correct position for each electrode
If excessive hair, remove with shaver
Clean with alcohol pad to remove oils if needed
Ask patient to lay still and obtain tracing

28. 12-Lead Tracing: