Atrial Dysrhythmias pt.1 (Exam 2) Flashcards
Atrial Dysrhythmias
Premature atrial contraction (PAC)
Atrial fibrillation
Atrial flutter
Paroxysmal supraventricular tachycardia (PSVT)
Premature Atrial Contraction
Isolated premature atrial beat
One time early discharge of ectopic beat outside of the SA node
What causes PAC’s?
Usually benign
ELETRYOLYTES
Stress
Cardiac stimulants (caffeine)
May indicate atrial pathology
-Pre-cursor to afib
When seeing new onset PAC’s or they are increasing in frequency
CHECK ELECTROLYTES
mag - calc - potassium
Increasing frequency of PAC’s may be an indication
that the patient is about to convert to a-fib
What will the patient look like with PAC’s and how do we treat them?
Begin = do not do anything
Pathologic = treat as if they are in A-fib
Atrial Fibrillation
Total disorganization of atrial electrical activity due to multiple ectopic foci, resulting in loss of effective atrial contraction
Atrial rate > 400 bpm
Ventricular rate 100-175 bpm
R to R = irregularly irregular
Is the SA node in charge in A fib?
No
The SA node is taken over by all the other irritable foci in the atrium that want to be the pacemaker
What is the most common dysrhythmia?
Atrial Fibrillation
Prevalence of afib increases with
age
T/F: A person can live with atrial fibrillation?
Yes because what really matter in the ventricular rate (powerhouse)
Ventricular rate has to be controlled
What causes Atrial Fibrillation?
Occurs with underlying heart disease
Electrolyte imbalance
Hypoxia
Cardiac surgery
Atrial Fibrillation is a problem because
Atria is not contracting properly so pooling of blood happens
This pooling of blood leads to clot formation
Increase risk for embolus
STROKE
What will a patient with atrial fibrillation look like?
Depends on ventricular rate, how long rhythm has been present, and the patients CV status
Typically, onset is FAST - so s/s are those of tachydysrhythmia
Atrial Flutter
Atrial tachydysrhythmias identified by recurring, regular, saw-tooth-shaped flutter waves
Originates from a SINGLE ectopic focus; reentry impulse is repetitive and cyclic
R to R interval is regular or irregular
Atrial rate may be >250
Ventricular rate slower
Does atrial flutter originate from multiple or a single ectopic focus
a single
Does atrial fibrillation originate from multiple or a single ectopic focus?
multiple
The sawtooth waves we see in atrial flutter are
F waves
What causes Atrial Flutter?
Rarely occurs in healthy heart = underlying heart condition
Electrolyte imbalance
What will a patient with atrial flutter look like?
Depends on ventricular rate, how long rhythm has been present, and the patients CV status
Typically, onset is FAST rate- so s/s are those of tachydysrhythmia
T/F are patient with atrial flutter at risk for emobli?
True
Both patient with atrial flutter and atrial fibrillation are at risk
Atrial Fib / Flutter: How do we treat?
Goal = Ventricular rate control
Rhythm control
Prevent embolic stroke
Rate control drugs for Atrial Fib / Flutter
B-adrenergic blockers (metoprolol)
Calcium channel blockers (diltiazem - verapamil)
initially IV route
Rhythm control drugs for atrial fib / flutter
Amiodarone
doFETilide
initially IV route
What is priority for atrial fib / flutter, rate or rhythm?
Rate takes priority
Patient with atrial fibrillation or flutter that is stable, but symptomatic
Slow ventricular rate with IV
CCB or Beta blocker or Digitalis or Amiodarone
Start bolus and a drip
If patient with atrial fibrillation or flutter is unstable and hemodynamically compromised
Synchronized cardioversion (life pack)
Synchronized Cardioversion
Choice of therapy for hemodynamically unstable supraventricular tachydysrhythmias
Synchronize circuit delivers a countershock on the R wave of the QRS complex of the ECG
Synchronizer switch must be turned ON
Anytime we have a hemodynamically unstable patient with a tachy dysrhythmias that originated above ventricle, we treat with
Synchronized cardioversion
In order to cardiovert a patient, the patient must have a
R wave in the QRS complex
Synchronized cardioversion nonemergency
The patient is sedated before the procedure
Synchronized cardioversion is started with
initial energy at 50 to 100 joules: increased if needed
Before discharging cardioversion
Be sure that all personnel are all clear
No one touching bed
If patient becomes pulseless loss after cardioversion
Turn the synchronizer switch off (loss of R wave) and perform defibrillation
Cardioversion: Nursing care
Maintain patent airway
Administer oxygen
Assess V.S and LOC
Monitor for dysrhythmias
Provide emotional support
Document result of cardioversion
If patient has a-fib for > 48 hours
Anticoagulation therapy with warfarin is recommended for 3 to 4 weeks before cardioversion and for 3 to 4 weeks after successful cardioversion
Before cardioverting somewith a-fib/flutter a _____ may be performed to make sure no clots are in the atrium
TEE
In emergent cardioverion a
low-molecular weight heparin or heparin drip will be initiated
If treatment for a fib/flutter doesn’t work then
long term anticoagulation is required (warfarin)
Alternative anticoag drugs:
-dabigatran-apixaban twice daily
-ribaroxaban, eboxaban once daily
Disadvantage of using warfarin with long term treatment of afib / flutter
Have to monitor INR regularly
Alternative anticoag drugs for patients with non-vlavular afib
dabigatran, apixaban = twice daily
rivaroxaban, eboxaban = once daily
Advantage and disadvantage of alternative long term drug therapy for afib / aflutter
Advantage:
Do not require routine lab testing
Disadvantage:
Cost more than once daily dosing and contraindicated with impaired renal function
Non pharmacologic treatments for Afib and Aflutter
Catheter ablation
-radiofrequency or cryothermal therapy
Maze procedure
Catheter Ablation
Invasive procedure that destroys a irritable focus causing the dysrhythmias
Must undergo EP studies and mapping procedures to locate the focus
Maze procedure
Surgical procedure consist of creating incisions in atrium to disrupt the circuits that creates a one way path from the SA node to the AV node
