Cardiovascular Flashcards
is anything other than a NSR
Dysrhythmia
Dysrhythmia
Electrical causes include
(5)
Occur when the SA node fires slower than 60 or more than 100
The SA node fails
Conduction is blocked
Aberrant conduction pathways are activated
Ectopic foci initiate impulses
Every cardiac cell has the ability to generate a beat
Dysrhythmia Pathological causes include
6
Metabolic Electrolyte imbalances Chronic illnesses Medications Congenital disorders Abuse of stimulants
Dysrhythmia Pathological causes Metabolic include
derangements such as hypoxia, acidosis, alkalosis
Dysrhythmia Pathological caues Electrolyte imbalances, include
(4)
hypokalemia, hyperkalemia, hypocalcemia, hypomagnesemia
Dysrhythmia Pathological causes chronic illness, include
3
coronary artery disease, COPD, CHF
Dysrhythmia Pathological causes Medications, include
cardiac glycosides and bronchodilators
Dysrhythmia Pathological causes include abuse
4
caffeine, nicotine, cocaine, and amphetamines
Normal P - R interval is
0.12 to 0.20 seconds
Normal QRS duration is
0.06 to 0.12 seconds
what is a Mural clot?
the development of a thrombus on or against an interior wall of the heart
what are some causes of Atrial Fibrillation and Flutter (14) 5 that begin with C 3 that begin with H 3 that begin with P
- Atrial enlargement
- cardiac valve disease
- cardiomyopathy
- chronic lung disease
- CHF
- CAD
- HTN
- hyperthyroid
- hypoxia
- pericarditis
- myocarditis
- PNA
- pulmonary
- embolus
what are three ways to treat atrial fibrillation and flutter?
anticoagulation
cardioversion
calcium channel blockers
Cardioversion; A fib treated with cardioversion, the patient should be treated with an anticoagulant first, because cardioversion can cause the thrombi to mobilize
Patients with A fib can be treated with calcium channel blockers in order to control rapid ventricular rate, as well as beta blockers
what defines a Wandering pacemaker?
Defined as at least three different P wave configurations to be present to constitute wandering atrial pacemaker
What is Wolf Parkinson White?
Is a preexcitation syndrome that can occur intermittently, which permits impulse conduction from the atria to the ventricles while bypassing the AV node.
what are the symptoms of Wolf Parkinson White?
Usually asymptomatic, often found incidentally on an EKG that is unrelated to the CC.
Symptoms may include heart palpitations and a rapid heart rate.
How is Wolf Parkinson White identified on an EKG?
WPW is identified by a widened QRS and a slurred upstroke or delta wave
Junctional Dysrhythmias
Occur when…
Occur when; the SA node fails to generate an impulse, an SA generated impulse is blocked from leaving the node or not conducted into the ventricles, or the rate of the SA node is slower than that of the AV junction
____ ____ ____ (hint: PJC) is less common than a PAC or a PVC and is rarely problematic. They can occur in healthy hearts and rarely require intervention.
Premature Junctional Complex
When the SA node fails and the AV node assumes pacemaker of the heart. A ____ ____ ____ occurs when three or more consecutive beats occur.
junctional escape rhythm
junctional escape rhythm is usually between __ - __ BPM
Usually between 40 - 60 BPM
Describe P waves in a Premature Junctional Complex
P wave can occur before, during, or after the QRS complex. The P is commonly inverted.
describe P waves in a Junctional escape rhythm
P waves can occur anywhere, or be absent
Because a junctional rhythm originates above the ventricles, the QRS is typically ____, and it’s rhythm is ____
narrow
regular
Junctional Escape Rhythm Management if ____ with ____, ____, or ____ ____.
symptomatic
O2, atropine, or transcutaneous pacing.
an accelerated junctional tachycardia occurs when an ectopic focus in the AV node begins firing faster than the SA node and takes over as the pacemaker is called what?
Accelerated Junctional Tachycardia
By definition, an accelerated junctional tachycardia is __ to __ BPM
7
130
This dysrhythmia occurs in patients with heart disease, digoxin toxicity, MI, or myocarditis
Can develope ischemia as a result
Treatment involves managing the underlying cause
Accelerated Junctional Tachycardia
These Occur when the myocardium is irritable and an ectopic focus in the ventricles causes depolarization
Premature Ventricular Contractions or PVC’s
What are some causes of PVC’s?
Most often?
Can also result fom…(5)
Most often arise in patients with cardiac disease or myocardial ischemia or when infarction occurs.
Can also result from ; conditions that cause hypoxia, hypovolemia, electrolyte imbalances such as hypokalemia or hypomagnesemia, or abuse of stimulants such as nicotine or caffeine
Describe Unifocal PVC’s
can occur in healthy individuals and patients are usually unaware
Describe Multifocal PVC’s
PVCs look different and arise from various foci points and present various configurations. Patients with multifocal premature ventricular complexes should be closely monitored because these complexes indicate a more serious condition
What is Bigeminy?
is a pattern in which every other beat is a PVC
Waht is Trigeminy?
a repeating pattern in which every third beat is a premature ventricular contraction. Each PVC arises from the same ectopic focus
What is a Couplet?
is a pair of PVCs, and are usually from the same ectopic foci. These are considered potentially dangerous PVC complexes because they can become arrhythmogenic for ventricular tachycardia.
Define Ventricular Tachycardia
Is a series of three or more beats of PVCs.
Rarely happens in people who don’t have heart disease.
This type of Ventricular Tachycardia usually lasts less than 30 seconds and does not require treatment unless the patient is symptomatic.
Nonsustained
Sustained V tach is potentially fatal because of the
increased demand for O2 and the reduction in cardiac output, causing transition into ventricular fibrillation
Test new card
This is a new card
This is another new card
New card 2
V tach can be ____or ____
Poly morphic or monomorphic
Polymorphic v tach is called what
Torsades de pointes
Torsades de pointes Can result from
(2) 3, 2
Can result from
- medications that prolong the QT interval, such as amiodarone, Ibutilide, Procainamide,
- toxic levels of drugs such as tricyclic antidepressants and congenital long QT syndrome
Unstable patient with monomorphic ventricular tachycardia, expect what?
immediate synchronized cardioversion
For unstable patient with polymorphic or torsades, what is the priority
immediate defibrillation is the priority
Ventricular Fibrillation what is the Most common cause
Coronary artery disease CAD
AV blocks can be the result of these three meds
tricyclic antidepressants, clonidine, digoxin
Lyme disease ; late stage can present as
third degree block
2nd degree
Type 1
Management; administer ____ of the patient has symptomatic bradycardia, which should not delay the implementation of ____ ____ for patients with poor perfusion.
atropine
external pacing
2nd degree
Type 2
Most commonly the result from what?
considered life threatening because it can progress into ____ ____
Probably won’t respond to ____, expect ____ ____ or continuous infusion of ____ or ____ until when?
acute MI
third degree
atropine, expect transcutaneous pacing or continuous infusion of dopamine or epinephrine until transvenous pacing is initiated.
A bundle branch block in one bundle causes the ventricle on that side to ____ ____ than the ventricle in the intact side, resulting in an abnormal QRS that is what?
depolarize later
wide and bizarre
____ bundle branch block, which is the most common intraventricular conduction abnormality, can occur in healthy individuals.
____ bundle branch block, however usually indicates heart disease
Right
Left
This is a unique and recently described clinical and electrocardiographic disease that can result from a defect in the cardiac sodium channel.
Brugada syndrome
The specific characteristics of Brugada syndrome are
complete or incomplete right BBB with ST segment elevation in the right precordial leads V1 through V3.
Although patients with Brugada syndrome are usually young and asymptomatic, they are at risk for ____ ____ ____ which can be prevented how?
pharmacological treatment for this syndrome is what?
To prevent sudden cardiac death, patients may receive an implantable cardiac defibrillator (ICD)
sudden cardiac death.
No pharmacological treatment currently exists for this syndrome.
To prevent sudden cardiac death, patients may receive an implantable cardiac defibrillator (ICD)