Atrial Dysrhythmias

Question 1

what are the atrial dysrhythmias

Answer 1

-Afib
-Aflutter
-premature atrial contraction (PAC)
-paroxysmal supraventricular tachycardia (PSVT)

Question 2

what is PAC

Answer 2

ectopic pacemaker in atrium discharges before SA node fires, usually a one time beat
isolated premature atrial beat

Question 3

what causes a PAC

Answer 3

-usually benign but if new onset or increases in occurrence -> check electrolytes (mg, ca, k)
-stress
-caffeine or stimulants
-may indicate atrial pathology

Question 4

an increase in frequencies of PAC may indicate what

Answer 4

patient is about to convert to afib

Question 5

if you notice new onset of PACs, what is your next best nursing action

Answer 5

connect the provider b/c we can give meds to prevent them from converting to afib

Question 6

how to treat benign PAC

Answer 6

do not need to treat

Question 7

what is Afib

Answer 7

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

Question 8

characteristics of afib

Answer 8

-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

Question 9

can you live w/ afib

Answer 9

yes as long as ventricular rate is controlled

Question 10

what causes afib

Answer 10

person usually has underlying heart disease
-electrolyte imbalance
-hypoxia
-cardiac surgery

Question 11

main risk if a person if in afib

Answer 11

afib leads to a fibrillating atria -> pooling of blood -> clot formation -> risk for embolus -> can throw clot to the brain causing a stroke

Question 12

what do symptoms of afib/aflutter depend on

Answer 12

ventricular rate
how long rhythm has been present
patient’s CV status

Question 13

S/s of Afib & aflutter

Answer 13

see key features

Question 14

what is Aflutter

Answer 14

a tachydysrhythmia that originates from a single ectopic focus -> re entry impulse is repetitive & cyclic

Question 15

characteristics of aflutter

Answer 15

-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

Question 16

what are the waves called in between the QRS in aflutter

Answer 16

F waves

Question 17

what causes aflutter

Answer 17

rarely occurs in a healthy heart
electrolyte imbalance

Question 18

what is a big risk of being in aflutter

Answer 18

emboli formation

Question 19

what is the goal of treating afib/aflutter

Answer 19

-control ventricular rate (priority)
-rhythm control
-prevent embolic stroke

Question 20

what are the rate control drugs used for afib/aflutter

Answer 20

-beta blockers
-CCB (diltiazem, verapamil)
~digitalis
give IV first

Question 21

what are the rhythm control drugs used for afib/aflutter

Answer 21

-amiodarone
-dofetilide
~digitalis
give IV first

Question 22

drugs to prevent clots

Answer 22

warfarin

Question 23

how to treat stable afib/aflutter

Answer 23

IV medications using a bolus then maintenance drip

Question 24

how to treat unstable afib/aflutter

Answer 24

synchronized cardioversion

Question 25

how to treat afib/aflutter that has been occurring for >48 hrs

Answer 25

put patient on anticoagulant for 3 to 4 weeks before cardioversion and for 3 to 4 weeks after successful cardioversion

Question 26

what needs to be done before a cardioversion if the patient has a history of afib

Answer 26

perform an TEE to confirm there is no clots in the atrium

Question 27

if treatment for afib/aflutter doesn’t work

Answer 27

long term use of anticoag is required (warfarin or new class)

Question 28

what are the new class of anti coags

Answer 28

dabigatran, apixanabn, rivaroxaban, eboxaban

Question 29

if you are on long term warfarin

Answer 29

have to monitor INR regularly

Question 30

if you are on long term new class anti coag

Answer 30

routine testing not required but there is no antidote for the drug, cost & contraindicated for a pt w/ impaired renal function

Question 31

what limits drug therapy for afib/aflutter

Answer 31

-high failure rates
-potential for drug toxicity

Question 32

non pharmacology treatments for afib/aflutter

Answer 32

-catheter ablation
-maze procedure
both in cath lab

Question 33

what does PSVT usually start with

Answer 33

a PAC

Question 34

what is paroxysmal supraventricular tachycardia (PSVT)

Answer 34

originates in ectopic focus anywhere above bifurcation of bundle of his

Question 35

characteristics of PSVT

Answer 35

-runs of repeated premature beats
-abrupt onset and termination (unless sustained and then it doesn’t terminate)

Question 36

what causes PSVT

Answer 36

-overexertion
-emotional stress
-stimulants
-digitalis toxicity
-various forms of heart disease

Question 37

what does symptoms of PSVT depend on

Answer 37

how long it lasts and how fast the ventricular rate is

Question 38

S/s of PSVT

Answer 38

look at key features

Question 39

how to treat PSVT (primary)

Answer 39

ensure they are connected to monitor
-valsalva/bear down (most effective)
-coughing
-carotid sinus massage (MD only)
-diving reflex/cold water immersion (rarely used)

Question 40

what medications can be used to treat PSVT if primary treatment did not work

Answer 40

adenosine IVP to slow HR

Question 41

adenosine facts

Answer 41

-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

Question 42

if all treatments (primary & drug) treatment fail for PSVT and patient becomes hemodynamically unstable, what is the next best action

Answer 42

cardiovert the patient