ECG

• Sinus Tachycardia-- heart rate greater than 100 beats per minute originating from the sinus node.

  • Rate: 100 to 180 beats per minute
  • P Waves precede each QRS complex
  • PR interval is normal
  • QRS complex is normal
  • Conduction is normal
  • Rhythm is regular

  Causes of sinus tachycardia may include exercise, anxiety, fever, drugs, anemia, heart failure, hypovolemia, and shock. Sinus tachycardia is often asymptomatic. Management, however is directed at the treatment of the primary cause. Carotid sinus pressure (carotid massage) or a beta-blocker may be used to reduce heart rate.
• Sinus Bradycardia


  Heart rate of less than 60 beats per minute and originates from the sinus node
• Sinus Bradycardia


  • Rate is less than 60 beats per minute
  • P Waves precede each QRS complex
  • PR interval is normal
  • QRS complex is normal
  • Conduction is normal
  • Rhythm is regular
• Causes of Sinus Bradycardia


  • Drugs
  • Vagal stimulation
  • Hypoendocrine states
  • Hypothermia
  • Sinus node involvement in MI
• Sinus Bradycardia in athletes


  They have quality stroke volume, so it may be normal
• Manifestations of Sinus Bradycardia


  • Asymptomatic
  • Syncope
  • Fatigue
  • Dizziness
• Management of Sinus Bradycardia


  1. Treat underlying cause

  2. Administer anticholinergic drugs like atropine sulfate as prescribed
• Premature Atrial Contraction


  Cells in the heart starts to fire or go off before the normal heartbeat is supposed to occur
• Premature Atrial Contraction


  • Premature and abnormal-looking P waves that differ in configuration from normal P waves
  • QRS complex after P waves except in very early or blocked PACs
  • P waves often buried in the preceding T wave or identified in the preceding T wave
• Causes of Premature Atrial Contraction


  • Coronary or valvular heart diseases
  • Atrial ischemia
  • Coronary artery atherosclerosis
  • Heart failure
  • COPD
  • Electrolyte imbalance
  • Hypoxia
• Treatment for Premature Atrial Contraction


  1. Usually there is no treatment needed

  2. May include procainamide and quinidine administration (antidysrhythmic drugs)

  3. Carotid sinus massage
• Atrial Flutter-abnormal rhythm that occurs in the atria of the heart. Atrial flutter has an atrial rhythm that is regular but has an atrial rate of 250 to 400 beats/minute. It has sawtooth appearance.

  • Normal atrial rhythm
  • Abnormal atrial rate: 250 to 400 beats/minute
  • Sawtooth P wave configuration
  • QRS complexes uniform in shape but irregular in rate

  Causes includes heart failure, tricuspid valve or mitral valve diseases, pulmonary embolism, cor pulmonale, inferior wall MI, carditis and digoxin toxicity.
• Atrial Flutter-abnormal rhythm that occurs in the atria of the heart. Atrial flutter has an atrial rhythm that is regular but has an atrial rate of 250 to 400 beats/minute. It has sawtooth appearance.
• Atrial flutter


  Abnormal heart rhythm
• Normal atrial rhythm


  Regular heart rhythm
• Abnormal atrial rate


  • 250 to 400 beats/minute
• QRS complexes


  • Uniform in shape but irregular in rate
• Causes of atrial flutter


  • Heart failure
  • Tricuspid valve disease
  • Mitral valve disease
  • Pulmonary embolism
  • Cor pulmonale
  • Inferior wall MI
  • Carditis
  • Digoxin toxicity
• Management of unstable atrial flutter


  Prepare for immediate cardioversion if ventricular rate greater than 150 bpm
• Management of stable atrial flutter


  1. Drug therapy may include calcium channel blocker, beta-adrenergic blockers, or antiarrhythmics

  2. Anticoagulation may be necessary due to pooling of blood in the atria
• Atrial fibrillation


  Uncoordinated twitching of atrial musculature caused by overly rapid production of atrial impulses
• Atrial Rate


  • 350 to 600 bpm
• Ventricular Rate


  • 120 to 200 bpm
• P wave


  • Not discernible with an irregular baseline
• PR interval


  • Not measurable
• QRS complex


  • Normal
• Rhythm


  • Irregular and usually rapid unless controlled
• Causes of atrial fibrillation


  • Atherosclerosis
  • Heart failure
  • Congenital heart disease
  • Chronic obstructive pulmonary disease
  • Hypothyroidism
  • Thyrotoxicosis
• Asymptomatic


  Without symptoms
• Clinical manifestations of atrial fibrillation


  • Palpitations
  • Dyspnea
  • Pulmonary edema