cardiac dysrhythmia OLOL 11/18 Flashcards
mastery
geminal patterns are associated with what type of dysrhythmia
PAC’s
What are 10 causes of PAC’s?
emotional distress CHF acute coronary syndromes mental and physical fatigue atrial enlargement digitalis toxicity valvular heart disease electrolyte imbalance hyperthyroidism stimulants like caffeine, nicotine, and cocaine
how are PAC’s treated?
PAC’s are not clinically significant in persons with healthy hearts and do not require treatment. A patient may be told to cough and drink water.
PAC’s may initiate what?
episodes of atrial fibrillation, flutter, or PSVT or paroxysmal supraventricular tachycardia. Resolutions can be found by treating the underlying cause
what are the EKG signs of a wandering pacemaker?
P waves vary in size, shape, and direction, look for 3 or more different morphologies in a rhythm strip
what causes a wandering pacemaker?
can occur in healthy hearts and during sleep, and caused by digitalis toxicity
a wandering pacemaker with a rate over 100 beats per minute is called what?
multifocal atrial tachycardia or MAT
name seven examples of Vagal maneuvers
coughing, squatting, breath-holding, carotid sinus pressure, application to cold stimulus to the face, Valsalvas maneuver, and gagging
Supraventricular Arrhythmias begin where?
above the bifurcation of the bundle of HIS such as the SA node, atrial tissue, and the AV junction
what is Paroxysmal atrial tachycardia?
atrial tachycardia that starts or ends suddenly
what causes atrial tachycardia?
stimulants such as caffeine, infection, electrolyte imbalance, acute illness with excessive catecholamine release, MI
what are some treatments of SVT?
Vagal maneuvers, Adenosine, calcium channel blockers, beta blockers
what is atrial flutter?
an ectopic atrial rhythm in which an irritable site fires at an extremely rapid rate, expressed in ratios of atrial to ventricular rate such as 3:1 or 4:1
what causes atrial flutter?
usually precipitated by a PAC and may last seconds to hours, chronic A flutter is very unusual
what is a paroxysmal rhythm?
something that starts and suddenly stops abruptly
what are some conditions that are associated with atrial flutter?
hypoxia, pulmonary embolism, chronic lung disease, valve stenosis or regurgitation, PNA, MI complications, ischemic heart disease, cardio myopathy, hyperthyroid, digitalis or quinidine toxicity, cardiac surgery, pericarditis/ myocarditis
how is atrial flutter treated?
vagal maneuvers
synchronized cardioversion- RRT may cardiovert on the floor
what causes atrial fibrillation?
altered automaticity or reentry
what are 13 clinical conditions that can contribute to A fib
HTN, MI, CAD, abnormal heart valves, congenital heart defects, overactive thyroid or other metabolic imbalance, exposure to stimulants such as ETOH, tobacco, caffeine, or medications, Lung disease, previous heart surgery, viral infections, stress due to PNA or surgery, sleep apnea
what is reentry?
is when an impulse returns to stimulate tissue that was previously depolarized
how is atrial fibrillation treated?
anticoagulation, rate control, and rhythm control
what are some anticoagulation medications for atrial fibrillation? (4)
Eliquis/ apixaban, Pradaxa/ dabigatran, Xarelto/ rivaroxaban, Coumadin/ warfarin
what are some Beta Blockers used to control A Fib?
Metoprolol, Propranolol, Esmolol, slows conduction velocity, decreases automaticity, prolongs refractory period
what are some side effects of Digoxin?
AV block, Sinus pauses, ventricular arrhythmias, drug toxicity, multiple drug to drug interactions
what is Digoxin and what does it do?
cardiac glycoside, slows conduction, increases the force of contraction, used in left ventricle dysfunction
where is the AV node located?
in the lower portion of the right atrium
the thing that connects the AV node with the bundle branches is the what?
the bundle of HIS
the bundle of HIS has a pacemaker rate of
40 to 60 beats per minute
the AV node and the nonbranching portion of the bundle of HIS is known as the what?
AV junction
if the AV junction is to pace the heart, the stimulus must travel in a retrograde direction to fire the atria, therefore the P waves will be
P waves may occur before, during or after the QRS
what has reverse impulse P waves and is kind of like a PAC?
Premature Junctional Complexes, or PJC’s
how do you identify a PJC?
it arises from an irritable site within the AV junction that fires before the next expected sinus beat. It is often followed by a noncompensatory or incomplete pause
describe a P wave in a PJC
may or may not be present, if it is it will be retrograde, and therefore inverted, and may precede or follow the QRS
is a PJC a rhythm?
no, it is a single beat
what heart disease originates from strep throat?
rheumatic heart disease
what are some causes of PJC’s?
CHF, acute coronary syndromes, mental and physical fatigue, valvular heart disease, digitalis toxicity, electrolyte imbalance, rheumatic heart disease, stimulants such as caffeine and cocaine
what is a junctional escape beat?
a beat that originates in the AV junction, preventing cardiac standstill
how do you identify a junctional rhythm?
it is several sequential junctional escape beats, has a rate of 40 - 60, is very regular, and will have retrograde inverted P waves if any
what are some drugs to treat Junctional rhythm?
Dopamine, atropine, Epi
what are the characteristics of accelerated junctional rhythm?
a junctional rhythm with a rate of 61-100
what are the causes of Accelerated junctional rhythm?
digitalis toxicity, acute MI, cardiac surgery, rheumatic fever, COPD, hypokalemia
what are the characteristics of Junctional tachycardia?
a junctional rhythm with a rate of 101-150
what is the value of a small square in an EKG strip?
0.04 seconds
what is the value of a large square in an EKG strip?
0.20 seconds
how many large squares in an EKG strip does it take to add up to one second?
5
what is the difference between a segment and an interval?
a segment is the space between two waves, an interval involves one or more waves and possibly a segment
what is a P-R interval and how long is it normally?
it starts at the beginning of the P wave and ends with the downward deflection of the Q wave, normally 0.12-0.20 seconds
what is the normal duration of a QRS complex interval?
0.06 - 0.10 seconds. Anything more than 0.10 seconds is considered wide.
what is the normal duration and parameters of the Q-T interval?
the beginning of the QRS to the end of the T wave, lasting less than half of the R - R interval.
a ventricular rhythm originates from where?
the purkinje fibers
what is the rate of a ventricular rhythm in beats per minute?
20 - 40 beats per minute
where dose a PVC come from
an irritable focus within a ventricle
a pair of two sequential PVC’s is called a what?
couplet
bigeminal PVC’s, or ventricular bigeminy, are identified by what?
every other beat is a PVC
trigeminal PVC’s, or ventricular trigeminy, is identified as what?
every 3rd beat is a PVC
what is the definition of sustained V tach?
a run of 30
PVC’s look the same if they are what? and if they look different what is it called?
they look the same if they are from the same site. If they look different, they are from different focal points and are called multifocal
what is an interpolated PVC?
a PVC that does not have an full compensatory pause, and is squeezed in between two regular complexes
what is an R on T PVC, and why is it significant?
the R of the PVC falls on the T of the preceding beat, it can cause VT or VF
Ventricular escape rhythm is also called what?
Idioventricular rhythm or IVR
How do you identify IVR?
three or more ventricular escape beats occurring in a row at a rate of 20 - 40 beats per minute
What is an agonal rhythm?
a ventricular rate of less than 20 beats per minute
what causes IVR or Idioventricular Rhythm?
the SA and AV are firing at a rate that is slower than the ventricles, initiating escape beats, may also be because of MI, digitalis toxicity, or metabolic imbalances. Basically nothing else is working
what is the treatment of idioventricular rhythm?
TCP or transcutaneous pacing
what is it called when three or more escape beats occur in a row at a rate of 41 - 100?
Accelerated Idioventricular rhythm or AIVR
what causes AIVR?
usually considered a benign escape rhythm and is often seen during the first 12 hours of an MI and is common after reperfusion therapy
what are some of the causes of AIVR?
Subarachnoid hemorrhage digitalis toxicity cocaine acute myocarditis hypersensitive heart disease dilated cardiomyopathy
three or more PVC’s in a row with a rate greater than 100 is called what?
ventricular tachycardia
what is the difference between sustained and non-sustained ventricular tachycardia?
whether its shorter or longer than 30 seconds
an unconscious person in VT is treated with what?
defibrillation
VT with uniform beats is said to be what?
monomorphic
VT with beats that are not uniform are said to be what?
polymorphic
Torresades is an example of what?
polymorphic VT
what are some causes of PEA or pulseless electrical activity? (10)
most commonly hypovolemia, pulmonary embolism acidosis tension pneumothorax cardiac tamponade hypoxia hyper or hypothermia MI hyper or hypokalemia drug overdoses
a depressed S - T interval is due to what?
possibly a past MI or ischemia
what is atropine use to treat and what does it do?
it blocks the chemicals at the endings of the vagus nerve. This allows more sympathetic nervous system activity, and an increased SA rate and AV conductivity
