Atrial Arrhythmias Flashcards
Anything with a rate below __ or above __ is from a pacemaker other than the SA node
40
160
Sinus NSR 60-100 Regular SB 40-60 Regular ST 100- 160 Regular SA Irregular
Everything from here on is considered _____
Arrhythmia
Premature Atrial Contractions (PAC)
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
Do not count _____ in rate of PAC
premature contraction
How do PACs differ from heart rate change
HR change - the new rate would continue after the change
PAC- goes back to the underlying rhythm
How do you know that the impulse originated in the atria?
The P wave is upright
When the P wave is hidden inside the T wave, it changes the morphology, making it bigger
Patient probably doesn’t feel PAC.
An occasional PAC is nothing to worry about.
Several PACs occurring indicates:
irritability of the heart
With an irritable heart, what do you want to consider?
Electrolytes, volume, pulmonary pressure, COPD
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:
gravity
Embolic Stroke
Atrial Tachycardia (PAT)
Rhythm: Regular Rate: 140-250 P waves: Hidden in preceding T wave PR: Not measurable QRS: < .10 seconds
Paroxysmal Atrial Tachycardia (PAT)
Paroxysmal means:
it comes and it goes
A natural reaction to PAT and a way to fix it is:
Vagal response, valsalva maneuver
-cough, bear down, ice water on face,
What does patient look like in PAT
Anxious – often a sign of HYPOXIA
- the reduction in filling time leads to a hypoxic state and loss of perfusion
- increase in respiratory rate
Atrial Flutter
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
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
Atrial flutter
Less than 100 ventricular impulses means it is -
Over 100 -
Controlled
Uncontrolled
What med slows the heart rate
Digoxin
When flutter waves are not regular:
Variable ratios
Atrial Fibrillation
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
The defining characteristic of atrial fibrillation is that:
It is highly irregular
1 risk factor of atrial fibrillation are:
Embolic Strokes
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.
A. Fib and Flutters are treated similarly.
Time makes a big difference.
<48 hours treat with:
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
What is the goal of cardioversion?
To STOP the heart with the goal of the SA node taking over
If its been greater than 48 hours, they will perform a ____
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.
A lot of patients in A. Fib have ____ issues
lung issues like COPD
What kind of meds are A. Fib. patients on?
Anticoagulants (Heparin, Warfarin, Enoxaparin) & Antiarrythmias
Aspirin is not strong enough
What is a treatment for irritability of the heart?
Ablation - burning off the irritable site
