Transcript Chapter 5 Atrial Rhythms

Chapter 5
Atrial Rhythms
Gail Walraven, Basic Arrhythmias, Sixth Edition
©2006 by Pearson Education, Inc., Upper Saddle River, NJ
Wandering Pacemaker
Pacemaker site
wanders between
sinus node, atria, and
AV junction. Rate is
usually normal;
impulses are
conducted normally to
the ventricles.
Gail Walraven, Basic Arrhythmias, Sixth Edition
©2006 by Pearson Education, Inc., Upper Saddle River, NJ
Wandering Pacemaker
 Regularity: Slightly irregular
 Rate: Usually normal, 60–100
beats/minute
 P Wave: Morphology changes from
beat to beat
 PRI: Less than .20 seconds; may vary
 QRS: Less than .12 seconds
Gail Walraven, Basic Arrhythmias, Sixth Edition
©2006 by Pearson Education, Inc., Upper Saddle River, NJ
Wandering Pacemaker
Gail Walraven, Basic Arrhythmias, Sixth Edition
©2006 by Pearson Education, Inc., Upper Saddle River, NJ
Premature Atrial Contraction
Pacemaker is an
irritable focus within
the atrium that fires
prematurely and
produces a single
ectopic beat. Impulses
are conducted
normally to the
ventricles.
Gail Walraven, Basic Arrhythmias, Sixth Edition
©2006 by Pearson Education, Inc., Upper Saddle River, NJ
Premature Atrial Contraction
 Regularity: Depends on underlying rhythm;
usually regular except for PAC
 Rate: Usually normal; depends on underlying
rhythm
 P Wave: P wave of early beat differs from
sinus P Waves; can be flattened or notched;
may be lost in preceding T wave
 PRI: .12–.20 seconds; can be greater than
.20 seconds
 QRS: Less than .12 seconds
Gail Walraven, Basic Arrhythmias, Sixth Edition
©2006 by Pearson Education, Inc., Upper Saddle River, NJ
Premature Atrial Contraction
Gail Walraven, Basic Arrhythmias, Sixth Edition
©2006 by Pearson Education, Inc., Upper Saddle River, NJ
Atrial Tachycardia
Pacemaker is a single
irritable site within the
atria that fires
repetitively at a very
high rate. Impulses
are then conducted
normally to the
ventricles.
Gail Walraven, Basic Arrhythmias, Sixth Edition
©2006 by Pearson Education, Inc., Upper Saddle River, NJ
Atrial Tachycardia
 Regularity: Regular
 Rate: 150–250 beats per minute
 P Wave: Atrial P wave; differs from
sinus P wave; can be lost in preceding
T wave
 PRI: .12–.20 seconds
 QRS: Less than .12 seconds
Gail Walraven, Basic Arrhythmias, Sixth Edition
©2006 by Pearson Education, Inc., Upper Saddle River, NJ
Atrial Tachycardia
Gail Walraven, Basic Arrhythmias, Sixth Edition
©2006 by Pearson Education, Inc., Upper Saddle River, NJ
Atrial Flutter
Single irritable focus
within the atria
initiates rapid,
repetitive impulses.
AV node protects the
ventricles by blocking
conduction of some
impulses.
Gail Walraven, Basic Arrhythmias, Sixth Edition
©2006 by Pearson Education, Inc., Upper Saddle River, NJ
Atrial Flutter
 Regularity: Atrial Rhythm regular; ventricular
rhythm usually regular but can be irregular if
there is variable block
 Rate: Atrial rate 250–350 beats per minute;
ventricular rate varies
 P Wave: Characteristic sawtooth pattern
(F waves)
 PRI: Unable to determine
 QRS: Less than .12 seconds
Gail Walraven, Basic Arrhythmias, Sixth Edition
©2006 by Pearson Education, Inc., Upper Saddle River, NJ
Atrial Flutter
Gail Walraven, Basic Arrhythmias, Sixth Edition
©2006 by Pearson Education, Inc., Upper Saddle River, NJ
Atrial Fibrillation
Many irritable sites
within atria fire
repetitively, causing
ineffective atrial
depolarization. AV
node blocks most
impulses, so ventricular
rate is usually slower
than atrial.
Gail Walraven, Basic Arrhythmias, Sixth Edition
©2006 by Pearson Education, Inc., Upper Saddle River, NJ
Atrial Fibrillation
 Regularity: Grossly irregular
 Rate: Atrial greater than 350 beats per
minute; ventricular rate varies greatly
 P Wave: No discernible P waves; atrial
activity is referred to as fibrillatory
waves (f waves)
 PRI: Unable to measure
 QRS: Less than .12 seconds
Gail Walraven, Basic Arrhythmias, Sixth Edition
©2006 by Pearson Education, Inc., Upper Saddle River, NJ
Atrial Fibrillation
Gail Walraven, Basic Arrhythmias, Sixth Edition
©2006 by Pearson Education, Inc., Upper Saddle River, NJ
Chapter 5 Practice Strips
Gail Walraven, Basic Arrhythmias, Sixth Edition
©2006 by Pearson Education, Inc., Upper Saddle River, NJ
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©2006 by Pearson Education, Inc., Upper Saddle River, NJ
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©2006 by Pearson Education, Inc., Upper Saddle River, NJ
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©2006 by Pearson Education, Inc., Upper Saddle River, NJ
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©2006 by Pearson Education, Inc., Upper Saddle River, NJ