What is going on guys? Don checking in, welcome to MINT, where we bring nursing to you.
So today, we're going to talk about the easiest way to do your Junctional Rhythms. But, if
you haven't already, I highly recommend that you check out our EKG video. That will really
help you a lot. So I'm going to link it down below. So, if you're ready, I'm ready. Let's
get going. Alright guys, today we are going to talk about Junctional Rhythms. We are going
to talk about the basic about this dysrhythmia, what you need to know for you to interpret
your strips.
But before anything else, we are going to have a quick review about the conduction system
of the heart and the inherent heart rates. Basically the conduction system of the heart
is pretty much these special cardiac cells right here that are responsible in conducting
signals that cause our heart to contract. The first special cell is called the SA node
or the sinoatrial node. This is also known as the natural pacemaker of the heart because
this is where the beginning of the conduction takes place. So from the SA node, the conduction
system goes to the AV node, right over here, or the atrioventricular node. This is also
known as the gate keeper of the heart because it gets to decide whether what impulse to
let through. If the SA node generates a weak impulse or it doesn't fire at all, the AV
node will perceive that and will decide not to let that impulse go through. And instead,
it conducts its own impulse. So from the AV node, it goes through the single structure
right here called the Bundle of His. From the Bundle of His, the cells will continue
and will then bifurcate, one to the left and one to the right. This will now be called
the Left and Right Bundle Branches. And from the Bundle Branches, they will continue within
the apex of the heart, and these cells will now be called the Purkinje fibers. So this
is you conduction system of the heart. And when the conduction goes from here all the
way to the Purkinje fibers, it will generate a heart beat. So another concept that we need
to review will be the inherent heart rates. When you say inherent heart rates, these are
heart rates that we generate depending on which cardiac cell sends an impulse. If the
impulse starts from the SA node and goes all the way to the Purkinje fibers, this will
generate a heart rate of 60 to 100 beats per minute. But, if the SA node fails, then the
AV node will generate its own impulse. And this will give us a heart rate of between
40 to 60 beats per minute. The AV node and the Bundle of His can actually generate a
heart rate of 40 to 60 beats per minute. If the AV node fails or the Bundle of His fail,
then the Left and Right Bundle Branches and the Purkinje fibers can take over. And they're
able to generate a heart rate of 20 to 40 beats per minute. Now in Junctional Rhythms,
the SA node fails. It doesn't fire at all or it has a weak impulse. This means that
the AV node takes place and will generate its own impulse. What this means is that our
typical junctional rhythm heart rate would be 40 to 60 beats per minute. And I said typical
because if you're out of that range, we will call the dysrhythmia a different name. And
we're going to talk about that later on. But for now, let us talk about the characteristics
of Junctional Rhythm. And I already mentioned that earlier, the typical heart rate of Junctional
Rhythms would be 40 to 60 beats per minute. And the reason being is that the SA node failed,
hence, the AV node kicked in. Another characteristic of Junctional Rhythm, and this is actually
the hallmark characteristic of Junctional Rhythm, would be the P wave is inverted or
absent. This is what a normal EKG looks like. As you can see the P wave, this is our P wave,
QRS , and the T wave. The P wave should be upright and present. But, in our Junctional
Rhythm, it would be inverted just like this or it will be absent. Now, depending on which
part of the AV node starts an impulse, you may also have what we call a retrograde P
wave where in the inverted P wave goes after the QRS complex. Now let us discuss the different
classifications of Junctional Rhythms. These are Junctional Rhythm, this is your typical
Junctional Rhythm. The accelerated Junctional Rhythm, the Junctional Tachycardia, and your
Junctional Bradycardia. Just a reminder, all of these have the same hallmark sign, it's
either the P wave is inverted or absent. The only thing that will differentiate these from
one another would be their heart rates. So as mentioned earlier, your typical Junctional
Rhythm will have a heart rate of 40 to 60 beats per minute. If your heart rate will
go beyond 60 beats per minute, you will call this Accelerated Junctional Rhythm. Your heart
rate is between 60 to 100 beats per minute. You go beyond the typical heart rate of a
Junctional Rhythm, which is 40 to 60 beats per minute. Now if you go beyond 100 beats
per minute, you will call this Junctional Tachycardia. Just like any other dysrhythmia,
anything that is above 100 beats per minute, it will be called tachycardia. And finally,
if your heart rate is below 40 beats per minute, you will call that Junctional Bradycardia.
Now there are also other classifications of Junctional Rhythm such as the Premature Junctional
Complex and the Wandering Junctional Pacemaker Dysrhythmia, but I might do that in a different
video. But just keep in mind that all of these classifications, they have one thing in common.
And that is, that the P wave is inverted or absent. That is your Junctional Rhythms.
That is it for today guys. I hope you guys found that video helpful. And if you haven't
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