Published Jun 26, 2009
A patient was on telemetry and had an irregular heart rate. The rhythm looked like sinus, and it wasn't really afib. What would you call that?
mama_d, BSN, RN
I'd have to see the strip...there are too many choices from the description you gave.
would have to see it to be sure, but my guess is sinus arrhythmia. If you have central Tele monitoring, call them up and ask next time...they can usually tell you what is going on.
I dont know without seeing the strip, and you did'nt mention the rate.
I'd really have to see the strip . did you have one p wave,...two p waves...more p waves than qrs's.What was your PRI and QTI? There are many many things you have to look at.
PostOpPrincess, BSN, RN
Where is the strip? Impossible without it.
blondy2061h, MSN, RN
This wasn't related to respirations, though.
Nope, no central monitoring.
I didn't save the strip, however, there was only 1 p wave to each QRS. PRI and QTI were within range. It truly looked like sinus rhythm, except for that the rate was irregular.
Maybe the patient was throwing occasional PAC's which can be tricky to spot out sometimes. Plus I've noticed that the monitors don't always say that the patient is having PAC's it'll just say that it's irregular.
ghillbert, MSN, NP
Was it "regularly irregular" or just randomly irregular R-R interval? Rate?
If the PR interval is between 0.12-0.2, the sinus node is communicating with the AV node, thus making it sinus rhythm (electrical conductivity originating at the sinus node). If the QRS complex is between 0.08-0.1 (or 0.12), that shows the effective conduction from the AV node down the bundle of his, sending the impulse to the purkinge fibers which stimulate the cardiac cells of the ventricles to fire (systole).
As long as the PR interval is always the same and a QRS complex follows it, the heart rate is being controlled by the sinus node, and systole is electrically normal.
About your patient, like others have said, it's impossible to determine without more information--was it a normal rate with occasional breaks (ie, missed complexes)? Was it obviously irregular? Was the patient doing anything during the irregular times, or was s/he resting? Were there any aberrant P waves? Like Ghillbert asked, was it regularly irregular or irregularly irregular?
I love tele.
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