Atrial Dysrhythmias Flashcards
Name the 4 types of Atrial Dysrhythmias
Premature Atrial Contraction (PAC)
Atrial Fibrillation
Atrial flutter
Paroxysmal supraventricular tachycardia (PSVT)
Define Premature Atrial Contractions
Ectopic pacemaker in atrium discharges before SA node fires
What causes Premature Atrial Contractions?
Usually, benign
Check electrolytes (If you notice new onset of PAC’s/ increased in frequency check for electrolyte imbalance)
Increase in frequency may be indicated patient is about to convert to a-fib
Stress
Cardiac stimulants (caffeine)
May indicate Atrial pathology
Define Atrial Fibrillation
Total disorganization of serial electrical activity due to multiple ectopic foci,resulting in loss of effective Atrial Contraction (kick)
Atrial rate >400bpm Ventricular rate >100-175bpm
R to R intervals are Irregularly Irregular
Most common dysrhythmia
Prevalence increases with age
What causes Atrial Fibrillation?
Usually occurs with some underlying heart disease (all of them)
Electrolyte imbalance
Hypoxia
Cardiac surgery
Atrial Fibrillation risk/complication
Atrial Fibrillation=fibrillating atria=pooling of blood=clot information=risk for embolus
Note: If in LA (left atria) can cause a stroke
What will the patient with Atrial Fibrillation look like?
Depends on Ventricular rate, how long rhythm has been present, and the patient’s CV status.
Typically, Onset is FAST rate-so s/s are those of tachydysrhythmia
Define Atrial flutter
Identified by recurring, regular, saw-toothed-shaped flutter waves
Originates from a single ectopic focus; reentry impulse is repetitive & cyclic (one irritable cardiac cell in the atria that wants to be in charge)
R to R interval is regular or irregular
Atrial rate may be >250bpm; Ventricular rate slower
What causes Atrial flutter?
Rarely occurs in a healthy heart; underlying heart condition (any of them)
Electrolyte imbalance
What does the patient with atrial flutter look like?
Depends on Ventricular rate, how long the rhythm has been present, and the patient’s CV status
Typically, onset is FAST rate- so s/s are those of tachydysrhythmia
And-Yes at risk for emboli.
Atrial Fibrillation/Flutter goals
Ventricular rate control
Rhythm control
Prevent embolic stroke
drugs to treat Atrial Fibrillation/Flutter?
Drugs for RATE control: B-adrenergic Blockers(metoprolol),calcium channel Blockers(diltiazem, verapamil)-initially IV route
Drugs for RHYTHM control: amiodarone & doFETilide-initially IV route
Drugs to prevent clots: warfarin
How do we treat Atrial Fibrillation/Flutter?
If stable, but symptomatic?
If unstable/hemodynamically compromised?
If stable, but symptomatic?
Slow Ventricular rate with IV either calcium channel blocker, beta blocker, digitalis, amiodarone
May be “bolus” & start a drip…
If unstable/hemodynamically compromised?
Synchronized cardioversion
Define Synchronized cardioversion
Choice of therapy for hemodynamically unstable supraventricular tachydysrhythmia
Synchronized circuit delivers a countershock on the R wave of the QRS complex of the ECG (need to have a R wave before cardioverting a patient)
Synchronizer switch must be turned ON
If the synchronized cardioversion is non-emergency the patient is sedated before the procedure (True/False)
True