atrial dysrhythmias

Question 1

early P wave that may be inverted, hidden in T wave, or have different morphology

Answer 1

PAC (premature atrial contraction)

Question 2

what can cause PACs?

Answer 2

nicotine, caffeine, ETOH
myocardial ischemia, HF
meds (digitalis)
electrolyte imbakance (low K and mag)

Question 3

describe rhythm in PAC

Answer 3

regukar, but interrupted by PAC

Question 4

PAC treatment

Answer 4

none in most cases eleiminate exposure to cause

Question 5

sudden burst of 3 or more PACs that become the rhythm for a short time
-starts and stops suddenly

Answer 5

PAT (paroxysmal atrial tachycardia)

Question 6

why does PAT occur?

Answer 6

emotions, nicotine, ETOH
MI
meds (digitalis)

Question 7

What does PAT normally begin with, and what does it look like?

Answer 7

begins with PAC, looks like a quick run of tachycardia with a new P wave occuring before a T wave can occur

Question 8

treatment option of PAT are similar to what?

Answer 8

SVT

Question 9

rapid, sustained atrial tachycardia when the mechanism is unknown

Answer 9

SVT (supraventricular tachycardia)

Question 10

what dysrhythmias fall under SVT?

Answer 10

ones that originate above AV node
-sinus tach
-atrial flutter
-atrial fibrilaltion

Question 11

what is SVT treamtent targeted toward?

Answer 11

heart rate reduction

Question 12

describe rate, rhythm, P waves, and PR interval in SVT

Answer 12

rate = >130
rhythm = regular
P waves = non-identifiable (too fast / hidden in T wave)
PR = immesurable

Question 13

adverse effects of SVT

Answer 13

dec. CO and hypoTN

Question 14

SVT treatment (stable/unstable)

Answer 14

stable: first = valsalva maneuver
next = carotid massage
then, adenosine (stop/start heart)
then, amiodarone, CC blockers, beta blockers

unstable or if all fails: electrical cardioversion

Question 15

when is the shock delivered in a cardioversion

Answer 15

on R wave

Question 16

what would happen if a shock was delivered on T wave?

Answer 16

v-fib or lethal dysrhythmias

Question 17

a SVT characterized by atrial rate of around 300

Answer 17

a flutter

Question 18

what does a flutter look like

Answer 18

sawtooth

Question 19

is the sawtooth atrial pattern P waves?

Answer 19

NO
they are called F waves

Question 20

what are ventricular conduction rates in a flutter?

Answer 20

2:1, 3:1, 4:1
2:1 is fastest
4:1 is slowest

Question 21

what conditions does a flutter often occur in?

Answer 21

CAD
cor pulmonae
rheumatic heart disease

Question 22

what conditions resule from lack of atrial contraction in a flutter?

Answer 22

PE
stroke
MI

Question 23

what are the 2 goals of a flutter treatment

Answer 23

convert back or sinus
OR
achieve ventricular rate control (HR < 100)

Question 24

treatment of a flutter (stable/unstable)

Answer 24

long term anticoagulats
stable: amiodarone (convert to NSR), beta blockers, CC blockers, digoxin
unstable: synchronized cardioversion

Question 25

rapid atrial ectopic rhythm occuring with atrial rate of 350-500

Answer 25

a fib

Question 26

how do “p waves” appear if a fib

Answer 26

small squiggly

Question 27

what happens to SV in afib/aflutter

Answer 27

decreases 20%

Question 28

QRS in afib

Answer 28

irregularly irregular

Question 29

what conditions does afib commonly occur in

Answer 29

HF
ischemia/CAD
pulmonary disease
after open heart
mitral valve disease

Question 30

ventricular rhythm (RR) in afib

Answer 30

irregular

Question 31

afib treatment (stable/unstable)

Answer 31

long term anticoagulats
stable: amiodarone (convert to NSR), beta blockers, CC blockers, digoxin
unstable: synchronized cardioversion

Question 32

what is done before a synchronized cardioversion is a stable patient with afib/aflutter

Answer 32

TEE to r/o clot

Question 33

what is use of radiofrequency energy to cause targeted localized cardiac lesion sometimes used in afib

can prevent initiation of the dysrhythmia ectopic area and disrupt condution pathway

Answer 33

ablation therapy