PEA can present as which of the following organized rhythm?
1) Atrial fibrillation
2) Ventricular tachycardia
3) Sinus rhythm
4) Atrial flutter
The Correct Answer and Explanation is :
The correct answer is 3) Sinus rhythm.
Pulseless electrical activity (PEA) refers to a clinical condition where there is organized electrical activity on the electrocardiogram (ECG) but no effective mechanical heart contraction, resulting in the absence of a detectable pulse. PEA can present with different underlying electrical rhythms, but the key point is that despite the presence of an organized rhythm, the heart is not functioning effectively enough to generate a pulse.
Sinus rhythm is a normal rhythm originating from the sinoatrial (SA) node, characterized by regular heartbeats and the presence of P waves preceding each QRS complex on the ECG. In the context of PEA, a patient can have a sinus rhythm showing organized electrical activity while still being pulseless due to various causes, such as severe hypovolemia, tension pneumothorax, cardiac tamponade, or massive pulmonary embolism.
In contrast, atrial fibrillation, ventricular tachycardia, and atrial flutter typically indicate more chaotic electrical activity and are often associated with mechanical contractions that can generate a pulse if the heart is capable of effective contractions. For instance, atrial fibrillation is characterized by irregularly irregular heartbeats without discernible P waves, while ventricular tachycardia usually results in a rapid heart rate with wide QRS complexes. Atrial flutter shows a rapid, organized atrial rate but may or may not generate effective ventricular contractions.
In summary, while PEA can occur with organized electrical activity, sinus rhythm is the most representative rhythm that can present as PEA. Understanding this distinction is crucial for appropriate assessment and management during advanced cardiovascular life support (ACLS) scenarios.