Chapter 11 PowerPoint Flashcards
What is atrial fibrillation?
350-450 BPM
Irregular rate, muscle is Quivering
Irritated foci depolarizing but running into each other.
How does atrial fibrillation appear on an ECG?
No clear p wave
QRS spaced irregularity
What is the biggest issue in atrial fibrillation?
Coagulation is biggest issue
Anticoagulation for more than month required before shock treatment
What is the treatment for atrial fibrillation?
Treatment: Synchronized Cardioversion
VR> 100 is Rapid VR
< 100 is Normal rate
What is the second most common type of SVT?
AV Reentrant Tachycardia (AVRT)
What is Wolff-Parkinson-white syndrome?
A type of AVRT
What occurs in Wolff-Parkinson-white syndrome?
Signal bypasses AV node and reaches Ventricle myocardium before normal signal causing pre-excitation.
How does Wolff-Parkinson-white syndrome appear on an ECG?
Note Delta Waves just before QRS
What is Wolff-Parkinson-white syndrome caused by?
Caused by a congenital bypass
“Bundle of Kent”
How is Wolff-Parkinson-white syndrome solved?
Solved with Catheter Ablation
Who is AV Nodal Reentrant Tachycardia most common in?
Most common in young women. Healthy hearts
What is the typical rate of AV Nodal Reentrant Tachycardia?
Paroxysmal – Suddenly 250 +/- 50 bpm
What are the symptoms of AVNRT?
Light headedness, dizziness SOB, chest pain/pressure, fatigue or anxiety
What is AVNRT often misdiagnosed as?
Mis-diagnosed with anxiety or panic attacks
What is the treatment for AVNRT?
Resolution of episode is on own. No treatment
Reentry refers to occurring bc of right circumstances
How does AVNRT appear on an ECG?
ECG appearance
Rapid regular Ventricular Rate
Normal width QRS complex
No visible P wave
Retrograde p waves – II, III, aVF
AVNRT is dependent on ____ of conduction and ____ time of ____ ____?
AVNRT is dependent on speed of conduction and refractory time of AV node
What are four tachycardia rhythms?
Ventricular Tachycardia
-Monomorphic V-Tach
-Polymorphic V-Tach
Torsades De Points
-Polymorphic V-Tach w/ prolonged QT interval
Ventricular Flutter
Ventricular Fibrillation
What is paroxysmal ventricular tachycardia?
3 PVC’s in a row or < 30 sec of PVC’s
Typically will convert back to NSR w/o medical intervention
What does VT come from?
VT comes from Ectopic Foci triggering Vent Depol
How does ventricular tachycardia appear on an ECG?
ECG appearance
Every Beat has Wide QRS w/ T wave in opp. deflection
Each beat is symmetrical and identical
Rhythm is regular or slightly irregular.
No P waves or sparse
Rate is >100 but < 250
What are causes of paroxysmal VT?
Causes: History of MI with Heart disease, Myocardial ischemia, electrolyte disturbances, Cardiomyopathy, MVP, Myocardial contusion, drug toxicity, cocaine
V-tach signs and symptoms?
Signs and symptoms
Derive from decreased Cardiac Output
Hypotension, dyspnea, dizziness, lightheadedness, syncope
Chest pain or acute MI
Treatments for V-tach?
Medical treatment
911
Oxygen therapy, antiarrhythmic medication, cardioversion
Ablation if VT is consistently occurring
What is Torsade’s de pointes?
“Twisting around points”
QRS complex twists around isoelectric axis
Not typically a sustained run
Spontaneously terminates, recurs and degrades to Vfib
BTW VT and Vfib
What is associated with long QT syndrome?
Torsade’s de pointes
What is torsade’s de pointes generated by?
Generated from multiple foci in ventricles
QRS changes from Beat to Beat
Asymmetrical bc alternating in shape, height, and width
What are causes of torsade’s de pointes?
Cause
-Electro-disturbances
-Hypomagnesemia
-Hypokalemia
Medications
-Antiarrhythmics
-Tricyclic antidepressants
-Antibiotics (erythromycin
Treatment for torsade’s de pointes?
Treat Immediately : Defibrillator after pushing magnesium therapy.
Describe ventricular flutter?
250-350 BPM
Deadly and ineffective rhythm
1 foci in ventricle is irritated creating concurrent ventricular depolarization
No P waves
No BP
No Treatment but shock
Cannot self resolve
Describe ventricular fibrillation?
Rapid Arrythmia 400+/- 50
No organized depol or repol of ventricles
Quivering
No identifiable wave forms….. Chaotic electrical activity
No organized contraction of LV = no Cardiac Output = unconscious and pulseless patient
Defib required
EMERGENCY – deadly rhythm
350-450BPM Irregular
NO PULSE
NO BREATH
NO BLOOD PRESSURE
Bigger irregular scribble
No QRS complex
Shock advised!!!
Non synchronized cardioversion
