Electrocardiography

* an electrophysiologic study that measures the electric currents or impulses that are generated by the heart during a cardiac
cycle.
* The heart has the ability to produce impulses and contractions, and these impulses and contractions are able to conduct
electric currents that flow throughout the body.
* The electric activity is recorded in waveforms and complexes by an ECG and are analyzed with time intervals and
segments
* The electric impulses that are generated are conducted via the fluid-containing tissues of the body to the surface and to the
electrodes that are positioned in strategic places on the chest and extremities
* Analysis of the tracings obtained reveals varied diagnostic information
about cardiac function.
* The components of the cardiac cycle that are displayed and recorded
and that serve as a basis for analysis of the ECG are the P, Q, R, S, T,
and U waves
* The Q, R, and S waves are grouped and represent the QRS complex.
* Measurements are made in seconds or numbers of blocks (squares) on
the tracing paper.
* P waves record atrial depolarization as the impulse from the sinoatrial
(SA) node spreads through the atria to produce an atrial contraction.
* When present and normal in amplitude and width, the waves confirm
that the impulse originated in the SA node and not in an area outside the
node
* QRS complex waves record ventricular depolarization
associated with a ventricular contraction.
* On the tracing in sequence, the Q wave is a small, downward
or negative deflection; the R wave is a large, pointed, upward
or positive deflection; and the S wave is a small, downward
deflection. Any abnormal widening of this complex indicates
a prolonged ventricular depolarization time
* T waves record a period of ventricular repolarization with no
electric activity after the QRS complex and they appear
before another cardiac cycle begins.
* The PR interval is the time it takes for the impulse from the
SA node to travel to the ventricle or atrioventricular (AV)
node.
* It is the measured time between atrial depolarization (P wave
begins) and onset of ventricular depolarization (QRS
complex begins). A prolonged time indicates a delay in
conduction activity.
* QT or QRS interval is the time it takes for ventricular depolarization (Q wave begins) and repolarization (S wave ends).
* ST segment is the period between the end of depolarization and the beginning of repolarization of the ventricular
contraction.
* PR segment is the period from the end of the P wave to the beginning of the QRS complex.

INDICATIONS
* Identification and diagnosis of cause of arrhythmias as revealed by abnormal wave deflections
* Determination of heart rate

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* Determination of conduction defects or diseases revealed by delay of electric impulses, with abnormal time duration and
amplitude of waves and intervals recorded on the strip
* Determination of the site and extent of myocardial or pulmonary infarction
and myocardial ischemia revealed by abnormal wave and interval times and
amplitudes
* Determination of hypertrophy of chambers of the heart (atrial and ventricular)
or heart hypertrophy
* Determination of the position of the heart in the thoracic cavity
* Suspected electrolyte imbalances of potassium, calcium, and magnesium
and their effect on the heart
* Evaluation of drugs such as digitalis preparations and antiarrhythmics,
vasodilators, and antihypertensives

EXPECTED TEST OUTCOMES

* Normal heart rate according to age, 60 to 100 beats per minute in adults
* Normal regular rhythm and wave deflections with normal measurement
ranges of cycle components and height, depth, and duration of complexes:
P wave: 0.12 seconds, or three small blocks, with amplitude of 2.5 mm
Q wave: less than 0.04 seconds
R wave: amplitude range of 5 to 27 mm, depending on lead
R wave: amplitude range of 5 to 27 mm, depending on lead
T wave: amplitude range of 1 to 13 mm, depending on lead
QRS complex: 0.12 seconds, or three small blocks
PR interval: 0.2 seconds, or five small blocks
ST segment: 1 mm
* No arrhythmias, myocardial infarction, electrolyte imbalances, myocardial ischemia, chamber hypertrophy, or conduction
abnormalities
* ECG abnormalities fall into 5 categories
Heart rhythm
Heart rate
Axis or position
Hypertrophy
Infarct/ischemia

TEST OUTCOME DEVIATIONS

* Typical abnormalities seen include:
Dysrhythmias,
conduction defects,
ischemia,
infarct,
hypertrophies,
pulmonary infarct,
pericarditis;
potassium, calcium, and magnesium electrolyte imbalance effects;
and drug effects

PROCEDURE
* The client is placed on an examination table or in a bed in a supine position.
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* The chest, arms, and legs are exposed and proper draping is done for privacy.
* A 5-minute rest period is allowed before the procedure.
* The sites for electrode placement are cleansed with alcohol.
* Excessive hair on the skin can be shaved, if necessary.
* The skin sites are dried and electrode paste is applied to provide conduction between the skin and the electrode.
* The electrodes are strapped in place on the extremities and placed in proper positions on the chest.
* The electrodes are color coded for placement sites (chest, right and left arm, and right and left leg) and matched to coded
lead wires with the sites labeled.
* The wires are connected to the matched electrodes and the ECG machine

Six unipolar precordial leads are placed on the chest:

V1 at the fourth intercostal space at the border of the right sternum

V2 at the fourth intercostal space at the border of the left sternum
V3 between V2 and V4
V4 at the fifth intercostal space at the midclavicular line

V5 at the level of V4 horizontally and at the left axillary line

V6 at the level of V4 horizontally and at the left midaxillary line.

Three bipolar limb leads (two electrodes combined for each)

are placed on the arms and legs:
Lead I combination of two arm electrodes,
lead II combination of the right arm and left leg
electrodes,
lead III is the combination of left arm and left leg
electrodes
PRETEST CARE
Explain to the client:
* That the procedure requires 15 minutes
* That there are no food or fluid restrictions but that smoking
may be disallowed before the test
* That electrodes are attached to the skin of the chest, arms,
and legs with a paste or pads and connected to the wires and ECG
machine
* That the electric impulses from the heart are transmitted
from the body and that no electricity is delivered to the body
* That no discomfort is associated with the procedure
Prepare for the procedure:

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* Obtain a history of known or suspected cardiac disorders and present cardiovascular status, medication regimen, and
associated diagnostic laboratory tests and procedures.
* Ensure that assessment of the cardiovascular system has been performed for use in interpretation of the study.

POSTTEST CARE
* Remove the electrodes from the skin sites and cleanse the paste from the skin.
* Monitor the heart rate, rhythm, and pulse deficit for possible arrhythmias or in instances of chest pain experienced and
noted on the strip during the procedure.
* Decreased cardiac output: Note and report peripheral pulses, skin color, capillary refill time, dyspnea, abnormal heart
sounds, angina, or decreased urinary output. Administer ordered oxygen and cardiac medications.
* Arrhythmias: Note and report cardiac rhythm abnormalities on the strip. Administer ordered oxygen, vasodilators, and
antiarrhythmics if infarction or ischemia, life-threatening arrhythmias, or ventricular tachycardia is revealed.

ECG INTERPRETATION
Methods for Calculating Heart Rate
Method 1: Count Large Boxes
* Regular rhythms can be quickly determined by counting the number of
large graph boxes between two R waves.
* That number is divided into 300 to calculate bpm.
* The rates for the first one to six large boxes can be easily memorized.
* Remember: 60 sec/min divided by 0.20 sec/large box = 300 large
boxes/min.

Method 2: Count Small Boxes

* Sometimes it is necessary to count the number of small boxes between
two R waves for fast heart rates.
* That number is divided into 1500 to calculate bpm. Remember: 60 sec/min divided by 0.04 sec/small box = 1500 small
boxes/min.
* Examples:
* If there are six small boxes between two R waves: 1500/6 = 250 bpm.
* If there are ten small boxes between two R waves: 1500/10 = 150 bpm.

Method 3: Six-Second ECG Rhythm Strip

* The best method for measuring irregular rates with varying R-R intervals is to count the number of R waves in a 6-sec strip
and multiply by 10.
* This gives the average number of bpm

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Analyzing a Rhythm
Rate

* The bpm is commonly the ventricular rate.

* If atrial and ventricular rates differ, as in a 3rd-degree block, measure both rates.
* Normal: 60100 bpm
* Slow (bradycardia): <60 bpm
* Fast (tachycardia): >100 bpm

Regularity
* Measure R-R intervals and P-P intervals.
* Regular: Intervals consistent
* Regularly irregular: Repeating pattern
* Irregular: No pattern

P Waves
* If present: Same in size, shape, position?
* Does each QRS have a P wave?
* Normal: Upright (positive) and uniform
* Inverted: Negative
* Notched: P
* None: Rhythm is junctional or ventricular.

PR Interval
* Constant: Intervals are the same.
* Variable: Intervals differ.
* Normal: 0.120.20 sec and constant

QRS Interval
* Normal: 0.060.10 sec
* Wide: >0.10 sec
* None: Absent

QT Interval
* Beginning of R wave to end of T wave

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* Varies with HR.
* Normal: Less than half the R-R interval

Dropped beats
* Occur in AV blocks.
* Occur in sinus arrest.

Pause
* Compensatory: Complete pause following a premature atrial contraction (PAC), premature junctional contraction (PJC), or
premature ventricular contraction (PVC)
* Noncompensatory: Incomplete pause following a PAC, PJC, or PVC

QRS Complex grouping

* Bigeminy: Repeating pattern of normal complex followed by a premature complex
* Trigeminy: Repeating pattern of 2 normal complexes followed by a premature complex
* Quadrigeminy: Repeating pattern of 3 normal complexes followed by a premature complex
* Couplets: 2 Consecutive premature complexes
* Triplets: 3 Consecutive premature complexes

NORMAL SINUS RHYTHM

* Rate = normal
* Rhythm= regular
* P waves = normal (upright and uniform)
* PR interval = normal (0.12-0.20 sec)
* QRS = normal (0.06-0.10 sec)

SINUS BRADYCARDIA
* results from slowing of SA node discharge
* Rate = slow (<60 bpm)
* Rhythm = regular
* P waves = normal (upright and uniform)
* PR interval = normal (0.12-0.20 sec)
* QRS = normal (0.06-0.10 sec)

SINUS TACHYCARDIA
* results from increased of SA node discharge
* Rate = fast (>100 bpm)
* Rhythm = regular
* P waves = normal (upright and uniform)
* PR interval = normal (0.12-0.20 sec)
* QRS = normal (0.06-0.10 sec)
SINUS ARRHYTHMIA
* SA node discharges irregularly

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* R-R interval is irregular
* Rate = usually normal (60-100); frequently
increases with inspiration and decreases with
expiration
* Rhythm = irregular; varies with respiration
* P waves = normal (upright and uniform)
* PR interval = normal (0.12-0.20 sec)
* QRS = normal (0.06-0.10 sec)

DISORDERS OF THE
CARDIOVASCULAR SYSTEM
The Heart
Coronary Artery Disease (CAD)
refers to a variety of pathologic conditions that cause
narrowing or obstruction of the coronary arteries,
resulting in decreased blood supply to the myocardium.
Atherosclerosis (deposits of cholesterol and lipids within
the walls of the artery) is the major causative factor.
Occurs most often between ages 30 and 50;
men affected more often than women;
nonwhites have higher mortality rates.
May manifest as angina pectoris or MI.
Risk factors
family history of CAD,
Elevated serum lipoproteins,
cigarette smoking,
diabetes mellitus, hypertension,
obesity,
sedentary and/or stressful/competitive lifestyle,
elevated serum uric acid levels.
Medical management, assessment findings, and nursing interventions:
Same as Angina Pectoris and Myocardial Infarction.

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Angina Pectoris
Transient, paroxysmal chest pain
produced by insufficient blood flow to the myocardium
resulting in myocardial ischemia

Risk factors
CAD, atherosclerosis,
hypertension,
diabetes mellitus,
thromboangiitis obliterans,
severe anemia,
aortic insufficiency
Precipitating factors
physical exertion,
consumption of a heavy meal,
extremely cold weather,
strong emotions,
cigarette smoking,
sexual activity
Two main types
Stable angina:
chest pain occurs with increased oxygen demand;
relieved when precipitating factor is removed or with
nitroglycerin.
Unstable angina
chest pain increases in frequency, duration, and intensity
at low levels of activity or at rest;
often a precursor to MI.
Medical management
Drug therapy:
nitrates,
beta-adrenergic blocking agents, and/or
calcium-blocking agents,
lipid reducing drugs if cholesterol elevated
Modification of diet and other risk factors
Surgery:
coronary artery bypass surgery
Percutaneous transluminal coronary angioplasty (PTCA)
Assessment findings
Pain:
substernal with possible radiation to the neck, jaw, back, and arms;
may be relieved by rest
Palpitations, tachycardia
Dyspnea
Diaphoresis
Increased serum lipid levels

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Diagnostic tests
ECG
may reveal ST segment depression and T-wave inversion during chest pain.
Stress test
may reveal an abnormal ECG during exercise.
Nursing interventions
Administer oxygen.
Give prompt pain relief with nitrates or narcotic analgesics as ordered.
Monitor vital signs, status of cardiopulmonary function.
Monitor ECG.
Place client in semi- to high-Fowlers position.
Provide emotional support.
Administer oxygen.
Give prompt pain relief with nitrates or narcotic analgesics as ordered.
Monitor vital signs, status of cardiopulmonary function.
Monitor ECG.
Place client in semi- to high-Fowlers position.
Provide emotional support.
Provide client teaching and discharge planning concerning
Proper use of nitrates
Nitroglycerin tablets (sublingual)
Allow tablet to dissolve.
Relax for 15 minutes after taking tablet to prevent dizziness.
If no relief with 1 tablet, take additional tablets at 5-minute intervals, but no more than 3 tablets within a 15-minute
period, reassess blood pressure after each tablet dissolved.
Know that transient headache is a frequent side effect.
Keep pills in original bottle, tightly capped and prevent exposure to air, light, and heat.
Ensure tablets are within reach at all times.
Check shelf life, expiration date of tablets.

Nitroglycerin ointment (topical)

Rotate sites to prevent dermal inflammation.
Remove previously applied ointment.
Avoid massaging/rubbing as this increases absorption and interferes with the drugs sustained action.
Ways to minimize precipitating events
Reduce stress and anxiety (relaxation techniques, guided imagery)
Avoid overexertion and smoking
Maintain low-cholesterol, low-saturated fat diet and eat small, frequent meals
Avoid extremes of temperature
Dress warmly in cold weather
Gradual increase in activities and exercise
Participate in regular exercise program
Space exercise periods and allow for rest periods

Instruct client to notify physician immediately if pain occurs and persists, despite rest and medication administration.

Myocardial Infarction (MI)

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 The death of myocardial cells from inadequate
oxygenation, often caused by a sudden complete
blockage of a coronary artery;
characterized by
localized formation of necrosis (tissue
destruction)
with subsequent healing by scar formation and
fibrosis.
Risk factors
atherosclerotic CAD,
Thrombus formation,
hypertension,
diabetes mellitus,
hyperlipidemia, and
genetic predisposition

Assessment findings
Pain
usually substernal with radiation to the neck, arm, jaw, or back; severe,
crushing, viselike with sudden onset;
unrelieved by rest or nitrates
Nausea and vomiting
Dyspnea
Skin: cool, clammy, ashen
Elevated temperature
Initial increase in blood pressure and pulse, with gradual drop in blood pressure
Restlessness
Occasional findings:
rales or crackles;
presence of S4;
pericardial friction rub;
split S1, S2
Diagnostic tests
Elevated WBC
Elevated CPK and CPK-MB
Elevated SGOT or AST
Elevated LDH, LDH1, and LDH2
Elevated troponin levels
ECG changes
specific changes dependent on location of myocardial damage and phase of the MI;
inverted T wave and ST segment changes seen with myocardial ischemia
Increased ESR, elevated serum cholesterol
Nursing interventions
Establish a patent IV line
Provide pain relief;
morphine sulfate IV (given IV because after an infarction there is poor peripheral perfusion and because serum
enzymes would be affected by IM injections) as ordered.
Administer oxygen as ordered to relieve dyspnea and prevent arrhythmias.
Provide bed rest with semi-Fowlers position to decrease cardiac workload.
Monitor ECG and hemodynamic procedures.

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 Administer antiarrhythmias as ordered.
Perform complete lung/cardiovascular assessment.
Monitor urinary output and report output of less than 30 mL/hour; indicates decreased cardiac output.
Maintain full liquid diet with gradual increase to soft; low sodium.
Maintain quiet environment.
Administer stool softeners as ordered to facilitate bowel evacuation and prevent straining.
Relieve anxiety associated with coronary care unit (CCU) environment.
Administer anticoagulants, as ordered.
Administer thrombolytics (tissue-type plasminogen activator or t-pa and streptokinase) and monitor for side effects
(bleeding).
Provide client teaching and discharge planning concerning
Effects of MI, healing process, and treatment regimen
Medication regimen including name, purpose, schedule, dosage, side effects
Risk factors, with necessary lifestyle modifications
Dietary restrictions:
low sodium, low cholesterol, avoidance of caffeine
Importance of participation in a progressive activity program
Resumption of sexual activity according to physicians orders (usually 46 weeks)
Need to report the following symptoms: increased persistent chest pain, dyspnea, weakness, fatigue, persistent
palpitations, light-headedness
Enrollment of client in a cardiac rehabilitation program
Percutaneous Transluminal Coronary Angioplasty
Percutaneous transluminal coronary angioplasty (PTCA), with or without placement of a stent,
can be performed as an alternative to coronary artery bypass graft surgery (CABG).
aim - to revascularize the myocardium, decrease angina, and increase survival.

Percutaneous transluminal coronary

angioplasty (PTCA). A, Balloon-tipped
catheter positioned in blocked
artery. B, Balloon is
centered. C, Balloon expands
to (D) compress blockage. E, Artery
diameter opened. From Polaski and
Tatro, 1996.

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 performed in the cardiac catheterization lab and is
accomplished by insertion of a balloon-tipped
catheter into the stenotic, diseased coronary artery.
The balloon is inflated with a controlled pressure and
thereby decreases the stenosis of the vessel.
Nursing interventions
preoperative and postoperative care is similar to the
care of the client undergoing cardiac catheterization

Coronary Artery Bypass Surgery

(CABG)
the surgery of choice for clients with severe CAD.
New supply of blood brought to diseased/occluded
coronary artery by bypassing the obstruction with a
graft that is attached to the aorta proximally and to
the coronary artery distally.
Several bypasses can be performed depending on
the location and extent of the blockage.
Procedure frequently requires use of extracorporeal
circulation (heart-lung machine, cardiopulmonary
bypass).
Some clients may be candidates for off pump
coronary artery bypass (OPCAB).
Nursing interventions: preoperative
Explain anatomy of the heart, function of coronary
arteries, effects of CAD.
Explain events of the day of surgery: length of time in
surgery, length of time until able to see family.
Orient to the critical and coronary care units and introduce to staff.
Explain equipment to be used (monitors, hemodynamic procedures, ventilator, endotracheal tube, drainage tubes).
Demonstrate activity and exercises (turning from side to side, dangling, sitting in a chair, ROM exercises for arms and
legs, effective deep breathing, and coughing).
Reassure client that pain medication is available.
Nursing interventions: postoperative
Maintain patent airway.
Promote lung reexpansion.
Monitor drainage from chest/mediastinal tubes, and check patency of chest drainage system.
Assist client with turning, coughing, and deep breathing.
Monitor cardiac status.
Monitor vital signs and cardiac rhythm and report significant changes, particularly temperature elevation.
Perform peripheral pulse checks.
Carry out hemodynamic monitoring.
Administer anticoagulants as ordered and monitor hematologic test results carefully.
Maintain fluid and electrolyte balance.
Maintain accurate I&O with hourly outputs; report if less than 30 mL/hour urine.
Assess color, character, and specific gravity of urine.
Daily weights.
Assess lab values, particularly BUN, creatinine, sodium, and potassium levels
Maintain adequate cerebral circulation: frequent neuro checks.

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 Provide pain relief.
Administer narcotics cautiously and monitor effects.
Assist with positioning for maximum comfort.
Teach relaxation techniques.
Prevent abdominal distension.
Monitor nasogastric drainage and maintain patency of system.
Assess for bowel sounds every 24 hours.
Measure abdominal girths if necessary.
Monitor for and prevent the following complications.
Thrombophlebitis/pulmonary embolism
Cardiac tamponade
Arrhythmias
Maintain continuous ECG monitoring and report changes.
Assess electrolyte levels daily and report significant changes, particularly potassium.
Administer antiarrhythmics as ordered.
Heart failure
Provide client teaching and discharge planning concerning
Limitation with progressive increase in activities
Encourage daily walking with gradual increase in distance weekly
Avoid heavy lifting and activities that require continuous arm movements (vacuuming, playing golf, bowling)
Avoid driving a car until physician permits
Sexual intercourse:
can usually be resumed by third or fourth week post-op;
avoid sexual positions in which the client would be supporting weight
Medical regimen:
ensure client/family are aware of drugs, dosages, proper times of administration, and side effects
Meal planning with prescribed modifications (decreased sodium, cholesterol, and possibly carbohydrates)
Wound cleansing daily with mild soap and H2O and report signs of infection
Symptoms to be reported: fever, dyspnea, chest pain with minimal exertion

Dysrhythmias
often called an arrhythmia,
is a disruption in the normal events of the cardiac cycle.
It may take a variety of forms.
Treatment varies depending on the type of dysrhythmia

Sinus Tachycardia
A heart rate of over 100 beats/minute, originating
in the SA node
May be caused by fever, apprehension, physical
activity, anemia, hyperthyroidism, drugs
(epinephrine, theophylline), myocardial ischemia,
caffeine
Assessment findings
Rate: 100160 beats/minute
Rhythm: regular
P wave: precedes each QRS complex with normal contour
P-R interval: normal (0.08 second)
QRS complex: normal (0.06 second)
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Treatment:
correction of underlying cause,
elimination of stimulants;
sedatives,
propranolol (Inderal).
Premature Atrial Complex (PAC)
Physical appearance:
single ECG complex that occurs early
Causes:
nicotine, alcohol, anxiety, low potassium
level, hypovolemia, myocardial ischemia
Assessment findings
Ventricular and atrial rate dependent on underlying rhythm
Rhythm;
irregular due to premature complexes
QRS shape;
usually normal
P wave:
morphology may be the same, different, or absent
P-R interval:
may be shorter but within limits (0.120.20 second)
P-QRS:
1:1
Sinus Bradycardia
A slowed heart rate initiated by SA node
Caused by
excessive vagal or decreased sympathetic
tone,
MI,
intracranial tumors,
meningitis,
myxedema,
cardiac fibrosis;
A normal variation of the heart rate in welltrained athletes
Assessment findings
Rate:
less than 60 beats/minute
Rhythm:
regular
P wave:
precedes each QRS with a normal contour
P-R interval:
normal
QRS complex:
normal
Treatment
usually not needed;
if cardiac output is inadequate, atropine and isoproterenol (Isuprel) are usually prescribed;
if drugs are not effective, a pacemaker may need to be inserted.

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Atrial Tachycardia
A heart rate above 160250, originates in the SA
node
May be
drug induced (including substance abuse),
caused by fever, severe blood loss, thyroid
storm, electrolyte imbalances, severe hypoxia
Assessment findings
Rate:
160250 beats/minute
Rhythm:
regular
P Wave:
precedes each QRS complex with normal contour
P-R interval:
normal (0.08 second)
QRS complex:
normal (0.06 second)
Treatment
correction of underlying problem,
betablockers,
calcium channel blocker,
amniodarone
Atrial Flutter
Atrial rate between 250 and 400, ventricular rate
between 75 and 150
May be idiopathic, associated with advanced age,
valvular disease, HTN, cardiomyopathy, pulmonary
disease, hyperthyroidism, moderate-to-heavy alcohol
consumption
Assessment findings
Rate:
250400 beats/minute
Rhythm:
irregular
P Wave:
varies to QRS
P-R interval:
difficult to distinguish due to rate
QRS complex:
normal or abnormal
Treatment
correction of underlying problem,
betablockers,
calcium channel blocker,
amniodarone,
digitalis
Atrial Fibrillation
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 An arrhythmia in which ectopic foci in the atria
cause rapid, irregular contractions of the heart
Commonly seen in clients with
rheumatic mitral stenosis,
thyrotoxicosis,
cardiomyopathy,
hypertensive heart disease,
pericarditis, and
coronary heart disease
Assessment findings
Rate
Atrial: 350600 beats/minute
Ventricular: varies between 100160 beats/minute
Rhythm:
atrial and ventricular regularly irregular
P wave:
no definite P wave; rapid undulations called fibrillatory (f) waves
P-R interval:
not measurable
QRS complex:
generally normal
Treatment
digitalis preparations,
propranolol,
verapamil in conjunction with digitalis;
Directcurrent cardioversion
Premature Ventricular Contractions (PVCs)
Irritable impulses originate in the ventricles
Caused by
electrolyte imbalance (hypokalemia);
digitalis drug therapy;
myocardial disease;
stimulants (caffeine, epinephrine, isoproterenol);
hypoxia;
congestive heart failure
Assessment findings
Rate:
varies according to number of PVCs
Rhythm:
irregular because of PVCs
P wave:
normal; however, often lost in QRS complex
P-R interval:
often not measurable
QRS complex:
wide and distorted in shape, greater than 0.12 second
Treatment
IV push of lidocaine (50100 mg) followed by IV drip of lidocaine at rate of 14 mg/minute
Procainamide (Pronestyl), quinidine
Treatment of underlying cause
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Ventricular Tachycardia
A run of three or more consecutive PVCs; occurs
from repetitive firing of an ectopic focus in the
ventricles
Caused by
acute MI,
CAD,
Digitalis intoxication,
Hypokalemia
Assessment findings

Rate
Atrial: 60100 beats/minute
Ventricular: 110250 beats/minute
Rhythm:
atrial (regular),
Ventricular (occasionally irregular)
P wave:
often lost in QRS complex
P-R interval:
usually not measurable
QRS complex:
greater than 0.12 second, wide
Treatment
IV push of lidocaine (1 mg/kg for a dose of 50100 mg), then IV drip of lidocaine 14 mg/minute
Procainamide via IV infusion of 26 mg/minute
Direct-current cardioversion
Bretylium, propranolol (Inderal)

Ventricular Fibrillation
Rapid and disorganized rhythm caused by quivering
of the ventricles
No atrial activity is seen
May be caused by idiopathic sudden death, electrical
shock
Assessment findings
Ventricular rate:
greater than 300
Ventricular rhythm irregular, without specific pattern
QRS shape and duration:
irregular, undulating waves without recognizable QRS pattern
Treatment:
counter-shock (defibrillation)

REVIEW OF ANTIARYTHMIC DRUGS

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