Asymptomatic Irregular Cardiac Rhythm

Carey, Mary G.; Al-Zaiti, Salah S.; Kozik, Teri M.; Pelter, Michele M.

doi:10.4037/ajcc2014438

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ECG Puzzler| September 01 2014

Asymptomatic Irregular Cardiac Rhythm

Mary G. Carey, RN, PhD, CNS;

Mary G. Carey, RN, PhD, CNS

Mary G. Carey is associate director for clinical nursing research, Strong Memorial Hospital, Rochester, New York. Salah S. Al-Zaiti is an assistant professor at the Acute and Tertiary Care Department, University of Pittsburgh, Pennsylvania. New York. Teri M. Kozik is a nurse researcher at St. Joseph’s Medical Center, Stockton, California. Michele M. Pelter is a professor at the Orvis School of Nursing, University of Nevada, Reno.

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Salah S. Al-Zaiti, RN, PhD, NP;

Salah S. Al-Zaiti, RN, PhD, NP

Mary G. Carey is associate director for clinical nursing research, Strong Memorial Hospital, Rochester, New York. Salah S. Al-Zaiti is an assistant professor at the Acute and Tertiary Care Department, University of Pittsburgh, Pennsylvania. New York. Teri M. Kozik is a nurse researcher at St. Joseph’s Medical Center, Stockton, California. Michele M. Pelter is a professor at the Orvis School of Nursing, University of Nevada, Reno.

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Teri M. Kozik, RN, PhD, CNS, CCRN;

Teri M. Kozik, RN, PhD, CNS, CCRN

Mary G. Carey is associate director for clinical nursing research, Strong Memorial Hospital, Rochester, New York. Salah S. Al-Zaiti is an assistant professor at the Acute and Tertiary Care Department, University of Pittsburgh, Pennsylvania. New York. Teri M. Kozik is a nurse researcher at St. Joseph’s Medical Center, Stockton, California. Michele M. Pelter is a professor at the Orvis School of Nursing, University of Nevada, Reno.

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Michele M. Pelter, RN, PhD

Mary G. Carey is associate director for clinical nursing research, Strong Memorial Hospital, Rochester, New York. Salah S. Al-Zaiti is an assistant professor at the Acute and Tertiary Care Department, University of Pittsburgh, Pennsylvania. New York. Teri M. Kozik is a nurse researcher at St. Joseph’s Medical Center, Stockton, California. Michele M. Pelter is a professor at the Orvis School of Nursing, University of Nevada, Reno.

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Am J Crit Care (2014) 23 (5): 429–430.

https://doi.org/10.4037/ajcc2014438

Scenario: This is a rhythm strip of lead V₅ from a 24-hour Holter study of a patient who is scheduled for elective orthopedic surgery. He is a physically fit 24-year-old white male with no medical history. The Holter study was performed because during his preoperative evaluation he was noted to have an irregular pulse rate.

This rhythm is an example of marked respiratory sinus arrhythmia at 71 beats/min. In this rhythm, sinus rhythm is present along with beat to beat variations in the P-P interval (time measured between consecutive P waves). This produces an irregular R-R interval resulting in sinus arrhythmia. It is extremely noticeable so the word marked is added to the description. Sinus arrhythmia is a change in heart rate that is concurrent with the respiratory cycle, so that with inhalation the heart rate accelerates and with exhalation the heart rate decelerates.

The characteristics of respiratory sinus...

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