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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
Q

Atrail flutter patho

A

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)

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26
Q

Artial arrythmias

-Atrial Fibrillation

A

-atrial cells can fire continuously from multiple foci or continuously due to multiple re-entrant “wavelets”

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27
Q

Atrial fibrillation patho

A

colliding wavelets generate fine choatic impulses. they in turn create new foci of activation (quick, short, jerky waves)

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28
Q

Atrial fibrillation

  • rhythm
  • p waves
  • PR interval
  • QRS
  • rate
A 
ALWAYS IRREGUALR
-no P waves, F waves
-PR interval not measurable
-normal QRS 
60-100
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29
Q

Atrial Flutter

  • rhythm
  • p waves
  • PR interval
  • QRS
  • rate
A

-regular or irregular
-no p waves, **F waves are sawtooth
-PR interval not measurable
-normal QRS
60-100

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30
Q

Atrial Fibrillation causes

A

MI
lung dz
valvular heart dz
hyperthyroidism

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31
Q

Atrial Fibrillation treatment

A

calcium channel blockers
beta blockers
digoxin
anticoagulants

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32
Q

How do you treat Atrial fibrillation if the patient is Unstable?

A

CARDIOVERSION.

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33
Q

What is cardioversion

A

shocks patient when the ventricles contract–> sends them from atrial fibrlilation to NSR

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34
Q

what must you give the patient BEFORE cardioversion if they have been in atrial fibrillation for >48 hours?

A

Give anticoagulants to break up clots

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35
Q

Supraventricular Tachycardia (SVT)-

  • where
  • rate
  • rhythm
  • p waves
  • PR interval
  • QRS
A
  • above the ventricles
  • 151-250
  • regular
  • p waves hard to identify because beating so fast
  • PR
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36
Q

What is unique about Supraventricular Tachycardia

A

There is no other rhythm that beats >150 and has a normal QRS and rhythm

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37
Q

Supraventricular tachycardia (SVT) treatment

A
  • vagal maneuvers
  • adenosine IVP with 10-20 ml of saline
  • adenosine 12 mg IVP with 10-20 ml of saline
  • Cardiversion (50-100 J)
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38
Q

when you give pt’s beta blockers and CCBs, what effect does it have on the heart?

A

These SLOW down the RATE, but do not covert the rhythm to NSR

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39
Q

What must you give to a patient when performing cardioversion?

A

SEDATION meds, (Versed 1-2mg)

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40
Q

Vagal maneuvers

A

Cough, bare down, suction

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41
Q

How does adenosine affect the heart?

A

makes them flat line for

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42
Q

3 Early Beats

A

1) Premature atrial contraction (PAC)
2) Premature Junctional Contraction (PJC)
3) Premature Ventricular contraction (PVC)

  • these are 1-2 beats, not rhythms
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43
Q

Premature atrial contraction (PAC)

  • causes
  • treatement
A
  • normal.

- decrease caffeine intake

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44
Q

Premature Junctional Contraction (PJC)

  • causes
  • treatment
A
  • Digoxin toxicity

- HOLD the digoxin

45
Q

Premature Ventricular contraction (PVC)

  • causes
  • treatment
A
  • heart disease, hypokalemia, hypoxia

- give AMIODARONE (anti-arrhythmic)

46
Q

PAC wave differences

  • p wave
  • QRS
A

P wave present

normal QRS

47
Q

PJC wave differences

  • p wave
  • QRS
A
  • p wave inverted or absent

- normal QRS

48
Q

PVC wave differences

  • p wave
  • QRS
A
  • NO p wave

- wide QRS

49
Q

Junctional Arrhythmias

A

1) Junctional rhythm
2) Accelerated Junctional Rhythm
3) Premature Junctional Contraction PJC

50
Q

where does the Junctional arrhythmia originate

A

the AV node (backup pacemaker)

51
Q

Junctional Rhythm

  • p wave
  • QRS
  • rate
A
  • absent, inverted, or after QRS
  • normal QRS
  • 40-60 bpm
52
Q

Accelerated Jinctional rhythm

  • p wave
  • QRS
  • rate
A
  • absent, inverted, after QRS
  • normal QRS
  • 61-100
53
Q

Causes of Junctional arrhythmias

A

DIGOXIN TOXICITY

  • SA node ischemia
  • myocarditis
  • valvular heart disease
  • MI
54
Q

Treatement of Junctional arrhythmias

A

Hold the DIG

  • if symptomatic from bradycardia:
    - - give atropine
55
Q

Bundle branch block

  • cause
  • change seen in strip
A
  • result of heart disease
  • QRS >0.10 sec
    • always an underlying rhythm
56
Q

Bundle Branch block treatment

A

NO treatment

57
Q

1st degree AV block

-pathophysiology

A

prolonged conduction delay in the AV node or Bundle of His

  • always an underlying rhythm
58
Q

1st degree AV block

-PR interval

A

> 0.20 seconds

59
Q

1st degree AV block

-causes

A
  • AV node ischemia
  • age related changes in heart
  • digoxin toxicity
  • side effects from BB or CCB
60
Q

1st degree AV block

-S/S

A

patients are NOT symptomatic

61
Q

1st degree AV block

-treatement

A

treat underlying cause if possible

62
Q

2nd and 3rd degree AV block

  • rhythm
  • p waves
A
  • **NO UNDERLYING RHYTHM

- ** MORE P waves than QRS complexes

63
Q

2nd Degree AV Block Type 1:

  • also known as
  • pathophys
A

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
Q

2nd Degree AV Block Type 1:

-change from NRS

A
  • PR interval lengthens until p wave not followed by a QRS

* * Rhythm always IRREGULAR

65
Q

2nd Degree Block type 2:

-pathophys

A

condunction is all or nothing (no prolonged PR interval)

-blocks typically occur in the Bundle of His

66
Q

2nd Degree Block type 2:

-change from NSR

A

P wave NOT followed by QRS
PR interval always constant
rhythm regular or irregular

67
Q

3rd Degree AV block

-pathophys

A

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
Q

3rd Degree AV block

-change from NSR

A
  • p waves completely blocked

- no relationship between QRS and p waves

69
Q

Interpreting AV blocks:

what does it mean if there a p waves “kissing” without a QRS inbetween them?

A

it is a 2nd or 3rd degree block!

70
Q

Can P’s Kiss?

-STEP 1

A

measure PR intervals for the entire strip

1) constant: 2nd degree block type 2
2) variable: need to go to step 2

71
Q

Can P’s Kiss?

-STEP 2

A

check regularity of the rhythm from R-R complexes

1) Regular: third degree block
2) Irregular: 2nd degree block type 2

72
Q

Idioventricular Rhythm

  • originates where
  • rate
  • rhythm
  • P waves
  • QRS
A
  • in the ventricles
  • 20-40
  • regular
  • NO P WAVES
  • WIDE AND BIZARRE QRS
73
Q

Idioventricular Rhythm

  • cause
  • treatment
A

-massive cardiac damage or hypoxia
-bradycardia treatment
-

74
Q

Accelerated Idioventricular Rhythm

  • originates
  • rate
  • rhythm
  • P waves
  • QRS
A

-ventricles with a HR faster than ventricular rate
-41-100
regular rhythm
-NP P WAVES
-WIDE AND BIZZARE QRS

75
Q

Accelerated dioventricular Rhythm

  • cause
  • treatment
A
  • massive cardiac damage or hypoxia

- bradycardia treatment

76
Q

Ventricle cell problems

1) PVC

A

cells fire occassionaly from 1 or more foci

77
Q

Ventricle cell problems

2) Ventricualr fibrillation

A

cells fire continuously from multiple foci

78
Q

Ventricle cell problems

3) Ventricular tachycardia

A

fire continuously due to a looping re-enternt circuit

79
Q

Ventricular tachycardia

  • rate
  • rhythm
  • p wave
  • qrs
A
  • > 100
  • regular
  • NO P WAVES
  • WIDE QRS
80
Q

Ventricular tachycardia

-cause

A

myocardial irritability

  • HF
  • MI
  • Electrolyte imbalance
  • rewarming during hypothermia
81
Q

Ventricualar tachycardia

-treatment WITH A PULSE

A

Amiodarone 150 mg over 10 min

or synchronized cardioversion

82
Q

Ventricular tachycardia

-treatment WITHOUT A PULSE

A
  • CPR
  • defibrillation (200 J)
  • Epi 1 mg during CPR
  • Amiodarone
  • Epi or vasopressors
83
Q

Whats the first thing you should do when you see a pt with V-tachy

A

check for a pulse!

84
Q

Torsades de Pointes

  • what is it
  • rate
  • rhythm
  • P waves
  • QRS
A
  • form of V-tachycardia
  • > 200
  • regular or irregular
  • NO P waves
  • WIDE QRS
85
Q

treatment for Torsades de Pointes

A

usually caused by low Magnesium, so treat it with 1-2 gram IV Magnesium

86
Q

Torsades de Pointes:

-treatment for UNCONSCIOUS PT

A

ONLY rhythm that you can use DEFIBRILLATION WITH A PULSE

87
Q

Ventricular Fibrillation

-patho

A

ventricles wiggle instead of contract

88
Q

Ventricular Fibrillation

  • rate
  • rhythm
  • p waves
  • QRS
A
  • cant determine rate, rhythm
    no p waves
    no QRS- just wavey, spiked baseline
89
Q

Ventricular Fibrillation

-cause

A 
caused by the same as V-tach:
myocardial irritability
-HF
-MI
-Electrolyte imbalance
-rewarming during hypothermia

Also near drowning, drug overdose, accidental shock

90
Q

Does V-fib ever have a pulse?

A

NO!

91
Q

Treatment for V-fib

A
  • CPR
  • Defib
  • Epi or vasopressin
  • defib
  • amiodarone 300 mg
  • epi
  • amiodarone 150 mg
92
Q

Asystole

-pathophys

A

ALL pacemakers of the heart have failed!

absense of electrical activity

93
Q

Asystole

-causes:

A

H’s and T’s

94
Q

H’s

A 
-hypovolemia
hypoxia
 hydrogen ion (acidosis)
 hyp/hyperkalemia
hypothermia
95
Q

T’s

A

Tension pneumothorax

  • tamponade
  • toxins
  • thrombosis
96
Q

Asystole

-treatment

A

Reverse the H & Ts

cardiac arrest guidelines

97
Q

Pulseless Electricle Activity (PEA)

-pathophys

A

there is electrical activity but NO MECHANICAL activity

98
Q

PEA

  • rhythm
  • pulse
  • cause
  • tx
A
  • any rhythm
  • NO PULSE
  • caused by H & T
  • tx same as asystole
99
Q

Immediate Post Cardiac Arrest Care

A

1) Oxygenation/intubation

2) treat hypotension

100
Q

Hypothermic protocol

-rational

A

only txt that improves neurological functioning

101
Q

Hypothermic protocol

-effect on body

A

stops metabolic demand

stunts inflammatory process

102
Q

methods for inducing hypothermia

-invasive

A

foley catheter
NG
central line

103
Q

methods for inducing hypothermia

-non- invasive

A

ice packs
cooling blanket
environmental temp

104
Q

what must you give when inducing hypothermia

A

PARALYTIC
SEDATION
PAIN MED

105
Q

Paced rhythm:

1) atrial paced rhythm

A

Spike BEFORE p wave

106
Q

Paced rhythm:

2) Venticular paced rhythm

A

spike BEFORE QRS

107
Q

paced rhythm:

3) atrial and ventricular

A

spike BEFORE p and QRS

108
Q

paced rhtyhm:

  • failure to capture
  • tx
A

pacer spikes NOT followed by a P wave or QRS

- increase output setting

109
Q

paced rhythm

  • failure to sense
  • tx
A

pacemaker spikes too closely behind QRS complex

  • not sensing the heart beat
  • increase sensitivity

Critical Care Test 2 (6 decks)

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