Atrial Dysrhythmias

Question 1

Atrial Flutter

Answer 1

Originates: Av Node - Overrides the SA Node

Re-Entry impulse that is REPETITIVE & CYCLIC

Regular atrial rhythm with an ATRIAL rate of > 250 bpm

Ventricular rate is slower

P wave classic “Sawtooth” appearance

QRS usually narrow

May be 2:1 3:1 4:1

Question 2

Atrial Flutter: Causes

Answer 2

• Coronary Heart Disease
• Cardiomyopathy
• Heart Valve Disease
• Congenital Heart Disease
• Inflammation of the heart (myocarditis)
• High BP
• Other conditions such a lung disease or overactive thyroid
• Electrolytes

**Something is wrong with the Heart

Question 3

Atrial Fibrillation

Answer 3

Multiple irritable spots in the atria (multiple impulse locations)

IRREGULARLY IRREGULAR
(both atrial + ventricular)
-random action potentials

HR: 100-175 bpm

NO identifiable “P” wave

“fibrillation” waves

R-R or P-P totally irregular

Question 4

Atrial Fibrillation: Clinical Manifestations

Answer 4

Palpations
Heart Racing
Fatigue
Dizziness
Chest Discomfort
Shortness of breath
May be asymptomatic

Question 5

AFIB w/RVR

Answer 5

Is it rate controlled?

-high HR isn’t going get the CO needed.

Question 6

Atrial Fibrillation: Causes

Answer 6

Electrolytes
Hypoxia
Cardiovascular disease (all)

Question 7

Atrial Fibrillation: Complications

Answer 7

Decreased CO
Heart Failure
EMBOLUS&raquo_space; Stoke (common!)
-clotting within atria

Question 8

Atrial Fibrillation: Treatment

Answer 8

Most common type of treated dysrhythmia

Rate Control: Beta blockers, CCB, digitalis, amiodarone
-same for Atrial flutter

Stroke Prevention: anticoagulants, antiplatelet

Non-pharmacological
-Ablation, Cardioversion

Question 9

Premature Ventricular Contractions (PVCs)

Answer 9

Contraction coming from an ectopic focus in the VENTRICLES

It comes EARLIER than the QRS should, and doesn’t follow a normal rhythm or P-wave

WIDE and distorted in shape compared to normal QRS

Question 10

PVC’s Causes

Answer 10

Simulants
Electrolytes
Hypoxia
Fever
Exercise
Emotional stress 
CVD

Treat the Cause

Question 11

Premature Ventricular Contractions (PVCs): Subtypes

Answer 11

1. Bigeminy
   - every second beat
2. Trigeminy
   - every third beat
3. Quadrigeminy

Usually an electrolyte problem.
-can be positive or negative

Question 12

Ventricular Tachycardia (VTACH)

Answer 12

3 or more PVC’s together

Ectopic focus within the VENTRICLES takes control and fires repeatedly: NO atrial contractions occurring

SEROUSLY decreases CO

Question 13

VTACH: Causes

Answer 13

• MI
• CAD
• Significant Electrolyte abnormalities
• HF
• Drug toxicity

Question 14

Ventricular Tachycardia (VTACH): Stuff

Answer 14

Rate: 150-200, Usually regular

NO P-wave evident, PR not measurable

Question 15

VTACH: treatment

Answer 15

Depends on Pulse
-patient will be symptomatic very quickly unless converts back to other rhythm

May need anti-dysrhythmic medications like Beta blockers or CCB
-Electrolyte replacement

First Question: Pulse or Pulseless?
-some will, some won’t, eventually all become PULSELESS

Question 16

What to do in VTACH

Answer 16

Immediately check pulse, no? CPR

Question 17

Ventricular Fibrillation (VFIB)

Answer 17

Irregular waveforms of various shapes and sizes

The Ventricles are just ‘quivering’

NO effective contractions = NO CARDIAC OUTPUT

Question 18

What to do in VFIB?

Answer 18

Check pulse, CPR