monitor change with respiratory variation

[9309]

Hi all-

ER pt- slim 19 y/o female. She had seen her doc, and been given a halter monitor, recently removed. Her complaint was tachycardia. After the monitor was removed, she was told to go to the ER for rates over 120. She showed stating she had been 135, but on arrival she was around 100.

that's the background, here is the question: She was irregular with an underlying sinus rythm, and brief periods (2-3 beats) of slower sinus rythm. The ER doc said this was respiratory variation.

It looked like resiratory variation, except that the p wave of the slower beats were smaller, and distinctly different morphology. Does this make sense for respiratory variation?

9309

[Morettia2, BSN, RN]

Hi all-

ER pt- slim 19 y/o female. She had seen her doc, and been given a halter monitor, recently removed. Her complaint was tachycardia. After the monitor was removed, she was told to go to the ER for rates over 120. She showed stating she had been 135, but on arrival she was around 100.

that's the background, here is the question: She was irregular with an underlying sinus rythm, and brief periods (2-3 beats) of slower sinus rythm. The ER doc said this was respiratory variation.

It looked like resiratory variation, except that the p wave of the slower beats were smaller, and distinctly different morphology. Does this make sense for respiratory variation?

9309

from what I have learned, it sounds like sinus arrythmia. With respirations the rhythm changes, but it could be something else.

[HardwrknRN]

I agree with Morrettia2. It sounds like you are describing sinus arrythmia, it is the most common, but normal, heart rhythm irregularity that occurs during breathing. When a person breathes in, the heart rate normally speeds up for a few beats. It slows down again when a person breaths out. As far as the P wave changes, you mentioned that the patient had a holter monitor, I know what with many of the holter monitor systems they are able to perform p wave trending, P-amplitude trends are used in documenting supraventricular ectopic rhythms and episodes of atrioventricular dissociation and atrial fibrillation.:redbeathe It is sorta difficult to really tell you for sure without seeing the ecg tracing and having more information, also, have they performed an EP study? Might be a good idea if they think that her symptoms are possibly life threatning.:typing

[Spatialized]

Kind of sounds like she's got multiple foci firing causing the change in p-wave size and morphology. Whether or not this is related to respiration is hard to say. Could be a weird WAP/MAT presentation. At any rate, it sounds like she may need an EP study to see what's up...if this is causing her distress. On the other hand this may be normal for her. It sounds like classic sinus arrhythmia, but the different p-waves kind of throws that for a loop. This may just be a normal variant for her.

Cheers,

Tom