Atrial Dysrhythmias Flashcards

1
Q

Name the 4 types of Atrial Dysrhythmias

A

Premature Atrial Contraction (PAC)
Atrial Fibrillation
Atrial flutter
Paroxysmal supraventricular tachycardia (PSVT)

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2
Q

Define Premature Atrial Contractions

A

Ectopic pacemaker in atrium discharges before SA node fires

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3
Q

What causes Premature Atrial Contractions?

A

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

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4
Q

Define Atrial Fibrillation

A

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

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5
Q

What causes Atrial Fibrillation?

A

Usually occurs with some underlying heart disease (all of them)
Electrolyte imbalance
Hypoxia
Cardiac surgery

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6
Q

Atrial Fibrillation risk/complication

A

Atrial Fibrillation=fibrillating atria=pooling of blood=clot information=risk for embolus

Note: If in LA (left atria) can cause a stroke

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7
Q

What will the patient with Atrial Fibrillation look like?

A

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

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8
Q

Define Atrial flutter

A

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

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9
Q

What causes Atrial flutter?

A

Rarely occurs in a healthy heart; underlying heart condition (any of them)
Electrolyte imbalance

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10
Q

What does the patient with atrial flutter look like?

A

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.

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11
Q

Atrial Fibrillation/Flutter goals

A

Ventricular rate control
Rhythm control
Prevent embolic stroke

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12
Q

drugs to treat Atrial Fibrillation/Flutter?

A

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

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13
Q

How do we treat Atrial Fibrillation/Flutter?

If stable, but symptomatic?

If unstable/hemodynamically compromised?

A

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

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14
Q

Define Synchronized cardioversion

A

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

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15
Q

If the synchronized cardioversion is non-emergency the patient is sedated before the procedure (True/False)

A

True

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16
Q

What is the initial energy for synchronized cardioversion?

A

50 to 100 Joules (increase if needed)

17
Q

Make sure all personnel are “ALL CLEAR” before discharging the device during a synchronized cardioversion (True or False)

A

True

18
Q

What do you do if a patient becomes pulseless during a synchronized cardioversion?

A

Turn the synchronizer switch OFF & perform defibrillation

19
Q

Synchronized cardioversion nursing care

A

Maintain patent airway
Administer oxygen
Assess VS & LOC
Monitor for dysrhythmias
Provide emotional support
Document results of cardioversion

20
Q

How to treat Atrial Fibrillation if has a-fib for >48 hours

non-emergency

A

Anticoagulation therapy with warfarin (Coumadin) is recommended for 3 to 4 weeks before cardioversion and 3 to 4 weeks after successful cardioversion

21
Q

What procedure is performed before a Cardioversion (to make sure no clots in atrium)

A

TEE (Transesophageal Echocardiogram)

22
Q

What medication will be administered if emergent cardioversion performed?

A

Low-molecular weight heparin or heparin drip will be initiated.

23
Q

If treatment for atrial Fibrillation/Flutter doesn’t work, what’s next?

A

Long term anticoagulation therapy.
Drug of choice is typically warfarin (Coumadin)
Disadvantage-have to monitor INR regularly

Alternative anti-coag drugs
dabigatran (Pradaxa), apixaban (eliquis) Twice daily
Rivaroxaban (Xarelto), eboxaban (Savaysa) once daily
Advantage: (no routine lab testing)
Disadvantage: Cost, more than once daily dosing & contraindicated with impaired renal function

24
Q

What limits atrial Fibrillation/Flutter pharmacy therapy for dysrhythmias?

A

High failure rates
Potential for drug toxicity

25
Q

Non-pharmacology treatment for atrial Fibrillation/flutter.

A

Catheter ablation
Radio-frequency or cryothermal therapy

Maze procedure

26
Q

non-pharm Afib/Aflutter treatment

What is a Catheter ablation?

Invasive/non-invasive procedure?

that __________ an___________ causing the dysrhythmia

Must undergo _____ studies & mapping procedures to locate the focus.

A

Invasive procedure

that destroys an irritable focus causing the dysrhythmia

Must undergo EP studies & mapping procedures to locate the focus.

27
Q

non-pharm Afib/Aflutter therapy

What is a Maze procedure?

Surgical/nonsurgical procedure?

consists of creating a number of incisions in _______ to disrupt the re-entrant circuits.

Looks schematically like a children’s Maze with only one path from the _______ to the _______

A

Surgical procedure

consists of creating a number of incisions in atrium to disrupt the re-entrant circuits.

Looks schematically like a children’s Maze with only one path from the SA node to the AV node.

28
Q

Define Paroxymal Supraventricular tachycardia (PSVT)

A

Originates in ectopic focus anywhere above bifurcation of Bundle of His

Run repeated premature beats is initiated and it usually starts with a PAC

Paroxysmal refers to an abrupt onset and termination (without warning).

29
Q

What causes PSVT?

A

In normal heart
Overexertion
Emotional stress
Stimulants

Digitalis toxicity
Various forms of heart disease

30
Q

What does the patient look like with PSVT?

A

Depends on how long it lasts & how FAST Ventricular rate

(See Key Features slide) Tachydysrhythmias

31
Q

How do we treat PSVT?

A

Vagal maneuvers (should be on monitor)
Valsalva (most effective)- Hold breath 10-15 seconds (should see neck distention), then resume breathing.
Coughing
Carotid sinus massage (CSM) MD ONLY
Diving reflex/cold water immersion- submerge face in cold water (triggers vagal response)-Due to complexities, rarely used in modern clinical medicine

32
Q

How to treat PSVT if vagal maneuvers fail?

A

Adenosine IV push
VERY short half life (follow with rapid NS flush)
May cause a pause on rhythm strip, patient may be aware

Onset=10-40 seconds/duration 1-2 minutes

33
Q

How do we treat PSVT if vagal maneuvers and/or drug therapy is ineffective and/or patient becomes hemodynamically unstable?

A

Cardioversion