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PathoPharm 2 > ch 35 dysrhythmias > Flashcards

ch 35 dysrhythmias Flashcards

1
Q

what does the P wave represent

A

depolarization of atria

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2
Q

what does the QRS wave represent

A

depolarization of ventricles

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3
Q

what does the T wave represent

A

repolarization of ventricles (refractory period)

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4
Q

cardiac output = ? x ?

A

heart rate x stroke volume

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5
Q

what happens to K, Na, and Ca during depolarization

A

K moves out
Na and Ca move in
contraction

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6
Q

what happens to K, Na, and Ca during repolarization

A

K moves in

Na and Ca move out

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7
Q

what are the steps to rhythm analysis (5)

A
  • what is heart rate?
  • is rhythm regular/irregular?
  • is there a P for every QRS?
  • is there a QRS for every P?
  • measure intervals (PR, QRS)
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8
Q

what is considered a normal QRS interval

A

<0.12 seconds (3 small boxes)

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9
Q

what is considered a normal PR interval

A

0.12-0.2 seconds (1 big box)

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10
Q

what can cause artifact

A

bad adherence to chest

movement

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11
Q

S+S sinus bradycardia

A
  • hypotension
  • pale cool skin
  • weakness
  • angina
  • dizziness/fainting
  • SOB
  • confusion
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12
Q

causes of abnormal sinus bradycardia (6)

A
  • hypothyroidism
  • hypoglycemia
  • increased intracranial pressure
  • hypothermia
  • b blocker or calcium channel blocker
  • vagal stimulation
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13
Q

atropine toxicity S+S

A
  • “hot as a hare” = increased temp
  • “mad as a hatter” = confused
  • “red as a beet” = flushed
  • “dry as a bone” = thirst
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14
Q

treatment for symptomatic sinus bradycardia (3)

A
  • atropine: 0.5 IVP and flush with NS fast
  • pacemaker
  • stop offending drugs
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15
Q

max dose in 24 hr for atropine

A

3 mg

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16
Q

how to calculate max sinus tachycardia

A

220 - person’s age

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17
Q

what is the HR for sinus bradycardia

A

<60 bpm

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18
Q

what is the HR for sinus tachycardia

A

101-180 bpm

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19
Q

what is the HR for paroxysmal supraventricular tachycardia

A

151-220 bpm

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20
Q

what is the HR for atrial flutter

A

200-350 bpm

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21
Q

what is the HR for atrial fibrillation

A

350-600 bpm

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22
Q

what is the HR for ventricular tachycardia

A

150-250 bpm

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23
Q

S+S sinus tachycardia

A
  • dizziness
  • dyspnea
  • hypotension
  • chest pain
  • decreased cardiac output
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24
Q

causes sinus tachycardia (2)

A
  • vagal inhibition

- sympathetic stimulation

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25
Q

what meds can cause sinus tachycardia (3)

A
  • atropine
  • epinephrine
  • albuterol
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26
Q

treatment for sinus tachycardia (3)

A
  • vagal maneuver
  • meds: B blockers, adenosine, or calcium channel blockers
  • synchronized cardioversion
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27
Q

what is the minimum amount of time you should give an IVP of B blocker over

A

atleast 5 mins

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28
Q

causes premature atrial contractions (PAC)

A
  • stress
  • fatigue
  • caffeine
  • alcohol
  • tobacco
  • hypoxia
  • electrolyte imbalance
  • disease states
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29
Q

S+S premature atrial contractions

A

palpitations

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30
Q

treatment premature atrial contractions (2)

A
  • remove offending agent

- b blocker

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31
Q

S+S paroxysmal supraventricular tachycardia (PSVT) (3)

A
  • hypotension
  • dyspnea
  • angina
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32
Q

causes PSVT (6)

A

(abrupt onset and ending)

  • overexertion
  • stimulants
  • disease
  • digitalis toxicity
  • deep inspiration
  • stress
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33
Q

1st priority for PSVT treatment

A

call a code!

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34
Q

treatment PSVT

A
  • vagal stimulation
  • IV adenosine rapid push with NS flush
  • IV b blocker
  • synchronized cardioversion if adenosine not effective
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35
Q

ECG characteristic of PSVT

A
  • can’t distinguish P from T waves
  • change occurs suddenly
  • HR 150-220
36
Q

risks with atrial flutter and atrial fibrillation

A
  • blood clot in atrium

- stroke

37
Q

ECG characteristics of atrial flutter

A
  • sawtooth pattern

- irregular rhythm

38
Q

treatment A flutter and A fib (4)

A
  • O2
  • if HR > 100 = digoxin, calcium channel blockers, b blockers, amiodarone
  • stroke prevention = enoxaparin, warfarin, or factor 10a inhibitor
  • radiofrequency ablation or cardioversion if amiodarone didn’t work
39
Q

toxicity S+S digoxin (5)

A
  • fatigue
  • dysrhythmias
  • visual disturbances **
  • anorexia
  • hypokalemia
40
Q

how do you give amiodarone

A

through a filter

41
Q

ECG characteristics of atrial fibrillation

A
  • irregular rhythm

- wavy baseline

42
Q

causes atrial flutter and fibrillation (2)

A
  • ectopic pacemakers in atria

- decreased cardiac output, blood pools in atria

43
Q

what endocrine imbalance can long term use of amiodarone lead to

A

hypothyroidism

44
Q

most common dysrhythmia after heart attack

A

1st degree AV block

45
Q

ECG characteristics of 1st degree AVB

A

long PR interval (>0.2)

-HR can be brady, normal, or tachy

46
Q

treatment for 1st degree AVB

A

none

continue to monitor

47
Q

ECG characteristics of 2nd degree AVB type 1

A
  • irregular rhythm
  • dropped beats **
  • not QRS for every P
  • PR intervals increasingly prolonged across ECG strip
48
Q

treatment 2nd degree AVB (types 1 and 2)

A

if symptomatic:

  • atropine
  • temporary pacemaker
49
Q

ECG characteristics of 2nd degree AVB type 2

A
  • irregular rhythm
  • not QRS for every P
  • P waves are punctual and normal **
  • same PR interval *
  • dropped beats
50
Q

what could be indicated by T wave not beginning at baseline

A

MI

51
Q

S+S 3rd degree AVB

A
  • hypotensive

- unconscious

52
Q

ECG characteristics of 3rd degree AVB

A
  • regular rhythm with dropped beats
  • not QRS for every P
  • wide QRS (>0.12)
  • PR intervals all different
53
Q

treatment 3rd degree AVB (2)

A
  • dopamine or epinephrine

- emergency pacemaker

54
Q

causes premature ventricular contractions (PVC)

A
  • stress
  • fatigue
  • caffeine
  • electrolyte imbalance
55
Q

ECG characteristics premature ventricular contractions

A
  • wide QRS

- early beats

56
Q

what does multifocal PVC mean

A

PVCs don’t look the same

57
Q

what is a couplet

A

2 PVCs in a row

58
Q

what is bigeminy

A

PVC q2nd beat

59
Q

what is trigeminy

A

PVC q3rd beat

60
Q

treatment PVC (2)

A
  • address underlying condition (maybe O2 or electrolyte replacement)
  • amioderone
61
Q

2 shockable pulse rhythms

A

vtach and vfib

62
Q

causes V Tach (3)

A
  • head injuries
  • MI
  • electrolyte imbalances
63
Q

S+S V Tach

A
  • severe hyperthermia

- “R on T phenomenon” next beat starts before ventricles are repolarized

64
Q

ECG characteristics V Tach

A
  • regular rhythm
  • QRS >0.2
  • HR 150-250 bpm
65
Q

what can sustained V Tach lead to

A
  • hypotension
  • pulmonary edema
  • decreased cerebral blood flow
  • cardiopulmonary arrest
66
Q

treatment for V Tach with pulse

A

-antidysrhythmics or cardioversion

67
Q

treatment for V Tach without a pulse

A
  • CPR and rapid defibrillation

- amiodarone can prevent going back into V Tach

68
Q

what is torsades de pointes

A

occurs with V Tach

next beat starts before ventricles are repolarized, varying heights of R waves

69
Q

1 cause of MI

A

v fib

70
Q

ECG characteristics V Fib

A
  • wavy baseline

- extremely irregular rhythm

71
Q

treatment for V Fib

A

CPR and debrillation

72
Q

causes v fib

A
  • MI
  • HF
  • electrolyte imbalances
  • severe alkalosis
  • drug toxicity
  • hypoxia
73
Q

ECG characteristics of asystole

A
  • absence of electrical impulses

- pt unresponsive and pulseless

74
Q

treatment asystole (5)

A
  • CPR
  • epinephrine 1 mg IVP q3-5 mins
  • intubation
  • temporary pacemaker
  • treat 5 Hs and 5 Ts
75
Q

5 (6) Hs with asystole

A
  • hypovolemia
  • hypoxia
  • hydrogen ion (acidosis)
  • hyper/hypokalemia
  • hypoglycemia
  • hypothermia
76
Q

5 Ts with asystole

A
  • toxins
  • tamponade
  • thrombosis (MI + pulmonary)
  • tension pneumothorax
  • trauma
77
Q

ECG characteristic of pulseless electrical activity (PEA)

A

any electrical pattern without pulse

78
Q

treatment PEA

A
  • CPR
  • epi IVP q3-5 mins
  • intubation
79
Q

how to use cardioversion

A
  • 50-100 J
  • sync to R wave
  • for supraventricular tach, a fib, a flutter, 2nd degree type 2 avb
80
Q

how to use defibrillation

A
  • 120-200 J
  • don’t sync to R wave
  • shock when clear
81
Q

what to tell pts about ICDs

A
  • don’t lift arm until cleared
  • avoid large magnets and MRIs
  • if fires once, call hcp; if once and sick or twice, call 911*
  • keep incision dry for several days after implant
  • avoid direct blows to site
82
Q

emergency management of dysrhythmias (6)

A
  • monitor ABCs
  • apply O2
  • take VS
  • 12 lead ECG
  • identify dysrhythmia
  • IV access
83
Q

what effect can b blockers and calcium channel blockers have on ECG strips (3)

A
  • bradycardia
  • prolonged PR interval
  • AV block
84
Q

who might need a pacemaker (6)

A
  • AV block
  • A fib
  • cardiomyopathy
  • HF
  • symptomatic bradycardia
  • tachydysrhythmias (V tach)
85
Q

who might need a temporary pacemaker (5)

A
  • maintaining HR and rhythm during surgery, cardiac cath, before permanent implant, drug therapy that may cause bradycardia
  • prophylaxis after open heart surgery
  • acute MI with 2nd or 3rd degree AVB
  • acute MI with symptomatic bradycardia
  • to evaluate pt with brady/tachydysrhythmias

PathoPharm 2 (33 decks)

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