Cardiology Nursing 1 Humber Final
sinus rhythm - ANS regular rhythm
Set by SA node at 60 to 100 bpm
P waves normal
normal qrs
PR 0.12 - 0.2
normal qrs less than 0.10
wide qrs is - ANS greater than 0.12
Sinus Tachycardia - ANS 100-160 bpm
SA node
reduced time for ventricle filling
assess for SOB or chest pain
a prolonged QT interval - ANS more prone to arrhythmia
NSR reflects the heart's - ANS normal electrical activity, providing synchrony between
the atria and the ventricles.
Sinus tachycardia occurs when the - ANS sinus node discharges impulses too fast (100
- 160 beats/minute). All other parameters are normal
Facts about sinus tachycardia - ANS Normal response of heart in certain
circumstances (for example exercise)
•Begins and ends gradually in contrast to other tachycardias
•Usually benign arrhythmia that goes away when underlying cause is treated
•Common causes: Anxiety, hypoxia, hypovolemia, hypotension, heart failure, pain,
drugs that increase sympathetic tone (epinephrine, norepinephrine, dopamine,
dobutamine, isoproterenol, nitroprusside), and drugs that decrease parasympathetic
tone (atropine)
,•Persistent sinus tachycardia may result in decreased cardiac output due to a decrease
in stroke volume. Cardiac output = stroke volume ×heart rate. A decrease in either
stroke volume or heart rate may result in a decrease in cardiac output.
Sinus bradycardia occurs when - ANS the sinus node discharges impulses too slow (40
- 60 beats/minute). All other parameters are normal.
Sinus bradycardia features - ANS regular rhythm, rate 40-60 bpm
Normal p waves
PR interval normal 0.12 to 0.2
QRS normal less than 0.1
Facts about sinus bradycardia - ANS Normal response of heart in certain
circumstances (for example relaxation, sleep)
•Most common arrhythmia associated with acute inferior wall myocardial infarction
•Other causes: Reperfusion rhythm following myocardial reperfusion procedures
(thrombolytic administration, angioplasty); vagal stimulation; sleep apnea; hyperkalemia;
increased intracranial pressure; disease of SA node; and administration of drugs, such
as digitalis, calcium channel blockers, and beta blockers
•Persistent bradycardia may result in decreased cardiac output due to a decrease in
heart rate. Cardiac output = stroke volume ×heart rate. A decrease in either stroke
volume or heart rate may result in a decrease in cardiac output.
Treatment of sinus bradycardia - ANS No treatment is necessary if patient is
asymptomatic.
•Symptomatic bradycardia is initially treated with oxygen and atropine IV push. If
unsuccessful, external pacing or transvenous pacing may be used.
•Chronic sinus bradycardia may require a permanent pacemaker.
Sinus arrhythmia occurs when - ANS the sinus node discharges impulses irregularly.
The heart rate may be normal range or slow. All other parameters are normal.
Sinus arrhythmia ECG features - ANS irregular rhythm
rate normal or slow
P waves normal
,PR interval normal 0.12 to 0.20
QRS normal less than 0.1
Facts about sinus arrhythmia - ANS Normal phenomenon usually associated with
phases of respiration (heart rate increases with inspiration and decreases with
expiration)
•Most commonly observed in infants, children, and young adults, although it may occur
in any age-group
•Frequently occurs along with sinus bradycardia, in which case it is usually called sinus
arrhythmia with a bradycardic rate
•Treatment: Does not require intervention unless accompanied by symptomatic
bradycardia (follow symptomatic bradycardia protocols)
Sinus pause - ANS A broad term used to describe a sudden pause in the basic rhythm
with one or more missing beats; two rhythms fall under this category:
Sinus arrest and Sinus exit block
sinus arrest - ANS SA node fails to initiate impulse; represents a problem with SA node
automaticity; basic rhythm does not resume on time following pause.
Sinus exit block - ANS SA node initiates impulse, but impulse is blocked as it exits SA
node; represents a problem with SA node conductivity; basic rhythm resumes on time
following pause.
Sinus arrest and sinus exit block ECG - ANS Rhythm: basic is regular with sudden
pause with one or more missing beats, HR may slow for several beats after pause but
then return to basic rate.
P waves: sinus with basic rhythm, absent during pause
PR interval: normal during basic, absent during pause
QRS normal during basic, absent during pause
Sinus block: basic rhythm resumes on time after pause
, Sinus arrest: basic rhythm does not resume on time after pause
irregular sinus rhythm can be associated with phases of respiration - ANS During
Inspiration, the Sinus Node fires faster
During Expiration, the Sinus Node slows down
Depolarization - ANS the spread of the electrical stimulus through the heart muscle,
producing the P wave from the atria and the QRS complex from the ventricles
Repolarization - ANS the recovery of the stimulated muscle to the resting state,
producing the ST segment, the T wave, and the U wave
Five lead system lead placement - ANS white - right arm
black - left arm
green - right leg
red - left leg
brown - chest
The 6 chest leads are... - ANS V1—4th interspace, right sternal border
V2—4th interspace, left sternal border
V3—midway between V2 and V4
V4—5th interspace, left midclavicular line
V5—5th interspace, left anterior axillary line
V6—5th interspace, left midaxillary line
False high rate alarms— - ANS Patient turning in bed or extremity movement. Solution:
Problem is usually intermittent and no correction is necessary. Movement artifact can be
reduced by avoiding placement of electrode pads in areas where extremity movement is
greatest (bony areas such as the clavicles).
Seizure activity can also produce high voltage
artifact potentials
False low rate alarms - ANS Continuous straight line related to dried conductive gel,
disconnected lead wire, or disconnected electrode pad. Solution: Check electrode
system; re-prep and reattach electrodes and leads as necessary. Note: A straight line
may also indicate the absence of electrical activity in the heart; the patient must be
evaluated immediately for the presence of a pulse.
sinus rhythm - ANS regular rhythm
Set by SA node at 60 to 100 bpm
P waves normal
normal qrs
PR 0.12 - 0.2
normal qrs less than 0.10
wide qrs is - ANS greater than 0.12
Sinus Tachycardia - ANS 100-160 bpm
SA node
reduced time for ventricle filling
assess for SOB or chest pain
a prolonged QT interval - ANS more prone to arrhythmia
NSR reflects the heart's - ANS normal electrical activity, providing synchrony between
the atria and the ventricles.
Sinus tachycardia occurs when the - ANS sinus node discharges impulses too fast (100
- 160 beats/minute). All other parameters are normal
Facts about sinus tachycardia - ANS Normal response of heart in certain
circumstances (for example exercise)
•Begins and ends gradually in contrast to other tachycardias
•Usually benign arrhythmia that goes away when underlying cause is treated
•Common causes: Anxiety, hypoxia, hypovolemia, hypotension, heart failure, pain,
drugs that increase sympathetic tone (epinephrine, norepinephrine, dopamine,
dobutamine, isoproterenol, nitroprusside), and drugs that decrease parasympathetic
tone (atropine)
,•Persistent sinus tachycardia may result in decreased cardiac output due to a decrease
in stroke volume. Cardiac output = stroke volume ×heart rate. A decrease in either
stroke volume or heart rate may result in a decrease in cardiac output.
Sinus bradycardia occurs when - ANS the sinus node discharges impulses too slow (40
- 60 beats/minute). All other parameters are normal.
Sinus bradycardia features - ANS regular rhythm, rate 40-60 bpm
Normal p waves
PR interval normal 0.12 to 0.2
QRS normal less than 0.1
Facts about sinus bradycardia - ANS Normal response of heart in certain
circumstances (for example relaxation, sleep)
•Most common arrhythmia associated with acute inferior wall myocardial infarction
•Other causes: Reperfusion rhythm following myocardial reperfusion procedures
(thrombolytic administration, angioplasty); vagal stimulation; sleep apnea; hyperkalemia;
increased intracranial pressure; disease of SA node; and administration of drugs, such
as digitalis, calcium channel blockers, and beta blockers
•Persistent bradycardia may result in decreased cardiac output due to a decrease in
heart rate. Cardiac output = stroke volume ×heart rate. A decrease in either stroke
volume or heart rate may result in a decrease in cardiac output.
Treatment of sinus bradycardia - ANS No treatment is necessary if patient is
asymptomatic.
•Symptomatic bradycardia is initially treated with oxygen and atropine IV push. If
unsuccessful, external pacing or transvenous pacing may be used.
•Chronic sinus bradycardia may require a permanent pacemaker.
Sinus arrhythmia occurs when - ANS the sinus node discharges impulses irregularly.
The heart rate may be normal range or slow. All other parameters are normal.
Sinus arrhythmia ECG features - ANS irregular rhythm
rate normal or slow
P waves normal
,PR interval normal 0.12 to 0.20
QRS normal less than 0.1
Facts about sinus arrhythmia - ANS Normal phenomenon usually associated with
phases of respiration (heart rate increases with inspiration and decreases with
expiration)
•Most commonly observed in infants, children, and young adults, although it may occur
in any age-group
•Frequently occurs along with sinus bradycardia, in which case it is usually called sinus
arrhythmia with a bradycardic rate
•Treatment: Does not require intervention unless accompanied by symptomatic
bradycardia (follow symptomatic bradycardia protocols)
Sinus pause - ANS A broad term used to describe a sudden pause in the basic rhythm
with one or more missing beats; two rhythms fall under this category:
Sinus arrest and Sinus exit block
sinus arrest - ANS SA node fails to initiate impulse; represents a problem with SA node
automaticity; basic rhythm does not resume on time following pause.
Sinus exit block - ANS SA node initiates impulse, but impulse is blocked as it exits SA
node; represents a problem with SA node conductivity; basic rhythm resumes on time
following pause.
Sinus arrest and sinus exit block ECG - ANS Rhythm: basic is regular with sudden
pause with one or more missing beats, HR may slow for several beats after pause but
then return to basic rate.
P waves: sinus with basic rhythm, absent during pause
PR interval: normal during basic, absent during pause
QRS normal during basic, absent during pause
Sinus block: basic rhythm resumes on time after pause
, Sinus arrest: basic rhythm does not resume on time after pause
irregular sinus rhythm can be associated with phases of respiration - ANS During
Inspiration, the Sinus Node fires faster
During Expiration, the Sinus Node slows down
Depolarization - ANS the spread of the electrical stimulus through the heart muscle,
producing the P wave from the atria and the QRS complex from the ventricles
Repolarization - ANS the recovery of the stimulated muscle to the resting state,
producing the ST segment, the T wave, and the U wave
Five lead system lead placement - ANS white - right arm
black - left arm
green - right leg
red - left leg
brown - chest
The 6 chest leads are... - ANS V1—4th interspace, right sternal border
V2—4th interspace, left sternal border
V3—midway between V2 and V4
V4—5th interspace, left midclavicular line
V5—5th interspace, left anterior axillary line
V6—5th interspace, left midaxillary line
False high rate alarms— - ANS Patient turning in bed or extremity movement. Solution:
Problem is usually intermittent and no correction is necessary. Movement artifact can be
reduced by avoiding placement of electrode pads in areas where extremity movement is
greatest (bony areas such as the clavicles).
Seizure activity can also produce high voltage
artifact potentials
False low rate alarms - ANS Continuous straight line related to dried conductive gel,
disconnected lead wire, or disconnected electrode pad. Solution: Check electrode
system; re-prep and reattach electrodes and leads as necessary. Note: A straight line
may also indicate the absence of electrical activity in the heart; the patient must be
evaluated immediately for the presence of a pulse.
