Arrythmias Flashcards
PAC
premature atrial contraction
PAC can be cause by
stimulatns
hypoxia, respiratory failure
digoxin toxicity
HF
hypokalemia
QRS in PAC can be
1) normal
2) absent
3) wide
treatment for PAC
anti-arrhythmics if smypotoms occur
PAT
paroxysmal atrial tachycardia
symptoms of PAT
flutter/palpitation
blurred vision
vertigo
signs of low CO
treatment of PAT
carotid sinus massage
vagal maneuvers
synchronized cardioversion
A.Flutter
the VR will depend on
conduction ratio
treatment for A.Flutter
atrial anti-arrhythmics
calcium channel blockers
carotid massage
cardioversion
A.Fib the VR is always
irregular
treatment for A.Fib
calcium channel blockers
digoxin/ beta blockers
verapamil to control HR
cardioversion
anticoagulants
PJC
premature junctional contraction
PJC treatment
usually none
monitor serum digoxin level
Junctional Escape Rhythm (Passive junctional rhythm)
rate
40-60 rpm
2 dangers with junctional escape rhythm
1) Faster ectopic focus become pacemaker, leading to JT or VT;
2) Downward displacement of impulse formation to the ventricles (leading to IVR or VT)
treatment for junctional escape rhythm
atropine if rate if slow
cardiac pacing
d/c drugs thats slowing the HR
Accelerated junctional rhythm
rate
60-100 bpm
treatment for accelerated junctional rhythm
if digoxin toxicity: d/c drug, digiband
if not digoxin toxicity: verapamil adenosine
cardiac pacing
JT
junctional tachycardia
symptoms of JT
associated with fast rhythm:
dyspnea, ischemic chest pain
apprehension, decrease LOC
treatment of JT
d/c drugs causing arrhythmia
verapamil, adenosine, or lidocaine
carotid sinus massage
synchronized cardioversion of CO is low
PVC
premature ventricular contraction
causes of PVC
electrolyte imbalacnes
MI, ischemia, hypoxia
drug intoxication (e.g. cocaine)
excessive stimulants (e.g. caffeine, noctine, stress)
ECG of PVC
No P wave, no PR interval
QRS is distorted, bizarre and wide (>0.12 seconds)
T wave opposite to QRS
Treatment of PVC
Lidocaine, amiodarone, procainamide
Correct the causes
severe PCV can lead to
VT
IVR
idoventricular thythm
IVR rate
20-40 bpm
causes of IVR
Failure of higher pacemakers (MI, ischemia)
AV node conduction disturbances (3rd degree HB)
Reperfusion after thrombolytic therapy
Pacemaker failure
treatment of IVR
Atropine
Pacemaker insertion
May need CPR
NEVER use __ in IVR
lidocaine or anti-arrhythmic drugs
ECG og IVR
No P wave, no PR interval
QRS 20-40 times per minute, bizarre and wide
T wave opposite to QRS
VT
ventricular tachy
causes of VT
4 or more consecutive PVC (more severe PVC)
Advanced myocardial irritability
Intoxication of anti-arrhythmic agents
VT can lead to
Drop in CO, lead to hypotension, LVF, cardiogenic shock
treatment of VT
VT with pulse: amiodarone, lidocaine, pronestyl, cardioversion
VT w/o pulse: CPR!! Code blue
VFib
how much to shock
V-Fib=De-Fib
200 300 360 joules
Circus or Reentry tachycardia
a second pathway exists between the atria and the ventricles
- faster conduction time
- longer refractory period
same impulse keels traveling back and forth at a rapid rate, in a self sustaining and circular motion
Wolf-Parkinson-White Syndrome (WPW)
pre-excitation syndrome has accessory pathways called bundles of Kent, bypass AV node, connects atria and ventricles directly
Short PR interval, QRS occurs quickly after P wave, wider QRS
symptomatic SVT
best treatment is calcium channel blockers
