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
