Critical Care: Atrial Rhythms

I. PREMATURE ATRIAL CONTRACTIONS (PACs)

  • HEART RATE: Variable
  • RHYHTM: Irregular
  • P WAVES: Abnormal configuration, 1:1 ratio
  • P-R INTERVAL: Variable, may be shorter
  • QRS WIDTH: Usually normal
  • INTERVENTIONS: Continue to monitor, check pulse

II. PAROXYSMAL/SUPRAVENTRICULAR TACHYCARDIA (P/SVT)

  • HEART RATE: 100-300
  • RHYTHM: Regular
  • P WAVES: Abnormal, may be hidden
  • P-R INTERVAL: Variable, may be hidden
  • QRS WIDTH: Usually normal
  • INTERVENTIONS: Continue to monitor, may use vagal maneuvers and adenosine, cardioversion if other measures are ineffective

III. ATRIAL FIBRILLATION

  • HEART RATE: Atrial – >350, Ventricular – depends on AV block
  • RHYTHM: Irregular
  • P WAVES: Fibrillatory waves, “scribble”
  • P-R INTERVAL: Absent
  • QRS WIDTH: Usually normal
  • INTERVENTIONS: Prevent clots with anticoagulants, rate control with calcium channel blockers

IV. ATRIAL FLUTTER

  • HEART RATE: Atrial – 250-300, Ventricular – depends on AV block
  • RHYTHM: Atrial – regular, Ventricular – varies with AV
  • P WAVES: “Sawtooth” flutter waves
  • P-R INTERVAL: Absent
  • QRD WIDTH: Usually normal
  • INTERVENTIONS: Prevent clots with anticoagulants, rate control with calcium channel blockers
Image Source: #1, #2.
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