Cardiac Arrhythmias Flashcards
ECG, Pacemakers, Aneurysms, Heart Diseases & Treatment
What is the purpose of ECG/telemetry & how does it work?
Purpose:
- Monitor arrhythmias or potential myocardial ischemia, injury, or infarction
- Cardiac effects from electrolyte disturbances
- Effects of antiarrhythmic medications
How It Works:
- Electrodes securely & correctly placed on chest
What is meant by “different leads” when referring to telemetry?
Different leads provide different visualizations of the heart.
(i.e. Atrial or ventricular depolarization)
Pacemaker
Pace the heart to control irregular heart rhythms
Implantable Cardioverter Defibrillator (ICD)
Detects & prevents VT & VF by delivering an electrical shock to restore normal heartbeat
Possible Complications of Pacemakers & ICDs
- Lead dislodgement or fracture
- Infection
- Bleeding, hematoma
- Pneumothorax, hemothorax
Pacemaker: Nursing Implications & Patient Teaching *
- Avoid magnetic fields, metal
- Change electrodes, battery, generator
ICD: Nursing Implications
- CXR to document lead position & no pneumothorax
- Heart rate & rhythm monitored on ECG
- Assess cardiac output & hemodynamic stability
- Assess site for bleeding, hematoma, or infection
- Assess device function
- Assess for anxiety, depression, or anger (ineffective coping with ICD)
- Defibrillation life vest worn prior to ICD
ICD: Patient Teaching
- No driving until healed
- Wear sling, avoid lifting
- No phone on affected side, avoid electrical/magnetic fields
- Be aware of “shock”
- Lasts 5-10 years
Cardioversion
- Synchronized shock with patient’s ECG (QRS) to treat tachydysrhythmias
- Pulse but hemodynamically unstable
Defibrillation
- For emergency
- Terminates V-Fib & pulseless V-Tach
Ablation
Destroys cells that cause arrhythmia, performed most often for A-Fib
Sinus Bradycardia (Symptomatic): Treatment
- Atropine (increase HR)
- Isoproterenol (Isuprel); (increase BP)
Severe: pacemaker, cardioversion
Other: Dopamine, epinephrine
Atrial Fibrillation: Treatment
- Drugs for rate control:
- Digoxin
- Beta-adrenergic blockers
- Calcium channel blockers - Long-term anticoagulation: Coumadin (Warfarin)
- Convert to sinus rhythm:
- Antiarrhythmics: Amiodarone, Propafenone
- Cardioversion - A-Fib > 48 hrs → Anticoag therapy w/ warfarin 3-4 weeks before cardioversion, 4-6 weeks after successful cardioversion
-
Radiofrequency catheter ablation
- Cold (cryoablation)
- Heat (high-intensity ultrasound)
Ventricular Tachycardia (with or without pulse): Treatment
V-Tach with pulse
- Amiodarone (antiarrhythmic)
- Adenosine (antiarrhythmic, lowers HR)
- Verapamil (Ca+ blocker)
- Cardioversion
V-Tach without pulse
- Defibrillation
- CPR
Ventricular Fibrillation: Treatment
- Epinephrine
- Amiodarone
- Lidocaine
- Defibrillation
- AED, CPR
Most common dysrhythmia among elderly? Common side effect?
Atrial Fibrillation
Heart failure, MI, embolic events (stroke)
First medication given with V-Fib after unsuccessful defibrillation?
Epinephrine
Patient education for being discharged on propranolol
- Decreases HR & BP, prevents MI
- Suppresses dysrhythmia
- Taper off, abrupt withdrawal may cause life-threatening arrhythmias, HTN, or MI
- Orthostatic hypotension
How do you monitor a patient on an amiodarone drip?
- Monitor ECG, HR & rhythm
- Report bradycardia or worsening of arrhythmias
- Assess respiratory status
- Pulmonary toxicity, ARDS, hepatotoxicity
Risk Factors for an Abdominal or Thoracic Aneurysm & Rupture
Both: Atherosclerosis
Thoracic: Men 50-70 yrs
Abdominal: Elderly white men
Rupture: HTN, Nicotine use, genetic predisposition
Identify when a patient is at risk for an aneurysm rupture. S/Sx?
- Tobacco use
- Hypertension
- Genetic predisposition
- “Feel heart beating in abdomen” when lying supine
- Abdominal mass, edema
- Cyanosis
- Pulsatile mass (80% palpable) + Bruit
Identify how antibiotics are selected for endocarditis.
- Blood cultures to identify agent
- Based on S/Sx & echo
How to prevent rheumatic heart disease?
- Treat strep throat
- Antibiotic prophylaxis before procedures
- Ongoing oral hygiene
- Immunizations
Viral Myocarditis S/Sx
- Asymptomatic or flu-like symptoms
- Fatigue, dyspnea, syncope
- Palpitations, chest pain/discomfort
- Elevated WBC, CRP, ESR, leukocytes
Complications: Cardiomyopathy, HF
Antibiotic most widely prescribed before dental procedures for a patient with Hx of rheumatic heart disease
Amoxicillin (or penicillin)
Pericarditis S/Sx
- Asymptomatic
- Angina (with inspiration, lying down or turning)
- Creaky or scratchy friction rub at left lower sternal border
- Mild fever, anemia
- Elevated WBC, ESR, CRP
- Nonproductive cough or hiccup
- Dyspnea
- Complications: HF, pericardial effusion, cardiac tamponade
