7/30/2019 Cardiac Rhytms Review

1/2

Sinus Bradycardia

Slow heart rate, less than 60/min

Asymptomatic? Monitor

Symptomatic? Atropine, pressors, epinephrine, dopamine

Nursing? Watch for s/s of decreased loc, respiratory, decreased CO, ABCs

Complications?

Stop: betablockers, calcium channel blockers, dig

Do not give: tikosyn

Sinus Tachycardia

Fast heart rate, over 100/min

Symptomatic? Beta-blocker, calcium channel blocker, CP, palpiations

Nursing? Watch blood pressure, orthostatic hypotension, teach how to take pulse/blood pressure, find

out about drug/alcohol use, I&O, LOC related to cerebral prefusion, calm environment, thrombo

precautions, prolonged tachy following MI indicates further damage

Stop: atropine, pressors, epinephrine, dopamine

PACs

Premature P wave, (lost in the T)

Nursing? Continue to monitor, watch in pts in heart disease can lead to a-fib/a-flutter, electrolyte

imbalance, early sign of heart failure, can occur during periods of anxiety

Meds: dig, procainamide, quinidine

Stop: nicotine, caffeine, recreational drugs

SVTs

HR from 150-250

Symptomatic: adenosine, Hyundai sign, valsalvas maneuver, carotid massage (vagal them down)(not on

older pts), dig, betablockes, ccbs

Nursing? Continuous ECG during admin, large bore IV (for push), flush after push, CP, s/s decreased CO,

HF, MI, check the dig level

A-flutter

250-350 atrial rhythm, multiple p waves, SAWTOOTH

Symptomatic: cardioversion with R wave, anti-coags, dig, cardizem, amiodarone

Nursing: s/s of low cardiac output, dig levels r/t SA node depression, IV access, sedative for

cardioversion, crash cart, bradycardia

A-fib

Quivering atria, more common then flutter or a-tach, occurs commonly with other cardiac problems,

drugs (aminophylline and dig)

Uncontrolled (greater than 100): angina, syncope

7/30/2019 Cardiac Rhytms Review

2/2

Intervene: cardioversion and drugs to slow the HR (sodium channel blockers, magnesium, beta-blockers,

amiodarone, verapamil), anti-coags/thrombolytics, radiofrequency ablation,

Cant cardiovert if on warfarin for 3-4 weeks.

Nursing: call if syncope, dizziness, CP, dyspnea, peripheral edema. Watch fluid balance

PVCs

Wide and bizarre

PVCs together: 2=couplet, 3=salvo

PVCs patterns: every other=bigeminy, every third=trigeminy, multi-focal PVCs=WORST and can lead to

V-tach

Causes: caffeine, nicotine, alchohol, ischemia, DIG TOXICITY, electrolyte imbalance, OSA

Intervene: monitor, procainamide, lidocaine, amiodarone, sotalol

Nursing: check dig level, stop caffeine nicotine and alcohol, check electrolyte levels, sleep study for OSA

V-Tach

Undetermined rhythm, big mountains, long run of PVCs

Pulse and Stable

Intervene: amiodarone, cardiovert, beta adrenergics, beta blockers, sodium channel blockers, magnes

Nursing: sedative for cardioversion, teach to take pulse/bp, diet, mag considerations

Pulsess

Intervene: ET tube, CPR, de-fib, amdiodarone, lidocaine, mag, epi, pressors,

Nursing: ET tube (skin, hygiene, lung sounds, ROM, appearance) ACLS (epi, then atropine)

V-FIB

Non-specific rhythm, little mountain, no effect contraction/output

Intervene: d-fib, CPR, ETT, epi, pressors, surgical d-fib placement

Asystole

Dead

CPR, ETT, epi, atropine, transcutaneous pacing

AV block

Progressive widening PR interval