Basic EKG rhythms & Treatments an NP student must know

- NSR (Normal Sinus Rhythm)
- Sinus bradycardia
- Sinus tachycardia
- Sinus arrhythmias
- SVT
- Junctional rhythm
- PVC
- PVC trigeminy
- PVC (multifocal)
- Torsades (multifocal v-tach)
- PAC
- Agonal rhythm going to asystole
- Afib
-  1st degree AV block
- 2nd degree AV block - Wenkeback (Morbitz I)
- 2nd degree AV block - Morbitz II
- 3rd degree AV block - Complete heart block
- Vfib
- Failure to capture pacemaker


Meds:
- Magnesium: Torsades (remember in Pharm, mg levels can affect K levels and thus causing arrhythmias?)
- Adenosine: SVT (remember SVT needs to be slowed down? And, adenosine causes 'cardiac arrest' resetting the rhythm again?)
- Atropine: Mobitz II (2nd degree AV block) if not MI. If MI and given Atropine, will cause v-tach!!
- Epinephrine: agonal rhythm going to asystole, vfib
- Beta blocker: afib
- Anticoagulant: afib


Special cardiac procedures:
- Cath: for resuscitation survivors of vfib (depends on institution policy too)
- Ablation
- External pacemaker: junctional rhythm
- Cardiac cardioversion: a-fib, v-fib, if pt has SOB & CP but ur not sure if pt is SVT or VTach, treat pt first with cardiac cardioversion. However if pt is alert asymptomatic with just high BP, you still have some time to figure out which rhythm it is before treating the pt.
- Implantable defibrillator: v-fib
- Intubation: vfib
- IV: vfib
- Defibrillation: vfib
- CPR: Vfib
- Oxygen: vfib
- Repair/Replace pacemaker: failure to capture


Clinical picture:
SVT vs Vfib/V-tach:
- If pt is looking at u, it's probably SVT. But if pt is agonal, it's probably vfib
- If pt has SOB & CP but ur not sure if pt is SVT or VTach, treat pt first with cardiac cardioversion. However if pt is alert asymptomatic with just high BP, you still have some time to figure out which rhythm it is before treating the pt.

A STEMI can be localized by identification of ST elevation in the following.
STEMI type                            EKG changes                          Likely Artery
Anterior STEMI –                   V3 V4                                      LAD
Inferior STEMI –                    II III AVF                                 RCA >> Lcx
Posterior STEMI –                  STdepression V1 V2 V4 V4   RCA >> Lcx
Lateral STEMI –                     I AVL V5 V6                            Lcx
Anterolateral STEMI –           I AVL V3 V4 V5 V6                LAD / Lcx
Septal STEMI –                       V1 V2                                      LAD
Anteroseptal STEMI –           V1 V2 V3 V4                          LAD

THERE ARE ALSO NON-STEMIs WHICH LOOK AT ST DEPRESSION AND Q WAVES. HOWEVER, YOU NEED TO KNOW THE STEMIs BECAUSE THEY REQUIRE IMMEDIATE ACTION BECAUSE OFTEN IT IS INDICATIVE OF COMPLETE BLOCKAGE OF A VESSEL.  HOWEVER, BOTH STEMI AND NSTEMI ATTACKS NEED AGGRESSIVE TREATMENT.


See this:
http://tmedweb.tulane.edu/pharmwiki/doku.php/ecg_interpretation_of_arrhythmias