Cardiac Dysrhythmias (Exam 3) Flashcards by Isaiah Smith

Atrial depolarization

Atrial systole

First P wave bump

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Ventricular Depolarization

Ventricular systole

Big bump

QRS complex

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Ventricular Repolarization

The T wave

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Flow of the heart

SA node

P wave

AV node

Bundle of HIS-Purknje Fibers

QRS Complex

T wave

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What stimulates Atrial Depolarization?

SA Node

Sinoatrial Node

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What node sense atrial depolarizations and tells the ventricles to depolarize

The AV node

Atrioventricular node

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What is responsible for left ventricle contraction

Bundle of HIS

Purkinje fibers

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Normal Electrical Conductivity of Heart: SINUS RHYTHM

Rate: 60-100

Rhythm: Regular

P waves: Upright - Rounded - One before overy ORS

PR interval: 0.12-0.20 sec

ORS: <0.12 sec

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PR interval should be

0.12-0.20 seconds

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ORS should be

Narrow

< 0.12 seconds

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Sinus Arrhythmia

A degree of variability in the heart rate (Still between 60-120)

PR = still .12 -. 20

QRS = <12

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Sinus Arrhythmia: Causes

Respirations and autonomic NS

Common in young people

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Each box on ECG =

0.04 seconds

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Dysrhythmias are problems because they

alter our CO

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Sinus in front of something means

It is triggered in or around the SA node

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Sinus Bradycardia

Originates in the SA node

Rate: < 60 bpm

Rhythm: Normal

PR: 0.12-0.20

ORS: <0.12

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Causes of Sinus Brady

Hyperkalemia (Slow depolarizations)

Vagal response

Late hypoxia

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Clinical Manifestations of Sinus Bradycardia

Brain and Lungs are not getting prefused

Light Headed

Fatigue

Syncope

Dyspnea

Chest pain

Confusion

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Treatment of Symptomatic Bradycardia

atropine

pacemaker

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Sinus tachycardia

Originates SA node

Rate: 100-150 bpm

Rhythm: Regular

PR: 0.12-0.20 (Normal)

QRS: <0.12 (Normal)

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Sinus tachycardia causes

Fluid Volume Deficit (check first)

Exercise

Emotions (catecholamines)

Early Hypoxia

Treatment for Sinus tachycardia

hypovolemia

fever

pain

rate

Hypovolemia = fluids

Fever = antipyretics

Pain = Analgesics

Beta blockers to reduce HR and myocardial oxygen consumption

Paroxysmal Supraventricular Tachycardia (PSVT)

Orginiates in the AV node

HR: 150- 250

No P wave

QRS: <0.12

Begins suddenly and ends suddenly. HEART RACING

PSVT Causes

Over exertions

Emotional Stress

Stimulants

Wolff-Parkinson White Syndrome

PSVT: S/S

Palpitations Chest Pain Lightheadedness Dyspnea

Premature Atrial Contractions (PACs)

Early p waves that usually look a little strange Usually has no consequences, but if frequent indicates that patient at high risk for other dysrhythmia (usually afib) Check ELECTROLYTES

Atrial Dysrhytmias

Atrial Flutter Atrial Fibrillation

Atrial Flutter

Originate: AV node - Overrides the SA node Reentry impulse that in repetitive and cyclic Atrial Rate = Super high Ventricular = Normal P wave sawtooth: 2:1 - 3:1 - 4:1 ORS: <0.12

Causes of Atrial Flutter

HEART RELATED diseases Electrolytes abnormalites

Atrial Fibrillation

Occurs: Multiple irritable spots in the atria Irregularly irregular (both atrial and ventricular) Rate: 100- 175 bpm No identifiable P wave or T wave R's to R's not regular

A fib: Clinical Manifestations

Palpitations Heart Racing Fatigue Dizziness Chest discomfort Shortness of breath May be asymptomatic

What do we want to know about atrial fibrillation

Is it a controlled rate? If not controlled then we are worried that tissues are not being perfused?

Atrial Fibrillation Causes

Electrolytes Hypoxia Cardiovascular disease

New onset atrial fibrillation.. need to think

Are the electrolytes normal? Are they hypoxic?

Complication of Afib

Embolus in atria --> Stroke (Blood is pooling in the atria)

Treatment of A fib Pharmacological Non pharmacological

Beta blocker, CCB, Digitalis, amiodaron (Control Rate) Stroke prevention: Anticoagulants and antiplatelets (Prevent Clots) Non pharmacological: Ablation - cardioversion

Ventricular Dysrhythmias

PVCS (Premature ventricular Contractions) VTACH (Ventricular Tachycardia) VFIB (ventricular Fibrillation)

Premature Ventricular Contractions

Occurs within ventricles Comes earlier than QRS should come and does not follow P-wave Wide and distorted QRS. Larger than .12 secs

PVC causes

Stimulants Electrolytes hypoxia fever exercise emotional stress CVD

PVS Subtypes

Bigeminy (every 2nd beat) Trigeminy (every 3rd beat) Quadrigeminy (every 4th beat)

Ventricular Tachycardia: Definition

3 or more PVCS together Seriously decreases cardiac output

VTACH causes

MI CAD Electrolytes abnormalities Heart failure Drug toxicity

VTACH

Occurs within ventricles Rate: 150-200 No p-wave PR: not measurable ORS Long Immediate interventions

Treat VTACH

ACLS -- depend on pulse, patient symptomatic very quickly unless convert back to other rhythm

First question for VTACH patients

Any pulse?

Ventricular Fibrillation

Irregular waveforms of varying shapes and sizes The ventricles are just quivering No effective contraction = NO Cardiac Output Check pulse and start CPR

What causes dysrhythmias?

Inappropriate Automaticity Triggered activity Re-entry

Inappropriate Automaticity

A cell initiates action potential when it isn't supposed to.

Triggered activity

An extra impulse generated ruing of just after repolarization

Re-entry

Cell is one part of the heart continues to depolarize after main impulse is over