Atrial Dysrhythmias Flashcards
what are the atrial dysrhythmias
-Afib
-Aflutter
-premature atrial contraction (PAC)
-paroxysmal supraventricular tachycardia (PSVT)
what is PAC
ectopic pacemaker in atrium discharges before SA node fires, usually a one time beat
isolated premature atrial beat
what causes a PAC
-usually benign but if new onset or increases in occurrence -> check electrolytes (mg, ca, k)
-stress
-caffeine or stimulants
-may indicate atrial pathology
an increase in frequencies of PAC may indicate what
patient is about to convert to afib
if you notice new onset of PACs, what is your next best nursing action
connect the provider b/c we can give meds to prevent them from converting to afib
how to treat benign PAC
do not need to treat
what is Afib
total disorganization of atrial electrical activity due to multiple ectopic foci, resulting in loss effective atrial contraction (“kick”, p wave)
atria is quivering b/c SA node is no longer in charge of pacing
characteristics of afib
-no p wave
-R to R intervals are irregularly irregular
-atrial rate > 400 bmp
-ventricular rate >100-175 bmp
-most common dysrhythm
-increases w/ age
can you live w/ afib
yes as long as ventricular rate is controlled
what causes afib
person usually has underlying heart disease
-electrolyte imbalance
-hypoxia
-cardiac surgery
main risk if a person if in afib
afib leads to a fibrillating atria -> pooling of blood -> clot formation -> risk for embolus -> can throw clot to the brain causing a stroke
what do symptoms of afib/aflutter depend on
ventricular rate
how long rhythm has been present
patient’s CV status
S/s of Afib & aflutter
see key features
what is Aflutter
a tachydysrhythmia that originates from a single ectopic focus -> re entry impulse is repetitive & cyclic
characteristics of aflutter
-ID by recurring regular, saw tooth shaped flutter waves
-R to R is regular or irregular
-atrial rate may be >250 bmp
-ventricular is lower than atrial bc not every impulse is getting to the ventrical
what are the waves called in between the QRS in aflutter
F waves
what causes aflutter
rarely occurs in a healthy heart
electrolyte imbalance
what is a big risk of being in aflutter
emboli formation
what is the goal of treating afib/aflutter
-control ventricular rate (priority)
-rhythm control
-prevent embolic stroke
what are the rate control drugs used for afib/aflutter
-beta blockers
-CCB (diltiazem, verapamil)
~digitalis
give IV first
what are the rhythm control drugs used for afib/aflutter
-amiodarone
-dofetilide
~digitalis
give IV first
drugs to prevent clots
warfarin
how to treat stable afib/aflutter
IV medications using a bolus then maintenance drip
how to treat unstable afib/aflutter
synchronized cardioversion
how to treat afib/aflutter that has been occurring for >48 hrs
put patient on anticoagulant for 3 to 4 weeks before cardioversion and for 3 to 4 weeks after successful cardioversion
what needs to be done before a cardioversion if the patient has a history of afib
perform an TEE to confirm there is no clots in the atrium
if treatment for afib/aflutter doesn’t work
long term use of anticoag is required (warfarin or new class)
what are the new class of anti coags
dabigatran, apixanabn, rivaroxaban, eboxaban
if you are on long term warfarin
have to monitor INR regularly
if you are on long term new class anti coag
routine testing not required but there is no antidote for the drug, cost & contraindicated for a pt w/ impaired renal function
what limits drug therapy for afib/aflutter
-high failure rates
-potential for drug toxicity
non pharmacology treatments for afib/aflutter
-catheter ablation
-maze procedure
both in cath lab
what does PSVT usually start with
a PAC
what is paroxysmal supraventricular tachycardia (PSVT)
originates in ectopic focus anywhere above bifurcation of bundle of his
characteristics of PSVT
-runs of repeated premature beats
-abrupt onset and termination (unless sustained and then it doesn’t terminate)
what causes PSVT
-overexertion
-emotional stress
-stimulants
-digitalis toxicity
-various forms of heart disease
what does symptoms of PSVT depend on
how long it lasts and how fast the ventricular rate is
S/s of PSVT
look at key features
how to treat PSVT (primary)
ensure they are connected to monitor
-valsalva/bear down (most effective)
-coughing
-carotid sinus massage (MD only)
-diving reflex/cold water immersion (rarely used)
what medications can be used to treat PSVT if primary treatment did not work
adenosine IVP to slow HR
adenosine facts
-very short half life so follow w/ rapid NS flush
-onset: 10 to 40 seconds, duration 1-2 mins
-may cause a pause (asystole) on rhythm strip, pt may be aware
if all treatments (primary & drug) treatment fail for PSVT and patient becomes hemodynamically unstable, what is the next best action
cardiovert the patient
