if an impulse originates anywhere besides the SA Node
Ectopic
Premature Contraction
- Premature SA Nodal Contraction
- Premature Atrial Ectopic Contraction
- difference between the 2.
-P WAVE: similar to previous P wave= PSA
different to previous P wave= PAE
PSA Nodal can require a pacemaker down the road
Premature Nodal Contraction
- No P wave preceding it
- Node is located under Bundle of HIS through lower 3rd AV Node
- straight into the ventricles
- tight QRS wave (.08-.11 sec) [normal limits=tight]
Premature Ventricular Contraction
- No P wave
- originates in ventricular myocardium
- from muscle cell to muscle cell to muscle cell
- wide QRS wave
- most common
Ectopic equals what?
Protection
Athletes commonly have _____.
Premature Ventricular Contraction (PVC)
- training induced heart rate
- benign
Aberrant Ventricular Conduction
- only happens during Premature Atrial Contraction
1. Prolonged PR Interval - looks like 1st degree AV Block
2. Abnormal QRS Wave - wide QRS wave
Fusion Beat
two complexes fire at the same time
where did the wide QRS wave from the Aberrant Ventricular Conduction come from?
impulse wasn’t accepted into the RBBB but was accepted into the LBBB. causes impulse to travel muscle cell to muscle cell. This causes a wide QRS wave
Non-conducted Premature Atrial Beat
- No QRS Wave
- it is dropped because the impulse isn’t received by the ventricles
Sinus Arrest
- SA Node fails to fire
- All dysremnias
1. Ischemia:
2. Infarction
3. Abnormal Conduction - looks similar to a Premature Atrial Conduction with a non-ventricular response
- long flatline with no P Wave
- serious, non-life threatening
- SA Node, diseased—-Pacemaker
If you have a sinus arrest, the next impulse is automatically called an
Escape Beat
Paraoxysmal
sudden onset
only if you can see the sudden change
Tachycardia Resting Heart Beat
100+ BPM
Sinus Tachycardia
100-150 BPM
-rarely gets over 120
Atrial Tachycardia
150-250 BPM
Paroxysmal Atrial Tachycardia
150-250 BPM
Fusion Beat (P wave and T wave)
Amplitude of T Wave Changes
Paroxysmal Nodal Tachycardia
- looks just like PAT
- must see paroxysmal change
- unchanged T wave
- no P wave
- no fusion beat
Superventricular Tachycardia
Atrial Tachycardia or Nodal Tachycardia
- when you have no way to determine which it is
- you don’t see normal rhythm first to see the paroxysmal change
Wandering Pacemaker
- configuration of P wave changes from beat to beat
- indication that your SA node is disease (early warning signs)
- –may result in artificial pacemaker
- ischemia or infarction
- atrial rate is less than 100 BPM (between 60-100 bpm)
- irregular ventricular rhythm
- –inconsistent rate of R waves
Sick Sinus Syndrome
- slow ventricular rate
- 20-40 BPM
- P wave changes from beat to beat
Multifocal Atrial Tachycardia
-irregular ventricular rhythm
-changing P wave
- 100+ BPM
-multifocal: number of ectopics that are formed (2 or more)
in this condition, you will have dozen
Bradycardia-Tachycardia Syndrome
- rare (1 out of 100,000 people)
- hard to treat
- bounce back and forth about every 4-10 sec
- go in and kill SA Node and install an Atrial Pacemaker to control it
- won’t cause death, but causes bad symptoms
- never normal (light headedness to heart bouncing out of chest)
Premature contractions have 3 different rhythms
- Bigeminy (PAC every other beat)
- Trigeminy (PAC every 3rd beat)
- Quadgeminy (PAC every 4th beat)
