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Atrial Fibrillation Rhythm. One of the most common atrial dysrhythmias Presents with three definite characteristics 1. Notable absence of P waves 2. P waves replaced by F waves 3. Ventricular response rate totally irregular or termed “irregular irregularity”. Atrial Fibrillation Rhythm.
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Atrial Fibrillation Rhythm • One of the most common atrial dysrhythmias • Presents with three definite characteristics 1. Notable absence of P waves 2. P waves replaced by F waves 3. Ventricular response rate totally irregular or termed “irregular irregularity”
Atrial Fibrillation Rhythm • QRS complexes are usually within normal limits • Multiple ectopic foci from within atria blitzing AV node • AV node unable to handle or conduct each impulse • AV node allows impulses to enter conduction system at random
Atrial Fibrillation Rhythm • Rhythm may be chronic in nature, commonly associated with underlying heart disease, CHF, rheumatic heart disease • Also hypoxia, MI, digitalis toxicity, and electrolyte imbalances. • Treatment • Slow HR < 80-100 if rapid • Done with monitoring and digitalis
Supraventricular Tachycardia Rhythms • Encompasses all fast (tachy-) dysrhythmias in which heart rate is greater than 100 bpm • Applies to any tachycardic rhythm originating above the ventricle • Paroxysmal refers to sudden onset and/or cessation
Supraventricular Tachycardia Rhythms • Occurs when rapid atrial ectopic focus overrides the SA node and becomes the heart’s primary pacemaker • Can resemble a rapid sinus tachycardia • Sinus tachycardia seldom exceeds 160 to170 bpm at high range
Supraventricular Tachycardia • Causes can be overexertion, stress, hypoxia, excessive use of stimulants, hypokalemia, and ASHD • Treatment • Vagal maneuvers; Stimulation of the vagus nerve releases acetylcholine resulting in slowing ofheart rate • Bearing down, coughing, squatting, and carotid sinus massage • Drug therapy such as adenosine and/or synchronized cardioversion
Wolff-Parkinson-White Syndrome (WPW) • Characterized by two AV conduction pathways • Identified by DELTA WAVE seen on EKG • QRS is greater than 0.10 seconds • Due to ventricles stimulated by impulse originated outside normal conduction pathway
Clinical Significance of Atrial Rhythms • Premature atrial contraction (complex) • Isolated PACs are not significant • May be corrected by identifying underlying cause • Frequent PACs (more than 6/min) may signify underlying heart disease • May cause other atrial dysrhythmias
Clinical Significance of Atrial Rhythms • Atrial flutter rhythm • Related directly to patient’s condition • Ventricular rate normal • Well tolerated • Ventricular rate fast • Decrease in cardiac output • Treatment • Directed to decrease ventricular rate, either with medication (if stable) or cardioversion (if unstable)
Clinical Significance of Atrial Rhythms • Atrial fibrillation rhythm • Controlled atrial fib • No treatment • Rapid atrial fib • Treatment is to decrease the ventricular rate with medications (if stable) or cardioversion (if unstable) • Patients are at risk of atrial and systemic emboli due to decrease in cardiac output or loss of “atrial kick”
Clinical Significance of Atrial Rhythms • Supraventricular tachycardia rhythms • May occur in healthy hearts and may be tolerated for a short while • C/O heart “racing or running away” • If symptomatic, treatment directed at slowing the heart rate by use of vagal maneuvers, drug therapy, or synchronized cardioversion
