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Basic EKG Interpretation

Basic EKG Interpretation. Atrial Arrhythmias. Atrial Arrhythmias. Premature Atrial Contractions Atrial Tachycardia Paroxysmal NonParoxysmal Atrial Flutter Atrial Fibrillation Wandering Atrial Pacemaker Multifocal Atrial Tachycardia. Premature Atrial Contraction (PAC).

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Basic EKG Interpretation

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  1. Basic EKG Interpretation Atrial Arrhythmias

  2. Atrial Arrhythmias • Premature Atrial Contractions • Atrial Tachycardia • Paroxysmal • NonParoxysmal • Atrial Flutter • Atrial Fibrillation • Wandering Atrial Pacemaker • Multifocal Atrial Tachycardia

  3. Premature Atrial Contraction (PAC) • Caused by enhanced automaticity • Occurs in addition to underlying rhythm • P wave of PAC • Occurs early • Different looking • May have different PR interval • QRS of PAC • May be blocked or nonconducted – ventricle is still refractory • Can be normal or wide in duration

  4. Effects of PAC • May cause palpitations • May be precursor to worse arrhythmias – such as atrial flutter or fibrillation • May decrease cardiac output – occurs soon after previous beat, not enough time for ventricle to fill up again

  5. Premature Atrial Contraction (5th beat)

  6. Premature Atrial Contraction(5th beat)

  7. Blocked PAC

  8. Enlarged Photo

  9. PAC’s • Common causes • Emotions • Caffeine • Sympathomimetic drugs • ischemia

  10. Treatment of PAC • Usually none • Eliminate cause

  11. PAC: Nursing Implications • Monitor serum potassium levels • Monitor serum digoxin levels • Monitor for CHF • Eliminate causes • Monitor for more arrhythmias

  12. Atrial Tachycardia • Rapid Atrial Arrhythmia • Paroxysmal: Starts and stops suddenly • Usually caused by reentry • Usually initiated by PAC • Nonparoxysmal: Sustained • Usually caused by enhanced automaticity • Supraventricular Tachycardia (SVT): Generic term when P waves can’t be seen

  13. Atrial Tachycardia • P wave: Regular and upright, may be buried in preceding T wave; may be initiated by PAC • Rate: 160 - 220 beats/minute • Rhythm: Regular • QRS: May be less than P waves because of block; may be normal or wide in duration

  14. Causes of Atrial Tachycardia • Stress • Excessive use of stimulants • Accessory conduction pathway • Chronic lung disease • Digoxin toxicity (particularly atrial tach with block)

  15. Effects of Atrial Tachycardia • May decrease cardiac output – tachycardia causes less time in diastole • Decreased coronary perfusion - coronary arteries get less blow flow as less time in diastole • Chest pain – due to decreased coronary perfusion

  16. Atrial Tachycardia

  17. Atrial Tach with Block

  18. Non-Paroxysmal Atrial Tachycardia

  19. PAT

  20. Treatment of Atrial Tachycardia • Vagal stimulation • Carotid sinus massage • Valsalva maneuver • Diving reflex • Synchronized cardioversion • Overdrive pacing • Adenosine IV: 6 mg rapidly, may give 12 mg in 1 -2 minutes

  21. Treatment of Atrial Tachycardia • Diltiazem: 0.25 mg/kg bolus; then 10 mg/hr • Digoxin IV except if arrhythmia is due to accessory conduction pathway or digoxin toxicity • Amiodarone • Beta-blockers • Atenolol, metoprolol, esmolol

  22. Nursing Implications - Atrial Tachycardia • Check for clues as to cause • Monitor digoxin level • Have resuscitative equipment available • Supplemental oxygen • Assess for chest pain and CHF

  23. Atrial Flutter • Usually a transient rhythm • Usually precedes atrial fibrillation • Results either from reentry or enhanced automaticity • Seen in people with ischemic heart or valvular disease

  24. Atrial Flutter • Flutter waves: sawtooth pattern • Atrial rate: 250-350 beats/minute • Atrial rhythm: regular, may be buried in QRS complex • PR interval: not measurable • QRS: may appear distorted • QRS rate: described in terms of ratio of F waves to QRS (4:1, 2:1) • QRS rhythm: may be regular or irregular

  25. Atrial Flutter

  26. Atrial Flutter

  27. Atrial Flutter

  28. Atrial Flutter • Effects • Loss of Atrial Kick (delay of the impulse at the AV node so that the atria can contract to increase ventricular filling and cardiac output) • Decreased cardiac output • Treatments • Amiodarone, procainamide, beta-blockers, digoxin, calcium channel blockers • Cardioversion very effective • Ibutilide (Corvert) - chemical cardioverter: 1 mg/50 D5W over 10 min; may repeat in 10 min

  29. Nursing Implications: Atrial Flutter • Ensure adequate oxygenation • For cardioversion: need informed consent, if elective, sedation and resuscitative equipment

  30. Atrial Fibrillation • Due to enhanced automaticity • Usually chronic rhythm • Associated with: • Ischemic heart disease • Valvular disease • Chronic lung disease • Post cardiac surgery • Hypokalemia

  31. Atrial Fibrillation • Fibrillatory waves: wavy baseline • Atrial rate: over 350 beats/minute • Atrial rhythm: irregular • PR interval: not measurable • QRS: usually normal and alike • QRS rate: may vary • controlled: less than 100 beats/minute • uncontrolled: over 100 beats/minute • QRS rhythm: irregularly irregular

  32. Atrial Fibrillation

  33. Atrial Fibrillation

  34. Atrial Fibrillation

  35. Atrial Fibrillation • Effects: • Loss of atrial kick • May cause mural thrombi – thrombi on endocardial wall due to stagnant blood flow • Treatment: • Same as for atrial flutter • Anticoagulate if over 48 hours duration • Goal for chronic arrhythmia is to control ventricular rate • Cardioversion less effective, if chronic – usually delayed if greater than 48 hours duration until anticoagulated and atrial thrombi excluded

  36. Atrial Fibrillation: Nursing Implications • Consider this arrhythmia in irregular pulse with pulse deficit • Monitor for CHF • High risk for CVA • Consider hyperthyroidism, alcoholic cardiomyopathy – may cause atrial fibrillation

  37. Wandering Atrial Pacemaker • Due to several atrial and AV ectopic sites • Associated with: • Rheumatic heart disease • Vagal stimulation • Digoxin toxicity • Usually no effects on client

  38. Wandering Atrial Pacemaker • P waves: At least three different looking P waves. Some may be inverted • PR interval varies • QRS: • Usually normal and alike • Rate usually 60 - 100 beats/minute • Rhythm usually irregular • In rates greater than 100: Multifocal Atrial Tachycardia (MAT)

  39. Wandering Atrial Pacemaker

  40. MAT

  41. Wandering Atrial Pacemaker • Treatment: • Usually none except if digoxin toxicity • Coughing may help if due to vagal stimulation • Treatment usually ineffective for MAT • Nursing Implications: • Monitor serum digoxin levels • Monitor for bradycardia • Monitor for hypotension

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