Cardiac 2 Rhythms Flashcards
PSVT Treatment
Vagal Stimulation (Valsava, coughing, etc.)
Adenosine
Synchronized Cardioversion
PVC Treatment
Beta-blockers
Amiodarone
Lidocaine
PSVT Causes
Overexertion
Emotional Stress (EMO STRESS)
Stimulants (caffeine)
A-fib/ A-flutter Goals
Control ventricular rate
Rhythm Control
Prevent embolic stroke
A-fib/A-flutter Meds Rate Control
Metoprolol
diltiazem
Verapamil
Tele (White)
Below clavicle; mid-clavicular
Tele (Brown)
Right sternal border 4th ICS
Tele (Green)
Lower chest
Just above the right umbilicus
Tele (Black)
Below Clavicle
Mid-clavicular
Tele (Red)
Lower
Just above left to the umbilicus
Key features of tachydysrhythmias and bradydysrhythmias
Angina
restlessness
anxiety
confusion
dizziness
syncope
Palpitations
pulse deficit
SOA, tachypnea
Pulmonary crackles (LHF)
Orthopnea (LHF)
Orthostatic hypotension
S3 or S4 heart sounds (gallops)
JVD (RHF)
Weakness, fatigue
Pale, cool, in, diaphoresis
N/V
Decreased Urine Output
Delayed cap refill
Causes Sinus Bradycardia
Excessive vagal stimulation (carotid sinus massage, vomiting/gagging, Valsalva maneuvers, eyeball pressure, giving parasympathomimetic drugs)
Digitoxin Toxicity
Hyperkalemia (slow depolarization)
MI
Sinus Brady Treatment
Symptomatic
Atropine - 1mg q3-5 minutes, 3 mg MAX) increases HR
IF NOT that, a pacemaker
Pacemaker Malfunctions
Failure to sense: Does not sense depolarization
Failure to capture: Stimulation does not result in myocardial activation
Failure to pace: Doesn’t stimulate as expected
Pacemaker complications
Infection
Hematoma
Pneumothorax
Atrial/ventricular septum perforation
Lead misplacement
Post Op. Care of pacemaker
OOB
Limit arm and shoulder activity
Observe insertion site for bleeding and infection
Pt. teaching
Education r/t pacemakers
Follow-up appointments
Incision care
Arm Restrictions
Avoid direct blows, high output generator
No MRI but microwaves ok
Avoid antitheft devices
No traveling restrictions
Monitor pulse
Pacemaker and Medic Alert ID
Sinus Tachycardia Causes
Physical Activity
Anxiety
Pain
Stress
Fever
Anemia
Hypoxia
Dehydration/hypovolemia, MI, HF
Sinus Tachycardia TX
Fluid replacement
Analgesic
Anti-pyretic
Anxiolytic
Beta Adrenergic Blockers (decrease HR and myocardial O2 consumption
PAC causes
Stimulants
Electrolyte Imbalances
Stress
A-Fib
Multiple sources of signal firing (atrial kick isn’t effective)
Atrial > 400 bpm Ventricular =100-175
R-R interval = irregularly irregular
A-Fib Causes
Underlying heart disease
Electrolyte Imbalance
Hypoxia
Cardiac Surgery
A-fib complication
Stroke r/t emboli forming with blood sitting in the atrium
A-Flutter
Recurring, Regular r/t single source of impulse
R to R Interval = regular or irregular
Atrial >250 Ventricular Rate = slow
4 f waves:1 QRS complex
A-Flutter Causes
Electrolyte Imbalances
Heart Condition
A-Fib/ A-Flutter Tx
Ventricular rate control (B-blockers, CCB)
Rhythm Control (amiodarone, dofetilide)
Prevent Embolic Stroke (warfarin)
UNSTABLE = synchronized cardioversion
Maze Procedure/ Catheter Ablation
Synchronized Cardioversion Nursing Care
Maintain patent airway
Administer oxygen
VS and LOC
Monitor for dysrhythmias
Emotional support
Document results of cardioversion
Premature Ventricular Contractions
Contraction occur in the ventricle
Early before QRS complex
Widen QRS
“Ugly Lil Beats”
PVC causes
Electrolytes
Hypoxia
Exercises
Stimulants/Caffeine
CVD
Fever
Bigeminy
PVCs every other beat
Trigeminy
Every 3rd beat
Quadgeminy
Every 4th Beat
V-Tach
3 or more PVCs
Rate = 150-200
Regular rate
No p wave (there cannot measure PR interval)
CAD, MI, CAD, significant electrolyte imbalances, heart failure, drug toxicity
V-tach Tx
CHECK FOR A PULSE
Puleless? Defrib (ACLS)
Pulse? Cardiovert
TX THE CAUSE
Anti-Dysrhythmic Meds Beta blocker/ CCB/Amiodarone
V-Fib
Irregular Waveforms “quivering”
No effective contractions = NO CO
V-Fib Tx
CPR and ACLS (Defibrillation)
Defribillating Care
Emergency
NO CO
200-360 Joules
Unconscious
ECG monitor
First-Degree AV Heart Block
PROLONGED PR interval
Asymptomatic
Associated with increasing age, disease states, and certain drugs
1st Degree AV Heart Block TX
Monitor changes in heart rhythm
No specific tx
Second-Degree AV Block Type 1 (Mobitz I, Wenkebach)
Long Long Wekenbach
Ischemia
Well tolerated
2nd-Degree Type 1 Tx
Asymptomatic - Monitor
Symptomatic - Atropine and pacemaker
2nd-Degree, Type 2 (Mobitz II)
PR interval is =
QRS Complex dropped sometimes
Heart Disease and drug toxicity
Decreased CO
2nd-Degree, Type 2 Tx
Pacemaker (no ventricular response)
3rd-Degree Heart Block (Complete Heart Block)
The atrium and Ventricles are firing but no communication)
aka PURE CHAOS
Severe heart disease, some drugs, systemic diseases
Decreased CO, ischemia, HF, and Shock
Lead to syncope
3rd Degree TX
Pacemaker
Drugs that increase HR while waiting for pacing (positive chronotropes)
