Perfusion & Dysrhythmias — Study Notes

What is it?

Early ectopic atrial beats from outside the SA node; often benign.

What does it look like?

• Symptoms: none or “skipped beat” palpitations.
• ECG: premature abnormal P′ wave (different morphology), narrow QRS, non-compensatory pause.

How do I diagnose it?

• 12-lead ECG or Holter monitor.
• Labs: K⁺, Mg²⁺, TSH, troponin if ischemia; review caffeine, alcohol, tobacco, stimulants.

How do I treat/manage it?

• Chemical: none or low-dose β-blocker if symptomatic.
• Nursing: identify triggers, correct electrolytes, monitor and reassure.

What is it?

Chaotic atrial electrical activity with loss of effective contraction; irregular AV conduction and ↑ thromboembolism risk.

What does it look like?

• Symptoms: palpitations, dyspnea, fatigue; may be asymptomatic.
• ECG: irregularly irregular rhythm, no distinct P waves, fibrillatory baseline.

How do I diagnose it?

• 12-lead ECG, TTE, TEE if >48 h or unknown onset (check for clots).
• Labs: CBC, CMP, TSH, troponin if ischemia. Assess stroke risk (CHA₂DS₂-VASc).

How do I treat/manage it?

• Rate control: β-blocker, diltiazem, or verapamil; digoxin if HF.
• Rhythm control: synchronized cardioversion (after anticoagulation/TEE); amiodarone IV 150 mg → 1 mg/min × 6 h → 0.5 mg/min × 18 h.
• Stroke prevention: DOAC or warfarin per risk; avoid aspirin.
• Procedures: ablation, Maze, left atrial appendage occlusion.
• Nursing: monitor for stroke/HF, verify anticoagulation and electrolytes, patient teaching.

What is it?

Macro-reentrant atrial circuit (usually right atrium around tricuspid annulus).

What does it look like?

• Symptoms: similar to AF.
• ECG: “sawtooth” flutter waves (II, III, aVF), atrial rate 250–350 bpm; often 2:1 conduction.

Diagnosis

ECG, echo, labs similar to AF.

Treatment/Management

• Rate & anticoagulation: as in AF.
• Rhythm control: synchronized cardioversion or CTI ablation.
• Nursing: monitor for recurrence, ensure anticoagulation compliance.

What is it?

Re-entry involving the AV node (AVNRT) or accessory pathway (AVRT); narrow-complex tachycardia.

What does it look like?

• Symptoms: sudden palpitations, dizziness, dyspnea, chest discomfort.
• ECG: regular narrow tachycardia (150–250 bpm); P waves hidden or pseudo-r′/S.

Diagnosis

• 12-lead ECG, check electrolytes, rule out WPW if wide/irregular.

Treatment/Management

• Vagal maneuvers → adenosine 6 mg → 12 mg IV; alternatives: diltiazem/verapamil or β-blocker.
• Synchronized cardioversion if unstable or refractory.
• Catheter ablation for definitive cure.
• Nursing: prepare crash cart, monitor ECG, teach Valsalva.

What is it?

AV junction acts as pacemaker (rate 40–60 bpm).

ECG Features

Absent or inverted P, narrow QRS, rate 40–60 bpm.

Treatment

• Atropine 1 mg IV q3–5 min (max 3 mg); dopamine/epi infusion if needed.
• TCP if drugs fail; pacemaker long-term.
• Nursing: prepare pads, analgesia/sedation, confirm capture.

Definition

PR > 200 ms with 1:1 conduction.

ECG Features

Constant prolonged PR, narrow QRS.

Management

• Asymptomatic: monitor.
• Symptomatic: treat like bradycardia (atropine → TCP).

Definition

Sinus rhythm < 60 bpm, physiologic or pathologic.

Management

• Symptomatic: atropine 1 mg IV → repeat → TCP/dopamine/epi.
• Asymptomatic: monitor and correct causes.