6) Ventricle & Pace Flashcards
BBB:
Bundle Branch Block / intraventricular block: (L or R) can give P waves w/ wide QRS
QRS sharp edge “knife” bc:
coming from a side of heart
Ventricular Arrhythmias:
= from Disorders/sturbances of Conduction, Maybe found in PTa w/ HX of an MI, CHF, CAD
Can go into later from MI
Post ROSC & last breath
Artsclerosis:
Atherosclerosis:
= stiffening of vessels
= build up in make up of arteries
Ventricle rhythms:
= IVR, AIVR, Agonal, PVC, VT, TdP, VF, asystole, Pacemaker
Ventricular rhythms definer:
QRS >0.12secs or 3 small boxes w/ no P waves
1 (IVR)
2 Definer:
3 Rules:
4 Etiology:
5 Symptomology:
6 Treatment:
1= AV slows downs so slow Bottom is faster & louder
2= QRS >3SB or 0.12secs w/ cadence & w/o P waves
3= 15-40BPM, Reg rhythm, Ps & PRI N/A Pace Site: Ventricles, QRS: Wide, >0.12 secs
4= Slowing atrial pace sites, Often 1st rhythm after defib/ROSC
5= Can sig/ decrease CO possibly to life threatening Lvls,
6= If signs of poor perfusion, prepare for TCP }if slow &/or nonperfusing, “PEA/EMD” (electrical mechanical dissociation) follow (AHA) cardiac arrest protocol
1 (IVR)
2 Definer:
1= AV slows downs so slow Bottom is faster & louder
2= QRS >3SB or 0.12secs w/ cadence & w/o P waves
1 (AIVR):
2 Definer:
3 Rules:
4 Rhythm Etiology:
5 Symptomology:
6 Treatment:
1= SNS anxiety releasing EPI & NORepi
2= wide QRS, 41-100BPM, Reg/ Rhythm
3= Rules: 41-100BPM, Reg/ Rhythm,No P Waves & PRI, Pacemaker Site: Ventricles, QRS: Wide, >0.12 seconds
4= Impulses from higher pacemakers fail to reach ventricles, Discharge rate of higher pacemakers becomes < that of ventricles, Commonly found w/ AMI
5= Can sig/ decrease CO, possibly to life threatening levels.
Can be perfusing or nonperfusing: Pulseless & w/ pulse
6 poor perfusion, prepare for TCP} nonperfusing, follow (AHA) cardiac arrest protocol
1 (AIVR):
2 Definer:
1= SNS anxiety releasing EPI & NORepi
2= wide QRS, 41-100BPM, Reg/ Rhythm
1 Premature Ventricular Contractions (PVC):
2 Definers:
3 types:
4 Symptomology:
5 Treatment:
6 Meds:
1= >50% (Don’t + w/ HR) “Pissed off & shouting out”
2= Premature, Wide QRS, no P-wave
3= Benign or Malignant (“>6 PVCs per min)
4= PT may c/o “palpitations” or “skipping” feeling in chest
5= Isolated PVCs in PTs w/ no underlying heart disease usually have no sig/ & usually require no treatment! (majority dont need treat) heart disease w/ ACS, PVCs maybe treated w/
antiarrhythmic med
6= Lidocaine, Amiodarone, Procainamide (best)
1 Premature Ventricular Contractions (PVC):
2 Definers:
1= >50% (Don’t + w/ HR) “Pissed off & shouting out”
2= Premature, Wide QRS, no P-wave
(PVC) Unifocal:
Multifocal:
= same fire site & shape
= dif fire spots & shape
(PVC) Bigeminy:
Trigeminy
Quadgeminy
= 2rd beat uni/PVC regularly “boom PVC” (1:1 pattern)
= 3rd beat is uni/PVC regularly “boom boom PVC)
= 4rd beat is uni/PVC regularly “boom boom boom PVC” 2-3x
(PVC) Couplet:
Triplets:
Run on VT:
= 2PVCs back to back “couple coming” (Can be multi/unifocal)
= 3PVCs in row “poligemist” (Can be multi/unifocal)
= >3PVCs in a consecutive row
Lown Grading system:
benign or malignant for PVCs Grade 0-5 worst-dead
1 (VT):
2 Definer:
3 Rules:
4 Rhythm Description:
5 Monomorphic:
6 Polymorphic:
7 Etiology:
8 Symptomology:
9 Treatment:
10 Unstable Rx:
1= usually reentry prob
2= 100BPM or >, wide QRS
3= 100-250BPM, mostly reg/ Rhythm, Ps If present don’t go w/ QRS, No PRI, Ventricles Pace Site, QRS: >0.12 secs
4= >3 ventricular complexes in succession, (rhythm overrides natural pacemaker, atria & ventricles out of sync)
5= All QRSs look alike w/ same site (most common VT)
6= QRSs have dif morphology (least common VT)
7= MI, +sympathetic tone, Acid-base disturb/, Electrolyte imbalances, Hypoxia, idiopathic causes
8= Poor SV from RVR, may severely comp/ CO & coronary artery perfusion thus may deteriorate to VF
9= (Stable} Ischemic chest pain, dyspnea =antiarrhythmic med> Ami, procain, Lido
10= HypoBP, AMS, shock S/S, acute heart failure> synchronized cardioversion (100J then 200J then 300J to max) If nonperfusing, follow AHA protocol for VFib
1 (VT):
2 Definer:
3 note fusion P waves:
1= usually reentry prob
2= 100BPM or >, wide QRS
3= P waves trying to insert self in to VT
1 (TDP) Twisting of points
2 Definer:
3 Rules:
4 Rhythm Etiology:
5 Symptomology:
6 stable Treatment:
7 unstable Treatment:
8 Wrong treatment:
1= most common polymorphic VT “teeter toter of de & re /polarization of ventricles” (twisting ribbon)
2= Changes in shape w/ size (note w/ change of conduction)
3= 100-250BPM, usually irreg/ Rhythm, if Ps present, don’t associate w/ QRS, No PRI, QRS varies beat-beat, many ventricular pace/sites, QRS >0.12secs, morphology & size changes
4= women>men chance, certain/ mixing antiarrhythmics
5= Can cause severe hypoperfusion in perfusing rhythm,
6= (rare) MAG-SULFATE 1-0.5Gs, Overdrive pacing (ER) pacemaker faster than HR) Correct underlying electrolyte prob/s (hyperK) Ca-Cl, Na-Bicarb, LVN
7= Defib! (only time defib/ pulse) few mins before gone
8 = Amio will prolong QT & kill PT, Rx w/ antiarrhythmics usually used for treatment of VT can have disastrous consequences
1 (TDP) Twisting of points
2 Definer:
1= most common polymorphic VT “teeter toter of de & re /polarization of ventricles” (twisting ribbon)
2= Changes in shape w/ size (note w/ change of conduction)
