Cardiac Arrhythmias Flashcards
Sinus Brady
Sinus Brady Causes
Can occur in response to parasympathetic nerve stimulation and certain drugs
Also associated with some disease states
(Normal rhythm in aerobically trained athletes and during sleep)
Sinus Brady Manifestations
Hypotension
Pale, cool skin
Weakness
Angina
Dizziness or syncope
Confusion or disorientation
Shortness of breath
Sinus Brady Treaments
Stop offending drugs
IV Atropine
Pacemaker
Dopamine or epinephrine infusion
Sinus Tachy
Sinus Tachy causes
Caused by vagal inhibition or sympathetic stimulation
Associated with physiologic and psychologic stressors
Drugs can increase rate
Manifestations of Sinus Tachy
Dizziness
Dyspnea
Hypotension
Angina in patients with CAD
Sinus Tachy treatment
Guided by cause (e.g., treat pain)
Vagal maneuver
β-blockers, adenosine, or calcium channel blockers
Synchronized cardioversion
A patient’s cardiac rhythm is sinus bradycardia with a heart rate of 34 beats/min. If the bradycardia is symptomatic, the nurse would expect the patient to exhibit:
Palpitations.
Hypertension.
Warm, flushed skin.
Shortness of breath.
SOB
Premature Atrial Contraction (1 of 4)
What is PAC?
Contraction starting from ectopic focus in atrium in location other than SA node
Travels across atria by abnormal pathway, creating distorted P wave
May be stopped, delayed, or conducted normally at the AV node
Premature Atrial Contraction Causes
Emotional stress
Physical fatigue
Caffeine
Tobacco
Alcohol
Hypoxia
Electrolyte imbalances
Disease states
PAC Manifestations
Palpitations
Heart “skips a beat”
Paroxysmal Supraventricular Tachycardia (PSVT) (1 of 4)
PSVT def
Reentrant phenomenon: PAC triggers a run of repeated premature beats
Paroxysmal refers to an abrupt onset and ending
Associated with overexertion, stress, deep inspiration, stimulants, disease, digitalis toxicity
PSVT Manifestations
Manifestations
HR is 151 to 220 beats/min
HR greater than 180 leads to decreased cardiac output and stroke volume
Hypotension
Palpitations
Dyspnea
Angina
PSVT Treatment
Vagal stimulation
IV adenosine
IV β-blockers
Calcium channel blockers
Synchronized cardioversion
Pulse pressure of Pt
SBP - DBP = 40 or greater
If pulse pressure is less than 40
Pt has decreased cardiac output
If pulse pressure greater than 60
Cause due to atherosclerosis
Propertis of cell:
Automaticity = Potassium in/out
Excitability = to electrically stimulate
Contractility = mechanically to impulse
Conductivity = Mechanical
SA node (Pacemaker) > AV node (Gatekeeper) > Bundle of HIS > Purkinje fibers of heart
Slide#4
ST segnment Repolarization
Depolarization
Contraction
Repolarization
Relaxation
EKG Placement
1 Pulse = PQRST
1 small box = 0.04
5 boxes = 0.2
1 stip = 6 sconds
Count HR by counting the R waves and x 10
Slide#18
SA node, AV node = working good.
Slide#19
SNB
IV Atropine for Bradycardia
Give Dopamine to increase BP
Slide #25
SNT = 140 = HR
Slide#27
Dizziness
Dyspnea
Hypotension
Angina in CAD
Slide# 33
SVT is
150 bpm to 200 bpm and above
Causes of SVT
Stress/ Exersion/ Stimulant. Dig toxicity
With SVT
Cannot breathe anymore
Cardiac do not have enough o/p
Slide# 36
Treatment SVT
Vagal Stimulation
Adenosine
Beta blockers
Calcium Channel Blocker
Synchronized Cardioversion
Verpamil short hald life
Inject fast and raise hand immediately
Atrial Flutter
Flutter is saw tooth
CAD give
- Beta blockers : metoprolol not converting then develop thrombosis so give
Heparin or Coumadin - Cardioversion
- Ablation
Atrial fibrillation no P waves
P undistinguishable
QRS not equal
too many Ps cannot identify Ps
but can be regular in between
Treatment of a-fib
give anticoagulant (develop thrombosis)
cardioverson
RFA (Radio Frequency Ablation)
Cardiac Monitoring
ROSC first identified monitor them by
EKG, count pulse
a-fib question select
administer oxygen, IV access, monitor VS, ask hx before
Identify ROSC what you have to do
EKG, Oxygen, anticoagulants, IV establish, medication , Teaching Pt.
Slide $49
AV block 1
more than 0.12 - 0.20 PQ segment or P to Q distance
Second degree HB
Progressive P
smaller-long-longer QRS dropped.
Second deg HB give Morbitz 1 or Wenkcheback
Atropine (1) + Pace Maker (2) + EKG
Second degree Morbitz 2
7 Ps seen and 5 QRS waver…PR interval consistent = but drops QRS in between with R irregular
Morbitc type 2 associated with
Drug Toxicity
Heart Block
Slide #55 : Final Examination
3rd degree HB
P no association with QRS
P regular and QRS regular
PR interval independent
3rd degree HB s/s
decreased cardiac o/p > ischemia > develops shock.
Ventricular Tachycardia
Lethal monomorphic
single firing site
Pacemaker not firing that is SA node not firing and AV node not firing = no pulse
this can kill a patient
Beats in v-tach
200 - 280
Only ventricles are functioning
w/o pulse
QRS waves are wide.
Slide#65
Torsades de Pointe
different sizes
long QT, stable or unstable with pulseless ?
Slide # 66
v-fib
give amiodrone
pulseless = pumping + defib
v-tach cause is because
Hypoxia
CPR
Slide #68
V-fib pt. dies
Give epinephrine for pulseless
Amiodarone
Slide#69
SVT know meds