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RNSG 2432 UNIT 1 > Ch. 35 (cont.): Dysrrhytmias > Flashcards

Ch. 35 (cont.): Dysrrhytmias Flashcards

1
Q

What is a premature atrial contraction (PAC)?

A

-contraction starting from an ectopic focus in the atrium (location other than SA node) SOONER than expected
-travels by abnormal pthwy
-@ AV node can be stopped, delayed, or conducted normally

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2
Q

What can a PAC result from in a normal heart?

A

-emptional stress
-physical fatigue
-caffeine
-tabacco
-alcohol

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3
Q

What are other causes of PACs?

A

-hypoxia
-electrolyte imbalance
-hyperthyroidism
-COPD
-heart disease: CAD, valvular disease

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4
Q

What are manifestations of PACs?

A

-palpitations
-heart “skips a beat”

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5
Q

What is the treatment of PACs?

A

-monitor for more serious dysrhythmias
-withhold sources of stimulation (caffeine, epi, dopamine)
-BB

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6
Q

What is the clinical significance of PAC in healthy hearts?

A

not significant

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7
Q

What is the clinical significance of PACs in pts w/ heart disease?

A

may warn or start more serious dysrhythmias

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8
Q

What is supraventricular tachycardia (SVT)?

A

a rapid regular heartbeat that originates anywhere above the ventricles (supravetricular), caused by rapid firing of ectopic beats

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9
Q

What is reentrant phenomenon?

A

-SVT occurs bc of this
-reexcitation of the atria when there is a 1-way block
-PAC triggers a run of repeated premature beats

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10
Q

What does paroxysmal mean?

A

an abrupt onset and ending

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11
Q

What is SVT associated with in a normal heart?

A

-overexertion
-emotional stress
-deep inspiration
-stimulants (caffeine, tobacco)

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12
Q

What is SVT also associated with?

A

-rheumatic heart disease
-digitalis toxicity
-CAD
-cor pulmonale

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13
Q

What are the EKG characteristics of SVT?

A

-HR 151-220
-regular or slightly irregular rhythm
-p wave may be abnormally shaped or hidden
-PR interval shortened or normal
-QRS complex normal

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14
Q

What is the clinical significance of SVT?

A

depends on the associated symptoms
-prolonged episode of HR > 180 will ↓ CO (hypotension, palpitations, dyspnea, angina)

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15
Q

What is the treatment for SVT?

A

-vagal stimulation (valsalva, carotid massage, coughing)
-drugs (IV adenosine, IV BB, IV CCB)
-synchronized cardioversion

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16
Q

What is the drug of choice to treat SVT?

A

IV ADENOSINE
-has a short half-life (10 sec) and well tolerated

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17
Q

What is important to remember when administering IV adenosine?

A

-tell pt they may feel chest pressure after med is given
-inject as close to heart as possible
-give IV rapidly (1-2 sec) and follow with 20 mL NS flush
-monitor ECG, brief asystole common
-assess pt for flushing, dizziness, chest pain, palpitations

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18
Q

What is an atrial flutter?

A

atrial tachydysrhythmia id by recurring, regular, SAWTOOTH shaped flutter waves that originate from a single ectopic focus on r atrium (or less often l atrium)

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19
Q

Does atrial flutter occur in a healthy heart?

A

rarely

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20
Q

What is atrial flutter associated with?

A

-CAD
-hypertension
-mitral valve disorder
-pulmonary embolus
-chronic lung disease
-car pulmonale
-cardiomyopathy
-hyperthyroidism
-drugs: digoxin, quinidine, epi

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21
Q

What are the EKG characteristics of atrial flutter?

A

-atrial rate 200 to 350
-ventricular rate varies based on conduction ratio
-2:1, vent rate is 150
-usually regular
-PR interval not measurable
-QRS complex normal

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22
Q

What is the clinical significance of atrial flutter?

A

-high ventricular rate and loss of atrial “kick” = ↓ CO
-this can cause HF
-pts have an ↑ risk for STROKE

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23
Q

Why are pts with an atrial flutter at higher risk for STROKE?

A

-thrombi can form in atria from stasis of blood
-warfarin or other anticoagulants are given for prevention

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24
Q

What are s/s of HF?

A

-palpitations
-tachy
-fatigue
-malaise
-SOB onexertion
-dyspnea
-chest pain
-syncope

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25
Q

What is the treatment of choice for atrial flutter?

A

radiofrequency catheter ablation in an EPS laboratory

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26
Q

What are treatment options for atrial flutter?

A

-BB, CCB
-antidysrhythmic drugs (ibutilide [Corvert])

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27
Q

What is atrial fibrillation (Afib)?

A

-characterized by a total disorganization of atrial electrical activity
-paroxysmal or persistent
-MOST COMMON clinically sig dysrhythmia

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28
Q

In what pts does Afib usually occur in?

A

in pts w/ underlying heart disease
-CAD
-valvular heart disease
-cardiomyopathy
-hypertensive heart disease
-HF
-pericarditis

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29
Q

When can Afib develop acutely?

A

-thyrotoxicosis
-alcohol intoxication
-caffeine
-electrolyte problems
-stress
-heart surgery

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30
Q

What is Afib commonly seen together with?

A

HF bc of similar risks and common physiological changes

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31
Q

What are the EKG characteristics of Afib?

A

-atrial rate as hi as 350-600
-chaotic fibrillatory waves replace the P wave (no ID P wave)
-irregular ventricular rate

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32
Q

What is the clinical significance of Afib?

A

-results in ↓ CO bc of loss of atrial kick &/or a rapid ventricular response
-HIGH RISK for pulmonary or systemic emboli (Afib accounts for 20% of strokes)

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33
Q

What are the goals of Afib treatment?

A

1) ↓ ventricular response ( to <100 bpm)
2) prevent stroke
3) convert to sinus rhythm

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34
Q

What can electrical cardioversion do to Afib?

A

-may convert to a normal sinus rhythm

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35
Q

What is required if a pt is in Afib for > 48 hrs PRIOR to cardioversion?

A

warfarin therapy is NEEDED for 3-4 weeks PRIOR to cardioversion

36
Q

What procedure can be done to RULE OUT clots before the cardioversion?

A

-transesophageal echocardiogram
-if no clots found, anticoagulat therapy may not be needed

37
Q

What if drugs or cardioversion don’t convert the Afib to normal sinus rhythm?

A

-pts need long term anticoagulant therapy
-WARFARIN often used and monitor therapeutic levels

38
Q

What drugs are commonly used to control rate in pts with Afib?

A

-non-dihydropyridine CCB (diltiazem or verapamil)
- BB (carvedilol or metoprolol)
-digoxin

39
Q

What is the desired rate when treating Afib?

A

< 80 at rest and < than 110 w/ moderate exerion

40
Q

What drugs are commonly used for rhythm control in pts w/ Afib?

A

-amiodarone (MOST EFFECTIVE)
-dronedarone
-propafenone
-sotalol (BB and antiarrhythmic)

41
Q

What is preferred when treating Afib: rate control or rhythm control?

A

RATE CONTROL shows better outcome in decreasing CV hospitalization

42
Q

What are commonly used oral anticoagulants for stroke prevention in pts with Afib?

A

1) Warfarin (GOLD STANDARD)
-frequent monitoring, increase risk for major bleeding, narrow therapeutic range
2) Dabigatran (direct thrombin inhibitor)
3)Aprixaban, Edoxaban, Rivaroxaban (factor Xa inhibitors)

43
Q

What procedure is strongly recommended to pts with symptomatic paroxysmal Afib?

A

cardiac ablation
-also for pts unable to tolerate antiarrhythmic or refractory to drug treatment

44
Q

What is the Maze procedure?

A

-stops Afib by interrupting ectopic foci
-incisions made in both atria and cryoablation is used to stop formation and conduction of ectopic signals and restore normal sinus rhythm

45
Q

What is an atrioventricular heart block (AV block)?

A

-block of conduction from atria to ventricles
-CAD, MI, infections, enhanced vagal tone, drug effects (digoxin toxicity)

46
Q

What do you always assess for in pts w/ AV blocks?

A

assess for CO and treat cause

47
Q

What are the 4 types of AV blocks?

A

1) first-degree block
2) second-degree block, Morbitz type I Wenckebach
3) second-degree block, Morbitz type II
4) third degree block (COMPLETE)

48
Q

What is a first-degree AV block?

A

every impulse is conducted to ventricles, but the time of AV conduction is prolonged
-prolonged PR interval (>0.2)
-same PR interval for each beat

49
Q

What is first-degree AV block associated w/?

A

-increasing age
-MI
-CAD
-rheumatic fever
-hyperthyroidism
-electrolyte imbalance
-vagal stimulation
-drugs (digoxin, BB, CCB, flecainide)

50
Q

What are the ECG characteristics of first-degree AV blocks?

A

-HR normal
-rhythm regular
-normal P
-normal QRS
!! PR INTERVAL PROLONGED !!

51
Q

What is the clinical significance of first-degree AV block?

A

-typically NOT serious
-pts asymptomatic
-no treatment
-monitor for heart rhythm changes

52
Q

What is a second-degree type I AV block (Morbitz I, Wenckebach)?

A

-gradual lengthening of PR interval until an atrial impulse is non conducted and a QRS complex is blocked

53
Q

What may result in a second-degree type I AV block?

A

-drugs (digoxin, BB)
-CAD, ischemia, MI

54
Q

What are the EKG characteristics of second-degree type I AV blocks?

A

-regular atrial rate
-ventricular rate may be slower
-ventricular rhythm irregular
“longer,longer, longer, drop, now you have a Wenckebach”
-normal P and QRS

55
Q

What is the clinical significance of second-degree type I AV blocks?

A

-usually result from myocardial ischemia or inferior MI
-usually transient and well tolerated
-may be warning sign (acute MI) of more serious AV conduction prblms (complete heart block)
-may decrease CO

56
Q

When may second-degree type I AV blocks be symptomatic?

A

if fewer conducted beats (2:1 or 3:2 block) lead to ventricular brady
-hypoperfusion (fatigue, lightheadedness, syncope, presyncope, angina), HF

57
Q

What is the treatment for symptomatic pts with a second-degree type I AV block?

A

-atropine or temp pacemaker to increase HR (especially if pt has hx of MI)

58
Q

Where is the block most commonly in a second-degree type I AV block?

A

block is most commonly within AV node

59
Q

What is a type 2 second-degree AV block (Mobitz II)?

A

-P wave non conducted without progressive PR lengthening
-usually occurs when a block in 1 of the bundle branches is present
-more serious
-certain # of impulses from SA node are not conducted to ventricles (occurs in ratios 2:1, 3:1. etc.)

60
Q

What are type 2 second-degree AV blocks associated with?

A

rheumatic heart disease, CAD, anterior Mi, drug toxicity

61
Q

What are the ECG characteristics of a type 2 second-degree AV block?

A

-normal atrial rate and rhythm
-vent rate depends on degree of block, rhythm may be irregular
-normal P
-PR interval normal or prolonged
-QRS COMPLEX > 0.12 SEC BC OF BUNDLE BRANCH BLOCK

62
Q

What is the clinical significance of a type 2 second-degree AV block?

A

!!! DANGEROUS: can progress to 3rd degree block !!!
-↓ Hr often results in ↓ CO w/ subsequent hypotension and myocardial ischemia and angina

63
Q

What is the treatment for a type 2 second-degree AV block?

A

PERMANENT PACEMAKER

64
Q

What is a 3rd degree AV block?

A

!!! COMPLETE HEART BLOCK !!!
-a form of AV dissociation where NO impulse from atria are conducted to ventricles
-atria and ventricles beat independently

65
Q

What is 3rd degree AV block associated w/?

A

-severe heart disease (CAD, MI, myocarditis, cardiomyopathy)
-some systemic diseases (scleroderma)
-drugs (digoxin, BB, CCB)

66
Q

What drugs can cause 3rd degree AV block?

A

digoxin, BB, CCB

67
Q

What are the EKG characteristics of 3rd degree AV block?

A

-atrial rate 60-100
-ventricular rate depnds on site of block
*AV node: 40-60
* His-Purkinje: 20-40
-atrial and vent rhythms regular but unrelated
-normal P
-NO RELATIONSHIP btwn P wave and QRS complex

68
Q

What does the QRS complex look like if the escape rhythm starts at the bundle of His or above (3rd degree AV block)?

A

normal

69
Q

What does the QRS complex look like if the escape rhythm starts BELOW the bundle of His (3rd degree AV block)?

A

widened

70
Q

What is the clinical significance of 3rd degree AV block?

A

-usually results in ↓ CO w/ subsequent ischemia, HF, shock
-syncope may result from severe bradycardia or even periods of asystole

71
Q

What is the treatment for 3rd degree AV block?

A

symptomatic pts need a transcutaneous pacemaker until a temp transvenous one can be inserted
-PT NEEDD PERMANENT PACEMAKER ASAP

72
Q

What drugs can be given to treat 3rd degree AV block?

A

-dopamine and epi is an interim measure to ↑ HR and support BP until temp pacing starts
-atropine not effective

73
Q

Is atropine an effective treatment for 3rd degree AV block?

A

NO

74
Q

What is a premature ventricular contraction (PVC)?

A

-early QRS complex
-QRS is WIDE and DISTORTED

75
Q

When does ventricular tachycardia occur?

A

when theres 3 or > consecutive PVCs

76
Q

What are PVCs associated with?

A

-stimulants (caffeine, alcohol, nicotine, aminophylline, epi, isoproterenol)
-electrolyte imbalances
-hypoxia
-fever
-exercise
-emotional stress

77
Q

What diseases are associated with PVCs?

A

-MI, mitral valve prolapse, HF, cardiomyopathy, CAD

78
Q

What is the clinical significance of PVCs in a normal heart?

A

usually NOT harmful

79
Q

What do PVCs indicate in CAD or acute MI?

A

ventricular irritability

80
Q

What is the clinical significance of ventricular tachycardia (VT)?

A

-ominous sign
-LIFE-THREATENING bc of decreased CO and possible development of VFIB (LETHAL)

81
Q

What is the first line of treatment for a pt who is symptomatic bc of a junctional escape rhythm?

A

ATROPINE

82
Q

What are some possible pacemaker issues?

A

1) Failure to pace
2) Failre to capture
3) Failure to sense

83
Q

What is failure to pace?

A

(fire)
-pacemaker does not fire when it should
-cause: battery or pulse generator fail, wire issues, loose connection

84
Q

What is failure to capture?

A

electrical impulse (spike) generated but no depolarization
-cause: output set too low or displacement of wire, battery fail, fracture of pacemaker wire, increased pacing threshold

85
Q

What is failure to sense?

A

-doesnt sense pts cardiac rhythm and initiates pulse (earlier than programmed)
-cause: displaced pacemaker wire

RNSG 2432 UNIT 1 (3 decks)

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