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Cardiovascular Disorders
Cardiac Dysrhythmias
Route Rate Rhythm
Rhythm P Wave PR QRS Rate Regularity Life Causes
Interval Threatening
Normal Sinus Normal 0.12-0.20 <0.12 60-100 Regular No Normal Finding
Sinus Normal 0.12-0.20 <0.12 <60 Regular Dependant Sleep, inactivity,
Bradycardia on Cause athletic, vagal tone,
drugs, MI, K+,
respiratory arrest
Sinus Normal 0.12-0.20 <0.12 >100, Regular No Caffeine, exercise,
Tachycardia usually fever, anxiety, heart
100-150 failure, drugs, pain,
hypoxia,
hypotension, volume
depletion
Atrial Pause Looks like SR but drops a Normal or Irregular Depends on Elderly, digoxin
complex slow length and toxicity, MI,
frequency rheumatic fever
Atrial Flutter Saw tooth None <0.12 Atrial rate Regular or Dependant Valvular heart
250-400 Irregular on disease, MI, CHF,
ventricular pericarditis
rate
Atrial Wavy None <0.12 Atrial rate Irregular Dependant Heart disease,
Fibrillation unidentifia >400 on pulmonary disease,
ble ventricular emotional stress,
rate excessive alcohol or
caffeine
Junctional INVERTED <0.12 <0.12 40-60 Regular Dependant Electrical impulse not
Rhythm before or on arriving from SA
after QRS ventricular node, AV node fires
or absent rate at inherent rate
Accelerated INVERTED <0.12 <0.12 60-100 Regular Dependant Digoxin toxicity,
Junctional before or on damage to AV node
Rhythm after QRS ventricular
or absent rate
Junctional INVERTED <0.12 <0.12 >100 Regular Dependant Same as SVT
Tachycardia before or on
after QRS ventricular
or absent rate
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Supraventricu Pointed or Immeasu <0.12 150-250 Regular Dependant Caffeine, CHF,
lar hidden in T rable on rate and fatigue, hypoxia,
Tachycardia patient mitral valve disease,
ability to altered pacemaker in
tolerate heart
Idioventricula None None >0.11 20-40 Regular Yes Digoxin toxicity,
r Rhythm wide acute MI
and
bizarre
Ventricular None None >0.11 150-250 Regular Yes, may MI, ischemia, digoxin
Tachycardia wide have pulse toxicity, hypoxia,
and acidosis, ↓K+, ↓BP
bizarre
Ventricular None None None None Irregular, Yes, no pulse Follow PVC, VT, most
Fibrillation vary in size, common cause of
shape and sudden death
height
Asystole Possible None None None No QRS Yes Follows VT/VFib,
acidosis, hypoxia,
↓K+, hypothermia,
drug overdose
1° AV Block Normal >0.20 <0.12 Varies Regular or Usually Not First sign of
irregular increasing AV block
2° AV Block Normal Varies: <0.12 Varies Regularly Usually Not Acute inferior MI,
Type I progressi irregular: digoxin toxicity, vagal
vely QRS dropped stimulation,
prolonge after conduction system
d progressively disease
prolonged
PRI
2° AV Block Normal Consisten Normal Usually Regular or Dependant BBB, anterior MI,
Type II t normal or wide slow irregular; on overall lesions of conduction
or occasionally ventricular system
prolonge dropped QRS rate, may
d progress to
3° AV Block
3° AV Block Normal No Wide Slow Regular Yes: Atria and ventricles
relations pacemaker beat independently,
hip needed digoxin or K+ toxicity,
between acute MI, ischemic
PR & QRS heart disease
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Premature Yes, PAC P May <0.12 Rate of PAC No Coffee, tea, alcohol,
Atrial wave differ underlyi complexes CHF, emotions,
Contractions shaped from ng come early fatigue, fever,
different underlyin rhythm hypoxia, mitral valve
g rhythm disease
Premature Inverted <0.12 <0.12 Rate of PJC make it No Vagal tone, stress,
Junctional before or underlyi irregular caffeine, alcohol,
Contractions after QRS ng heart failure, digoxin
or absent rhythm toxicity, ↓K+
Premature None N/A >0.11 Depend Irregular due Depends on Ventricular
Ventricular wide ant on to premature frequency irritability, hypoxia,
Contractions and underlyi beat and how ↓K+, Ca, MI, digoxin
bizarre ng close to T toxicity, anxiety
rhythm wave
Sinus Bradycardia
Sinus bradycardia is essentially the result of the SA node initiating impulses at a slower rate than
normal. Conduction follows the correct path but at a slower rate.
1. Overview
a. Rhythm is regular
b. Rate <60
2. NCLEX® Points
a. Therapeutic Management
i. Determine cause
ii. Atropine may be administered to keep the rate >60
iii. Monitor hemodynamics, insure proper CO
iv. permanent pacemaker may be required
Cardiovascular Disorders
Cardiac Dysrhythmias
Route Rate Rhythm
Rhythm P Wave PR QRS Rate Regularity Life Causes
Interval Threatening
Normal Sinus Normal 0.12-0.20 <0.12 60-100 Regular No Normal Finding
Sinus Normal 0.12-0.20 <0.12 <60 Regular Dependant Sleep, inactivity,
Bradycardia on Cause athletic, vagal tone,
drugs, MI, K+,
respiratory arrest
Sinus Normal 0.12-0.20 <0.12 >100, Regular No Caffeine, exercise,
Tachycardia usually fever, anxiety, heart
100-150 failure, drugs, pain,
hypoxia,
hypotension, volume
depletion
Atrial Pause Looks like SR but drops a Normal or Irregular Depends on Elderly, digoxin
complex slow length and toxicity, MI,
frequency rheumatic fever
Atrial Flutter Saw tooth None <0.12 Atrial rate Regular or Dependant Valvular heart
250-400 Irregular on disease, MI, CHF,
ventricular pericarditis
rate
Atrial Wavy None <0.12 Atrial rate Irregular Dependant Heart disease,
Fibrillation unidentifia >400 on pulmonary disease,
ble ventricular emotional stress,
rate excessive alcohol or
caffeine
Junctional INVERTED <0.12 <0.12 40-60 Regular Dependant Electrical impulse not
Rhythm before or on arriving from SA
after QRS ventricular node, AV node fires
or absent rate at inherent rate
Accelerated INVERTED <0.12 <0.12 60-100 Regular Dependant Digoxin toxicity,
Junctional before or on damage to AV node
Rhythm after QRS ventricular
or absent rate
Junctional INVERTED <0.12 <0.12 >100 Regular Dependant Same as SVT
Tachycardia before or on
after QRS ventricular
or absent rate
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Supraventricu Pointed or Immeasu <0.12 150-250 Regular Dependant Caffeine, CHF,
lar hidden in T rable on rate and fatigue, hypoxia,
Tachycardia patient mitral valve disease,
ability to altered pacemaker in
tolerate heart
Idioventricula None None >0.11 20-40 Regular Yes Digoxin toxicity,
r Rhythm wide acute MI
and
bizarre
Ventricular None None >0.11 150-250 Regular Yes, may MI, ischemia, digoxin
Tachycardia wide have pulse toxicity, hypoxia,
and acidosis, ↓K+, ↓BP
bizarre
Ventricular None None None None Irregular, Yes, no pulse Follow PVC, VT, most
Fibrillation vary in size, common cause of
shape and sudden death
height
Asystole Possible None None None No QRS Yes Follows VT/VFib,
acidosis, hypoxia,
↓K+, hypothermia,
drug overdose
1° AV Block Normal >0.20 <0.12 Varies Regular or Usually Not First sign of
irregular increasing AV block
2° AV Block Normal Varies: <0.12 Varies Regularly Usually Not Acute inferior MI,
Type I progressi irregular: digoxin toxicity, vagal
vely QRS dropped stimulation,
prolonge after conduction system
d progressively disease
prolonged
PRI
2° AV Block Normal Consisten Normal Usually Regular or Dependant BBB, anterior MI,
Type II t normal or wide slow irregular; on overall lesions of conduction
or occasionally ventricular system
prolonge dropped QRS rate, may
d progress to
3° AV Block
3° AV Block Normal No Wide Slow Regular Yes: Atria and ventricles
relations pacemaker beat independently,
hip needed digoxin or K+ toxicity,
between acute MI, ischemic
PR & QRS heart disease
, from NRSNG.com
Premature Yes, PAC P May <0.12 Rate of PAC No Coffee, tea, alcohol,
Atrial wave differ underlyi complexes CHF, emotions,
Contractions shaped from ng come early fatigue, fever,
different underlyin rhythm hypoxia, mitral valve
g rhythm disease
Premature Inverted <0.12 <0.12 Rate of PJC make it No Vagal tone, stress,
Junctional before or underlyi irregular caffeine, alcohol,
Contractions after QRS ng heart failure, digoxin
or absent rhythm toxicity, ↓K+
Premature None N/A >0.11 Depend Irregular due Depends on Ventricular
Ventricular wide ant on to premature frequency irritability, hypoxia,
Contractions and underlyi beat and how ↓K+, Ca, MI, digoxin
bizarre ng close to T toxicity, anxiety
rhythm wave
Sinus Bradycardia
Sinus bradycardia is essentially the result of the SA node initiating impulses at a slower rate than
normal. Conduction follows the correct path but at a slower rate.
1. Overview
a. Rhythm is regular
b. Rate <60
2. NCLEX® Points
a. Therapeutic Management
i. Determine cause
ii. Atropine may be administered to keep the rate >60
iii. Monitor hemodynamics, insure proper CO
iv. permanent pacemaker may be required
