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Table 1-A. 1. Electrocardiographic (ECC) Characteristics and Causes of Atrial Rhythms

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Name

ECG Characteristics

Common Causes

PT Consideration

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Supraventricular

Regular rhythm, rate 1 60-250,

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Rheumatoid heart

May produce palpitations, chest tight

=

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tachycatdia

may originate from any location

disease (RHD),

ness, dizziness, anxiety, apprehension,

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above atrioventricular node, can be

mitral valve proweakness; PT would not treat if in

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paroxysmal (comes and goes withlapse, cor pulmosupraventricular tachycardia until

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out reason).

nale, digitalis

controlled.

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wxicity.

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Atrial flutter

Rhythm can be regular or irregular,

Mitral stenosis,

Signs and sympwms depend on presence or

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atrial rate of 250--350, ventricular

CAD, hyperabsence of heart disease but can lead to

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rate is variable and depends on the

tension.

CHF, palpitations, angina, and syncope

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conduction ratio (atrial:ventricuif cardiac output decreases far enough w

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lar-i.e., atrial rate 250, ventric

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reduce myocardial and cerebral blood

ular rate 125; 2:1 classic saw

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flow; PT treatment would depend on toltooth P waves.)

erance to the rhythm.

Atrial fibrilla

Irregular rhythm, atrial has no rate

One of most com

Can produce CHF, syncope secondary to no

tion (A F)

(just quivers) ventricular varies.

monly encoun

"atrial kick"; if new diagnosis, hold PT

tered rhythms,

until medical treatment; if chronic and

CHF, CAD, RHO,

nor in CHF, would treat with caution.

hypertension, cor

pulmonale.

Premature atrial

Irregular rhythm (can be regularly

Normal people with

Usually asympromatic but needs ro be

contractions

irregular, i.e., skip every third

caffeine, smokconsidered with other cardiac issues

beat); rate normal 60-100.

ing, emocional

at time of treatment; can proceed

disturbances;

with treatment with close monitoring;

abnormal with

if they are consistent and increasing

CAD, CHF, eleccan progress [Q AF.

trolyte disturbances.

AF = arrial fibrillation; CAD = coronary artery disease; CHF = congestive heart failure; RHO = rheumatoid heart disease.

Sources; Data from B Aehlert. ACLS Quic.k Review Srudy Guide. St. Louis: Mosby. 1993; and EK Chung. Manual of Cardiac Arrhythmias. Boston: Butterworth-Heinemann, 1 986.

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Table l-A.2. Electrocardiographic (ECG) Characteristics and Causes of Ventricular Rhythms

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Name

ECG Characteristics

Common Causes

PT Considerations

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Agonal rhythm

lrregular rhythm, rate <20,

Near death

Do not creat.

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no P wave

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Ventricular tachycardia

Usually regular rhythm, rate

CAD mosr common after

Do not trear; patiem needs

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(VT)

> 1 00, no P wave or with

acute Mlj may occur in

immediate medical assis

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retrograde conduction

rheumatoid hearr disease,

tance; patient may be Stag

and appears after the QRS

cardiomyopathy, hyperble (maimain CO) for

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complex

tension

shorr while bur can

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progress quickly to unsta

Of

ble (no CO) called pulse

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less VT.

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Multifocal VT (rorsades de

Irregular rhythm, rate > 1 50,

Drug induced with antiar

Do nor treat; patiem needs

r

poimes)

no P waves

rhythmic medicines (quiimmediate medical atten

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nidine, procainamide)j

tion.

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hypokalemia; hypo

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magnesemia; MI; hypothermia

Premature ventricular con

Irregular rhythm, (can be

In normal individuals,

Frequency will dictate effect

tractions (PVCs) (focal

regularly irregular, i.e.,

secondary to caffeine,

on COj need to monitor

=

one ecropic foci and all

skipped beat every fourth

smoking, emotional diselectrocardiograph with

look the same; multifocal

beat); rare varies bur is

turbances; CAD, MI,

treatment; can progress to

more than one ectopic

usually normal 60-100;

cardiomyopathy, MVP,

VTj and this is more likely

=

foci and will have differcouplet is 2 in a row;

digitalis toxicity

if multi focal in nature or

ent wave forms)

bigeminy is every other

if >6 per min; StOp treatbeat; trigeminy is every

ment or rest if change in

third beat

frequency or quality.

Ventricular fibrillation

Chaotic

Severe heart disease mOSt

Needs immediate medical

common after acute MI,

assistance; no PT treathyper- or hypokalemia,

ment.

hypercalcemia, electrocution

Idioventricular rhythm

Essentially regular rhythm,

Advanccd heart diseasc;

CHF is common secondary

rate 20-40

high degree of atriovento slow rateSj hold treat

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tricular blockj usually a

ment unless rhythm well

;:

terminal arrhythmia

tOlerated.

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CAD = coronary artery disease; CHF = congestive heart failure; CO = cardiac output; MI = myocardial infarction; MVP = micral valve prolapse; vr = ventricular tachycardia.

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Sources: Data from B Aehlert. ACLS Quick Review Study Guide. St. Louis: Mosby, 1 994; and EK Chung. Manual of Cardiac Arrhythmias.

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Boston: Bunerworth-Heinemann, 1986.

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