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Critical Care Test 2 > Cardiac Arrythmias > Flashcards

Cardiac Arrythmias Flashcards

1
Q

Normal path of impulse through nodes

A

SA node–> AV node–> Bundle of His–> Bundle branches–> Purkinje fibers

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2
Q

P wave patho

A

Atrial depolarization

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3
Q

QRS patho

A

ventricular depolarization

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4
Q

T wave patho

A

ventricular repolarization

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5
Q

PR patho

A

Atrial depolarization with a delay in AV junction

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6
Q

why is there a delay in the AV junction

A

allows time for the atria contract before the ventricles contract

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7
Q

pacemakers of the heart:

SA Node

A

dominant pacemaker rate.

60-100 bpm

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8
Q

Pacemakers of the heart:

AV node

A

back up pacemaker

40-60 bpm

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9
Q

Pacemakers of the heart:

Perkinje fibers

A

2nd back up pacemaker

20- 40 bpm

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10
Q

Normal sinus rhythm (NSR)

-where does impulse start

A

-impulse formed in the SA node

all rhythms that start this way are “normal”

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11
Q

NSR parameters

  • rate
  • regularity
  • P wave time
  • PR interval
  • QRS duration
A 
- 60-100
regular
normal, present
0.12-0.20
0.06-0.10
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12
Q

Arrythmias can arise from:

A
  • SA node
  • Atrial cells
  • AV junction
  • ventricular cells
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13
Q

SINUS Arrythmias

-type

A
  • Sinus bradycardia
  • Sinus tachycardia
  • sinus arrythmia (NOT TESTED)
  • Sinus arrest (not on test)
  • sinus block (not on test)
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14
Q

SA nodes Problems

  • fires too fast
  • fires too slow
A
  • -sinus tachycardia

- sinus bradycardia

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15
Q

Sinus Tachycardia

A

everything normal except rate between 101-150

*150 is max!

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16
Q

Sinus Tachycardia causes

A 
medications
fever
pain
anxiety
dehydration 
pulmonary embolus
CHF
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17
Q

Sinus tachycardia treatments

A

Make sure to treat the underlying cause

  • if fever give tylenol
  • if CHF give diuretic
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18
Q

Sinus bradycardia

A

everything normal except heart rate below 60

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19
Q

Sinus bradycardia causes

A

medications
athlete
brain injury

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20
Q

Sinus bradycardia treatment

-when to treat?

A

ONLY if symptomatic

  • chest pain
  • hypotension
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21
Q

Sinus bradycardia treatment

-order of treatment

A
  1. Atropine 0.5-3 mg
  2. Transcutaneous pacing
  3. Dopamine 2-10 mcg/kg/min
  4. Epinephrine 2-10 mcg/min
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22
Q

Types of ATRIAL arrythmias

A
  • atrial fibrillation
  • atrial flutter
  • supraventricular tachycardia
  • premature atrial contraction **this is an event, not a rhythm
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23
Q

Atrial arrhythmias

-Premature atrial contractions

A

atrial cells fire occasionally from a focus

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24
Q

Atrial arrythmias

-Atrial flutter

A

atrial cells fire continuously due to a loooing re-entrant circuit

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25
Atrail flutter patho
re-entrant circuit keeps looping around in the atria and finally makes it to the ventricles (looks like continuous waves and then bolts to a normal rhythm)
26
Artial arrythmias | -Atrial Fibrillation
-atrial cells can fire continuously from multiple foci or continuously due to multiple re-entrant "wavelets"
27
Atrial fibrillation patho
colliding wavelets generate fine choatic impulses. they in turn create new foci of activation (quick, short, jerky waves)
28
Atrial fibrillation - rhythm - p waves - PR interval - QRS - rate
``` ALWAYS IRREGUALR -no P waves, F waves -PR interval not measurable -normal QRS 60-100 ```
29
Atrial Flutter - rhythm - p waves - PR interval - QRS - rate
-regular or irregular -no p waves, **F waves are sawtooth -PR interval not measurable -normal QRS 60-100
30
Atrial Fibrillation causes
MI lung dz valvular heart dz hyperthyroidism
31
Atrial Fibrillation treatment
calcium channel blockers beta blockers digoxin anticoagulants
32
How do you treat Atrial fibrillation if the patient is Unstable?
CARDIOVERSION.
33
What is cardioversion
shocks patient when the ventricles contract--> sends them from atrial fibrlilation to NSR
34
what must you give the patient BEFORE cardioversion if they have been in atrial fibrillation for >48 hours?
Give anticoagulants to break up clots
35
Supraventricular Tachycardia (SVT)- - where - rate - rhythm - p waves - PR interval - QRS
- above the ventricles - 151-250 - regular - p waves hard to identify because beating so fast - PR
36
What is unique about Supraventricular Tachycardia
There is no other rhythm that beats >150 and has a normal QRS and rhythm
37
Supraventricular tachycardia (SVT) treatment
- vagal maneuvers - adenosine IVP with 10-20 ml of saline - adenosine 12 mg IVP with 10-20 ml of saline - Cardiversion (50-100 J)
38
when you give pt's beta blockers and CCBs, what effect does it have on the heart?
These SLOW down the RATE, but do not covert the rhythm to NSR
39
What must you give to a patient when performing cardioversion?
SEDATION meds, (Versed 1-2mg)
40
Vagal maneuvers
Cough, bare down, suction
41
How does adenosine affect the heart?
makes them flat line for
42
3 Early Beats
1) Premature atrial contraction (PAC) 2) Premature Junctional Contraction (PJC) 3) Premature Ventricular contraction (PVC) * these are 1-2 beats, not rhythms
43
Premature atrial contraction (PAC) - causes - treatement
- normal. | - decrease caffeine intake
44
Premature Junctional Contraction (PJC) - causes - treatment
- Digoxin toxicity | - HOLD the digoxin
45
Premature Ventricular contraction (PVC) - causes - treatment
- heart disease, hypokalemia, hypoxia | - give AMIODARONE (anti-arrhythmic)
46
PAC wave differences - p wave - QRS
P wave present | normal QRS
47
PJC wave differences - p wave - QRS
- p wave inverted or absent | - normal QRS
48
PVC wave differences - p wave - QRS
- NO p wave | - wide QRS
49
Junctional Arrhythmias
1) Junctional rhythm 2) Accelerated Junctional Rhythm 3) Premature Junctional Contraction PJC
50
where does the Junctional arrhythmia originate
the AV node (backup pacemaker)
51
Junctional Rhythm - p wave - QRS - rate
- absent, inverted, or after QRS - normal QRS - 40-60 bpm
52
Accelerated Jinctional rhythm - p wave - QRS - rate
- absent, inverted, after QRS - normal QRS - 61-100
53
Causes of Junctional arrhythmias
DIGOXIN TOXICITY - SA node ischemia - myocarditis - valvular heart disease - MI
54
Treatement of Junctional arrhythmias
Hold the DIG - if symptomatic from bradycardia: - - give atropine
55
Bundle branch block - cause - change seen in strip
- result of heart disease - QRS >0.10 sec * * always an underlying rhythm
56
Bundle Branch block treatment
NO treatment
57
1st degree AV block | -pathophysiology
prolonged conduction delay in the AV node or Bundle of His * always an underlying rhythm
58
1st degree AV block | -PR interval
>0.20 seconds
59
1st degree AV block | -causes
- AV node ischemia - age related changes in heart - digoxin toxicity - side effects from BB or CCB
60
1st degree AV block | -S/S
patients are NOT symptomatic
61
1st degree AV block | -treatement
treat underlying cause if possible
62
2nd and 3rd degree AV block - rhythm - p waves
- **NO UNDERLYING RHYTHM | - ** MORE P waves than QRS complexes
63
2nd Degree AV Block Type 1: - also known as - pathophys
Mobits 1 or Wenckeback - each atrial impulse ecounters a longer and longer delay in the AV node until one impulse (usually the 3rd or the 4th) fails to make it through the AV node
64
2nd Degree AV Block Type 1: | -change from NRS
- PR interval lengthens until p wave not followed by a QRS | * * Rhythm always IRREGULAR
65
2nd Degree Block type 2: | -pathophys
condunction is all or nothing (no prolonged PR interval) | -blocks typically occur in the Bundle of His
66
2nd Degree Block type 2: | -change from NSR
P wave NOT followed by QRS PR interval always constant rhythm regular or irregular
67
3rd Degree AV block | -pathophys
there is a complete block of conduction in the AV node, so the atria and ventricles form impulses independently of each other -without the impulses from the atria, the ventricles' own intrinsic pacemaker kicks in around 30-45 bpm
68
3rd Degree AV block | -change from NSR
- p waves completely blocked | - no relationship between QRS and p waves
69
Interpreting AV blocks: | what does it mean if there a p waves "kissing" without a QRS inbetween them?
it is a 2nd or 3rd degree block!
70
Can P's Kiss? | -STEP 1
measure PR intervals for the entire strip 1) constant: 2nd degree block type 2 2) variable: need to go to step 2
71
Can P's Kiss? | -STEP 2
check regularity of the rhythm from R-R complexes 1) Regular: third degree block 2) Irregular: 2nd degree block type 2
72
Idioventricular Rhythm - originates where - rate - rhythm - P waves - QRS
- in the ventricles - 20-40 - regular - NO P WAVES - WIDE AND BIZARRE QRS
73
Idioventricular Rhythm - cause - treatment
-massive cardiac damage or hypoxia -bradycardia treatment -
74
Accelerated Idioventricular Rhythm - originates - rate - rhythm - P waves - QRS
-ventricles with a HR faster than ventricular rate -41-100 regular rhythm -NP P WAVES -WIDE AND BIZZARE QRS
75
Accelerated dioventricular Rhythm - cause - treatment
- massive cardiac damage or hypoxia | - bradycardia treatment
76
Ventricle cell problems | 1) PVC
cells fire occassionaly from 1 or more foci
77
Ventricle cell problems | 2) Ventricualr fibrillation
cells fire continuously from multiple foci
78
Ventricle cell problems | 3) Ventricular tachycardia
fire continuously due to a looping re-enternt circuit
79
Ventricular tachycardia - rate - rhythm - p wave - qrs
- >100 - regular - NO P WAVES - WIDE QRS
80
Ventricular tachycardia | -cause
myocardial irritability - HF - MI - Electrolyte imbalance - rewarming during hypothermia
81
Ventricualar tachycardia | -treatment WITH A PULSE
Amiodarone 150 mg over 10 min | or synchronized cardioversion
82
Ventricular tachycardia | -treatment WITHOUT A PULSE
- CPR - defibrillation (200 J) - Epi 1 mg during CPR - Amiodarone - Epi or vasopressors
83
Whats the first thing you should do when you see a pt with V-tachy
check for a pulse!
84
Torsades de Pointes - what is it - rate - rhythm - P waves - QRS
- form of V-tachycardia - >200 - regular or irregular - NO P waves - WIDE QRS
85
treatment for Torsades de Pointes
usually caused by low Magnesium, so treat it with 1-2 gram IV Magnesium
86
Torsades de Pointes: | -treatment for UNCONSCIOUS PT
ONLY rhythm that you can use DEFIBRILLATION WITH A PULSE
87
Ventricular Fibrillation | -patho
ventricles wiggle instead of contract
88
Ventricular Fibrillation - rate - rhythm - p waves - QRS
- cant determine rate, rhythm no p waves no QRS- just wavey, spiked baseline
89
Ventricular Fibrillation | -cause
``` caused by the same as V-tach: myocardial irritability -HF -MI -Electrolyte imbalance -rewarming during hypothermia ``` Also near drowning, drug overdose, accidental shock
90
Does V-fib ever have a pulse?
NO!
91
Treatment for V-fib
- CPR - Defib - Epi or vasopressin - defib - amiodarone 300 mg - epi - amiodarone 150 mg
92
Asystole | -pathophys
ALL pacemakers of the heart have failed! | absense of electrical activity
93
Asystole | -causes:
H's and T's
94
H's
``` -hypovolemia hypoxia hydrogen ion (acidosis) hyp/hyperkalemia hypothermia ```
95
T's
Tension pneumothorax - tamponade - toxins - thrombosis
96
Asystole | -treatment
Reverse the H & Ts | cardiac arrest guidelines
97
Pulseless Electricle Activity (PEA) | -pathophys
there is electrical activity but NO MECHANICAL activity
98
PEA - rhythm - pulse - cause - tx
- any rhythm - NO PULSE - caused by H & T - tx same as asystole
99
Immediate Post Cardiac Arrest Care
1) Oxygenation/intubation | 2) treat hypotension
100
Hypothermic protocol | -rational
only txt that improves neurological functioning
101
Hypothermic protocol | -effect on body
stops metabolic demand | stunts inflammatory process
102
methods for inducing hypothermia | -invasive
foley catheter NG central line
103
methods for inducing hypothermia | -non- invasive
ice packs cooling blanket environmental temp
104
what must you give when inducing hypothermia
PARALYTIC SEDATION PAIN MED
105
Paced rhythm: | 1) atrial paced rhythm
Spike BEFORE p wave
106
Paced rhythm: | 2) Venticular paced rhythm
spike BEFORE QRS
107
paced rhythm: | 3) atrial and ventricular
spike BEFORE p and QRS
108
paced rhtyhm: - failure to capture - tx
pacer spikes NOT followed by a P wave or QRS | - increase output setting
109
paced rhythm - failure to sense - tx
pacemaker spikes too closely behind QRS complex - not sensing the heart beat - increase sensitivity

Critical Care Test 2 (6 decks)

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