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Arrhythmias > Arrhythmias > Flashcards

Arrhythmias Flashcards

1
Q

Sinus tachycardia characteristics

A

Regular
100-150 bpm
Normal intervals

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2
Q

Sinus tachy causes

A 
Fever
Activity
Hemorrhage
Stimulants
Anxiety
Injury
Hypoxia
Anemia
Low BP
COPD
Meds
MI
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3
Q

S/S hypoperfusion

A 
Dizziness
Weakness
Syncope
Disorientation
Chest pain
SOB
Diaphoresis
Pallor
Hypotension
Weak pulses
Palpitations
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4
Q

Sinus tachy tx

A

Treat cause (anxiolytics, bolus fluids, digoxin, beta blockers, calcium channel blockers)

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5
Q

Sinus brady characteristics

A

Regular
<60 bpm
Normal intervals

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6
Q

Sinus brady d/t

A

hypothermia
hypoxia
Digoxin, beta blockers/calcium channel blockers
Acute MI
Vagal stimulation (vomiting/suction/rectal exam)
Athletes

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7
Q

Sinus brady tx

A

Atropine
Epinephrine
Pacemaker (rare)

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8
Q

Normal sinus rhythm

A

Regular
60 bpm
Normal intervals

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9
Q

Rhythm strip interpretation

A

1) Regularity
2) Rate
3) P wave : QRS complex ratio
4) PR interval
5) QRS complex
6) QT interval
7) INTERPRETATION :)

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10
Q

Normal values

A

PR: 0.12-0.20 s
QRS: 0.06-0.12 s
QT interval: 0.36-0.44 s

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11
Q

Sinus arrhythmia

A

Irregular HR
60-100 bpm
Normal intervals

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12
Q

Sinus arrhythmia d/t s/s tx

A

Normal pressure changes in chest cavity during breathing
No s/s
No tx

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13
Q

Sinus pause

A 
Regular except for pauses
60-100 bpm
Normal intervals 
Calculate pause (b/t QRS complexes)
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14
Q

Sinus pause d/t

A

Ischemic, inflammatory or degenerative disease of SA node
Sleep apnea
Cardiac meds
Excessive vagal tone

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15
Q

Sinus pause s/s tx

A

Longer, more frequent pauses –> decreased CO –> s/s hypoperfusion
Atropine, epi, dopamine if symptomatic

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16
Q

SVT

A

Regular or irregular
150-250 bpm
Undefined P/T waves
Narrow QRS

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17
Q

SVT causes

A

Sinus tachy, a fib, a flutter, junctional tachy
Severe anxiety
Stimulants (coke, caffeine, amphetamines)
Alcohol, narcotics

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18
Q

SVT treatments

A

Stable: adenosine, vagal maneuvers
Unstable: Synchronized cardioversion

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19
Q

A fib

A

Irregular
60-180 bpm
Undefined P/T waves - multiple P waves
QRS complex narrow

Slow <60 bpm
Fast >100 bpm

State rate as a range

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20
Q

A fib causes s/s

A

MI, longstanding CAD, COPD, atrial septal defects
Cardiac insufficiency, valve regurgitation, hypertrophy
S/S possible: hypoperfusion

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21
Q

A fib tx

A

New onset: IV heparin, IV amiodarone
Stable, fast: amiodarone, beta blockers, calcium channel blockers
Unstable (>180 bpm, hypotension, chest pain): synchronized cardioversion

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22
Q

A flutter

A 
Regular or irregular
Saw-toothed appearance: similar F-waves (one or two ectopic pacemakers bombard AV node) 
Undefined PR interval
Undefined QT interval
Narrow QRS complex
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23
Q

A flutter causes

A 
Antiarrhythmic drugs (to suppress a fib)
Obesity
Obstructive sleep apnea
Sick sinus syndrome
Pericarditis
Pulmonary disease
PE
Cardiomyopathy
Thyrotoxicosis
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24
Q

PAC

A

Irregular overall (regular other than PAC)
P wave for premature beat different than regular P waves
Normal QRS complex
Normal QT interval

25
Q

PAC causes

A 
Possible cardiac history
Food or meds
Anxiety
Caffeine
Exercise
Tobacco
ETOH
Electrolyte
26
Q

PAC s/s

A

Often no symptoms

Might feel palpation or skipped beat if frequent

27
Q

PAC treatments

A

Not usually treated
Eliminate ingested causes if d/t toxicity
Correct electrolyte imbalances

28
Q

Junctional rhythm

A

Regular
40-60 bpm
P wave: inverted (superior AV node), absent (mid AV node), after QRS complex (inf AV node)
QRS complex narrow

29
Q

Accelerated junctional rhythm

A

Regular rhythm
60-100 bpm
P wave: inverted, absent or after QRS complex
QRS complex narrow

30
Q

Accelerated junctional rhythm causes, s/s, tx

A

D/T: digoxin toxicity, electrolyte imbalances, ischemia
S/S: None or hypoperfusion
TX: Remove cause of SA node suppression (adjust meds)

31
Q

Junctional tachycardia

A 
Regular
100-180 bpm 
P wave: inverted, absent, after QRS complex
QRS complex narrow
Basically could also be SVT
32
Q

Junctional tachy causes, s/s, tx

A

D/T: anxiety, exercise, heart disease, caffeine, CNS stimulants
S/S: depends on rate - hypoperfusion
TX: stable: vagal maneuvers, calcium channel blockers, digoxin
Unstable: Synchronized cardioversion

33
Q

1st degree AV block

A 
Regular
60-100 bpm but may be brady/tachy
PR interval > 0.2 s + constant
QRS complex narrow
QT interval normal
34
Q

1st degree AV block causes s/s tx

A

D/T: aging, cardiomyopathies, myocarditis, congenital defects, ischemic heart disease, meds (digoxin, beta blocks, calcium channel blocks)
S/S: none
TX: reduce/eliminate meds if d/t intox

35
Q

2nd degree AV block type I (Wenkenbach)

A

Regular P waves
PR intervals get progressively longer until QRS complex is dropped
QRS complex narrow
QT interval normal

36
Q

2nd degree AV block type II

A

Regular P waves
PR interval regular and constant
QRS complex narrow and periodically absent

37
Q

2nd degree AV block type I causes

A 
Cardiomyopathies
Myocarditis
Congenital defects
Ischemic heart disease
Meds (dig, beta, calcium)
38
Q

2nd degree AV block type II causes

A

Cardiomyopathies
Myocarditis
Ischemic heart disease
Meds

39
Q

2nd degree AV block s/s, tx

A

S/S: none or hypoperfusion

TX: IV atropine, epinephrine and dopamine, pacemaker

40
Q

3rd degree AV block

A

20-60 bpm
P waves regular amongst themselves or hidden
QRS complexes regular amongst themselves
P waves and QRS complexes not in sync
Atrial rate > ventricular rate

41
Q

3rd degree AV block causes

A 
Cardiomyopathies
Myocarditis
Ischemic heart disease
Long term degenerative heart disease
CHF
Meds
42
Q

3rd degree AV block s/s

A 
None or hypoperfusion
Cheyne-Stokes breathing
Seizures
Apnea
Death
43
Q

3rd degree block tx

A

IV atropine, epi or dopamine

Pacemaker (transvenous)

44
Q

Bundle branch block

A

Reg or irregular depending on underlying rhythm (sinus rhythm with BBB, a fib with BBB)
Wide, irregular QRS complex (V1 = right, V6 = left)

45
Q

PVC

A

Irregular overall, regular other than PVCs
QRS complex wide and weird
P wave may be absent with premature beat
Run of 5 or more = v tach

46
Q

PVC causes

A 
MI, CHF, CAD
Anxiety, exercise
Caffeine, tobacco, etoh, drugs, meds 
Electrolyte imbalance (potassium) 
Hypoxia (COPD)
Normal following angio (reperfusion)
47
Q

PVC s/s, tx

A

S/S: often none, palpitations
TX: may not be treated
Treat cause
Antiarrhythmic meds

48
Q

Ideoventricular rhythm

A

Regular or irregular
20-40 bpm
Wide QRS complex
Often no P-wave - undefined PR interval

49
Q

Ideoventricular rhythm causes

A

Vagal stimulation
Cardiac depressant meds
MI, rheumatic heart disease, septal defects
Large dose of CNS depressants

50
Q

Ideoventricular rhythm s/s, tx

A

S/S: May be asymptomatic, or s/s hypoperfusion

TX: Atropine, epi drip

51
Q

Ventricular tachycardia

A 
Regular 
110-250 bpm
Wide weird QRS complex
With/out pulse
Sustained >30 seconds
52
Q

Vtach causes

A

Heart disease, ischemia, MI, CAD, congenital defects
Ventricular aneurysm, PVC on T wave , defib on T wave
Epi, thyroid meds, amphetamines, cocain, cardiac meds
Electrical shock

53
Q

Vtach s/s

A

Short runs = asymptomatic

Longer runs = s/s hypoperfusion –> changes in LOC, seizure, pupil dilation, no BP, no HR

54
Q

Vtach tx

A

VT with pulse: amiodarone, synchronized cardioversion

VT without pulse: CPR, defib

55
Q

Ventricular fibrillation

A

No CO = arrest
No rate
No QRS complex

56
Q

V fib causes, s/s, tx

A

D/T: Electric shock, PVC on T wave, defib on T wave, massive MI
S/S: No pulse, no BP, no RR
TX: CPR defib

57
Q

Torsades de pointes

A

Type of v tach with polymorphous QRS complexes
150-250 bpm
D/T: long QT syndrome (congenital or acquired)
Drug induced, eating disorders, electrolyte imbalance
S/S: short term palpitations
long term no pulse, no BP, no RR
Tx: IV Mg

58
Q

Artifact

A

What to do:
Go to bedside: verify replace reposition electrodes, wires
Ask patient to minimize movements
Ensure chest is shaved

Arrhythmias (1 decks)

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