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Atrial contraction pushes the last 1/3 of blood into the ventricles
Which wave represents the atrial rhythms?
Premature Atrial Complexes (PACs)
Premature beat (P wave) that occurs early before the next expected beat. Must ID underlying rhythm, count rate, and name the premature beats.
- If the normal beat following the premature complex occurs before expected
- (Distance is NOT the same)
- If normal beat following premature complex occurs when expected
- (Distance is the same)
Nonconducted (Blocked) PACs
P wave occurred too early. (AV junction is still refractory) No QRS present & appears as a pause. Differs from Sinus Pause, as a P wave is present or seen in preceding T wave.
If nonconducted P wave hidden in preceding T wave, it will change shape of T wave – adds amplitude or a “hump.”
2 PACs in a row (sequential)
Run or Bursts
- 3 or more sequential PACs
- “paroxysmal atrial tachycardia” (PAT) or “paroxysmal supraventricular tachycardia” (PSVT)
Atrial....Bigeminy & Trigeminy
- Bigeminy: every other beat is a PAC
- Trigeminy: every third beat is a PAC
Multifocal Atrial Rhythm (MFAR)
P waves vary in size, shape, & direction across the rhythm strip. Need to identify 3 different P wave shapes in the same lead to call the rhythm MFAR.
Supraventricular Tachycardias (SVT)
- –Sinus tachycardia (ST)
- –Atrial tachycardia (AT)
- –Supraventricular tachycardias (SVT)
- –Atrial flutter (A Flutter)
- –Atrial fibrillation (A Fib)
SVT & Atrial Tachycardia (AT)
SVT can be called atrial tachycardia if a visible P wave (atrial activity) is present.
Paroxysmal Supraventricular Tachycardia(PSVT)
Describes an SVT that starts & stops suddenly.
Wolff-Parkinson-White (WPW) Syndrome
Connects atria directly to the ventricles, completely bypassing normal conduction system.
Atrial Flutter appear as which wave?
"F" or "flutter" waves
Atrial Flutter (A Flutter)
An irritable atrial site depolarizes regularly at an extremely rapid rate (250-350 bpm). Results in waveforms that resemble the teeth of a saw or a picket fence.
Atrial Fibrillation (A Fib)
- Multiple atrial ectopic sites initiate rapid impulses (350-600 bpm) which causes ineffectual atrial contraction or quiver (fibrillate).
- Results in subsequent decrease in CO, loss of “atrial kick”, & risk of clot formation.
How can A Fib be identified?
ALWAYS IRREGULAR ventricular rhythm with normal QRS complex. No identifiable P waves.
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