Atrial Dysrhythmias Flashcards by Stef Sis

what are the atrial dysrhythmias

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

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what is PAC

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

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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

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an increase in frequencies of PAC may indicate what

patient is about to convert to afib

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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

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how to treat benign PAC

do not need to treat

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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

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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

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can you live w/ afib

yes as long as ventricular rate is controlled

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what causes afib

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

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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

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what do symptoms of afib/aflutter depend on

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

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S/s of Afib & aflutter

see key features

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what is Aflutter

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

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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

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what are the waves called in between the QRS in aflutter

F waves

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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