2.3 Atrial Dysrhythmias Flashcards
Atrial Dysrhythmias
- Premature Atrial Complex
- Atrial Flutter
- Atrial Fibrillation
- Supraventricular Rhythms (Dysrhythmias that occur above the ventricle)
- Conduction Abnormalities
Ventricular Dysrhythmias
- Premature ventricular complex
- Ventricular tachycardia (Fatal)
- Ventricular Fibrillation (Fatal)
- Ventricular Asystole (Fatal)
Tachycardia
- HR above 100 bpm
Sinus Tachycardia - Arises from the SA node
Atrial Tachycardia - Arises in the atrium (Supraventricular)
Junctional/Nodal Tachycardia - Arises from the AV node (Supraventricular)
- May not cause complications but untreated can lead to HF, Stroke, Sudden Cardiac Death
Causes H
- Hypoxia, Hypovolemia, Hydrogen Ions (acidosis), Hypo/Hyperkalemia, Hyperglycemia (DKA, HHS), Hyperthermia
Causes T
- Toxins, Cardiac Tamponade (fluid buildup in spaces around heart), Tension Pneumothorax (tension in pleural spaces affect cardiac function), Thrombosis, Trauma
Premature Atrial Contractions (PACs)
- Individual complexes occur earlier than expected
- Generated by atrial myocardium but does not originate in SA node.
- Typically benign but can be caused by pain, fever, anxiety, fear.
- Typically not concerning unless it increases in frequency.
Atrial Fibrillation (A-Fib)
- Most common dysrhythmias
- Total disorganization of atrial electrical activity due to multiple areas in the atria that are irritable and firing
- Atria only quivers which results in irregular rhythm. This causes them not to contract completely and in turn not empty adequately.
WHAT THIS CAUSES
- Blood sits in atria which increases risk of clotting. Once the atria does contract, it sends these clots to the body/brain.
- Atria supplies 30% of cardiac output. Loss of this output significantly impacts CO
ECG
- Fluctuating baselines without obvious P waves.
- RISK OF DEVELOPING AFIB INCREASES WITH AGE
A-Fib (Cont)
- Associated with underlying heart disease such as CAD, Cardiomyopathy, HF, Pericarditis, Thyrotoxicosis (extremely high levels of thyroid hormone), hyperthyroidism, alcohol intoxication, excessive caffeine, electrolyte disturbances, cardiac surgery.
Stable vs Unstable A-Fib
Unstable Manifestations
- Pale/Cyanotic
- Cool/Clammy
- SOB
- Weakness/Dizziness
- Chest Pain
- Unresponsiveness
A-Fib Treatment
ACUTE (Goal is to decrease ventricular rate/response and to prevent embolic stroke)
- Oxygen
- IV Fluids
- Rate Control (digoxin, betablockers, calcium channel blockers)
- Embolism Control (Long-term anticoagulants such as warfarin, apixaban, rivaroxaban, dabigatran)
Atrial Flutter
- Single irritable site at the atria (different from a-fib where there are multiple sites)
- Usually fires at a rapid rate (300 flutters per minute)
ECG
- Sawtooth pattern
- Variable Block - Flutter waves are buried in the QRS
- No P-Waves
- Normal Ventricular Rate and Normal QRS (60-100)
- Atrial Rate (250-350)
MEASUREMENT
- 3 flutter waves before QRS = 3:1 Flutter
- 10 flutter waves before QRS = 10:1 Block
- Variable Block - Different amount of flutters between QRS
- Waves are called F-Waves (Flutter-Waves)
SYMPTOMS (Usually No Symptoms)
- Palpitations
- SOB
- Dizziness
- Syncope
- Tachycardia
ASSOCIATED WITH
- CAD, Hypertension, Mitral Valve Disorders, PE, Hyperthyroidism
- Digoxin, Quinidine, Epinephrine
Atrial Flutter Treatment
Stable
- Monitor the patient
Unstable
- Oxygen
- IV Fluid
- Antidysrhythmic Medications
- Pacemaker can also be used as treatment.
If ventricular rate is slow (40 bpm) Atropine may be given to increase ventricular rate
- Epinephrine can be used if Atropine is not effective
- Dopamine is used if CO is affected or BP is low
If Ventricular rate is high then betablockers and calcium channel blockers are used to slow ventricular response.
PROCEDURES FOR BOTH AFIB AND AFLUTTER
- Ablation of Irritable Foci
- A-fib is hard to treat surgically due to being so widespread
