Atrial Arrhythmias

Question 1

Anything with a rate below __ or above __ is from a pacemaker other than the SA node

Answer 1

40

160

Question 2

Sinus
NSR 60-100 Regular
SB 40-60 Regular
ST 100- 160 Regular
SA Irregular 

Everything from here on is considered _____

Answer 2

Arrhythmia

Question 3

Premature Atrial Contractions (PAC)

Answer 3

Rhythm:		Underlying rhythm regular
				Irregular with PAC
Rate:		Rate of underlying Rhythm
P waves:		PAC P Wave is premature
				Abnormal in size, shape or direction
				May be hidden
PR:			.12 seconds - .20 seconds 
				(may be prolonged
QRS:		< .10 seconds

Question 4

Do not count _____ in rate of PAC

Answer 4

premature contraction

Question 5

How do PACs differ from heart rate change

Answer 5

HR change - the new rate would continue after the change

PAC- goes back to the underlying rhythm

Question 6

How do you know that the impulse originated in the atria?

Answer 6

The P wave is upright

Question 7

When the P wave is hidden inside the T wave, it changes the morphology, making it bigger

Question 8

Patient probably doesn’t feel PAC.

An occasional PAC is nothing to worry about.

Several PACs occurring indicates:

Answer 8

irritability of the heart

Question 9

With an irritable heart, what do you want to consider?

Answer 9

Electrolytes, volume, pulmonary pressure, COPD

Question 10

Atrial Rhythms are NOT lethal.

80-85% of blood volume moves from atria into ventricles by ____

Loss of atrial kick - atria not moving the last 20%

Remaining blood may clot, leading to:

Answer 10

gravity

Embolic Stroke

Question 11

Atrial Tachycardia (PAT)

Answer 11

Rhythm:		Regular
Rate:		140-250
P waves:		Hidden in preceding T wave
PR:		Not measurable
QRS:		< .10 seconds

Question 12

Paroxysmal Atrial Tachycardia (PAT)

Paroxysmal means:

Answer 12

it comes and it goes

Question 13

A natural reaction to PAT and a way to fix it is:

Answer 13

Vagal response, valsalva maneuver

-cough, bear down, ice water on face,

Question 14

What does patient look like in PAT

Answer 14

Anxious – often a sign of HYPOXIA

• the reduction in filling time leads to a hypoxic state and loss of perfusion
• increase in respiratory rate

Question 15

Atrial Flutter

Answer 15

Rhythm:		Regular or irregular	
Rate:		Atrial rate 250 – 400
				Ventricular rate varies depending
				 on AV node conduction
P wave:		Absent
				Flutter waves present
PR:			Not measurable
QRS:		 < .10 seconds

Question 16

Atrial flutter

The atrial rate is too fast for the ventricles. The AV node or junction, serves as the gatekeeper and doesn’t let all the beats through

Question 17

Atrial flutter

Less than 100 ventricular impulses means it is -

Over 100 -

Answer 17

Controlled

Uncontrolled

Question 18

What med slows the heart rate

Answer 18

Digoxin

Question 19

When flutter waves are not regular:

Answer 19

Variable ratios

Question 20

Atrial Fibrillation

Answer 20

Rhythm:		Very irregular
Rate:		Atrial rate 400 or more 
				Ventricular rate varies 
				depending on AV node conduciton
P wave:		Absent
				Fibrillatory waves present
PR:			Not measurable
QRS:		 < .10 seconds

Question 21

The defining characteristic of atrial fibrillation is that:

Answer 21

It is highly irregular

Question 22

1 risk factor of atrial fibrillation are:

Answer 22

Embolic Strokes

Question 23

Atria never contract with A. Fib., rather they quiver (fibrillates)

Isoelectric line of A. Fib. is wavy, reflecting the quiver.

A. Fib is second most common rhythm to sinus rhythm.

Question 24

A. Fib and Flutters are treated similarly.

Time makes a big difference.

<48 hours treat with:

Answer 24

Cardioconversion
-synchronized firing between complexes, discharging at a safe time (not during t wave or QRS complex)

This is different from defibrillation which is not a timed shock

Question 25

What is the goal of cardioversion?

Answer 25

To STOP the heart with the goal of the SA node taking over

Question 26

If its been greater than 48 hours, they will perform a ____

Answer 26

TEE- trans esophageal echo to make sure there is not a clot there.

Once they discover that there is no clot, then they can cardiovert.

If there is a clot, patient will need to go on anticoagulants and may need a filter.

Question 27

A lot of patients in A. Fib have ____ issues

Answer 27

lung issues like COPD

Question 28

What kind of meds are A. Fib. patients on?

Answer 28

Anticoagulants (Heparin, Warfarin, Enoxaparin) & Antiarrythmias

Aspirin is not strong enough

Question 29

What is a treatment for irritability of the heart?

Answer 29

Ablation - burning off the irritable site