Advanced Dysrhythmias Study Guide
with Accurate Solutions
H's and T's for abnormal heart rhythms (6/5)
• Hypovolemia - weight loss, low BP, incr. HR, concentrated blood (high hematocrit),
turgor/tenting
• Hypoxia - cyanosis (mouth, periphery, O2 sat below 95-100)
• Hydrogen ion (Acidosis) - more hydrogen ions, ABG (low pH, bicarb ≤22, low CO2 =
compensation, CO2 will be high if the cause bicarb above 26)
• Hypo/hyperkalemia - weakness, change in T waves
• Hypoglycemia - cold and clammy give candy
• Hypothermia
• Toxins - meds, comorbidities, kidneys (main excreters - will see high BUN, Cr, decr.
urine and GFR)
• Tamponade, cardiac - fluid buildup around heart
• Tension pneumothorax - collapsed lung r/t air; will present with absent breath
sounds on affect side, low O2 sat, tracheal shift, SOB
• Thrombosis - chest pain, neuro changes, etc.
• Trauma
, Sinus Tachycardia
• Atrial/ventricular rate and rhythm: > 100, but < 120 and regular
• P wave: Normal and consistent shape; always in front of QRS
• PR interval: Consistently between 0.12 and 0.2 seconds
• QRS shape and duration: Usually normal, but may be regularly abnormal
Etiology of Sinus Tachycardia
• Physiologic or psychological stress - movement, anxiety, pain, stimulants
(drug, caffeine)
• Sympathetic stimulants
• Enhanced SA node automaticity
• Autonomic dysfunction
*Management will depend on cause and symptoms with focus on identifying
and treating cause
*ABCs; palpitations, SOB
Sinus Arrhythmia
• Atrial/ventricular rate and rhythm: 60-100 and irregular; rate increases
with inspiration and decreases with expiration
• P wave: Normal and consistent shape; always in front of QRS
• PR interval: Consistently between 0.12 and 0.2 seconds
• QRS shape and duration: Usually normal, but may be regularly abnormal
• Does not cause significant hemodynamic effect and is typically not treated, "continue
to monitor"
• unequal spaces from R to R; cause is breathing - benign
Premature Atrial Complex (PAC)
with Accurate Solutions
H's and T's for abnormal heart rhythms (6/5)
• Hypovolemia - weight loss, low BP, incr. HR, concentrated blood (high hematocrit),
turgor/tenting
• Hypoxia - cyanosis (mouth, periphery, O2 sat below 95-100)
• Hydrogen ion (Acidosis) - more hydrogen ions, ABG (low pH, bicarb ≤22, low CO2 =
compensation, CO2 will be high if the cause bicarb above 26)
• Hypo/hyperkalemia - weakness, change in T waves
• Hypoglycemia - cold and clammy give candy
• Hypothermia
• Toxins - meds, comorbidities, kidneys (main excreters - will see high BUN, Cr, decr.
urine and GFR)
• Tamponade, cardiac - fluid buildup around heart
• Tension pneumothorax - collapsed lung r/t air; will present with absent breath
sounds on affect side, low O2 sat, tracheal shift, SOB
• Thrombosis - chest pain, neuro changes, etc.
• Trauma
, Sinus Tachycardia
• Atrial/ventricular rate and rhythm: > 100, but < 120 and regular
• P wave: Normal and consistent shape; always in front of QRS
• PR interval: Consistently between 0.12 and 0.2 seconds
• QRS shape and duration: Usually normal, but may be regularly abnormal
Etiology of Sinus Tachycardia
• Physiologic or psychological stress - movement, anxiety, pain, stimulants
(drug, caffeine)
• Sympathetic stimulants
• Enhanced SA node automaticity
• Autonomic dysfunction
*Management will depend on cause and symptoms with focus on identifying
and treating cause
*ABCs; palpitations, SOB
Sinus Arrhythmia
• Atrial/ventricular rate and rhythm: 60-100 and irregular; rate increases
with inspiration and decreases with expiration
• P wave: Normal and consistent shape; always in front of QRS
• PR interval: Consistently between 0.12 and 0.2 seconds
• QRS shape and duration: Usually normal, but may be regularly abnormal
• Does not cause significant hemodynamic effect and is typically not treated, "continue
to monitor"
• unequal spaces from R to R; cause is breathing - benign
Premature Atrial Complex (PAC)
