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critical care > Dysrhythmias > Flashcards

Dysrhythmias Flashcards

1
Q
A
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1
Q

Match the lead (V1, 2, 3, 4, 5, 6) to its correct location:
A. 4th intercostal space to the RT of the sternum
B. The 3rd intercostal space to the LT of the sternum
C. The left midaxillary line at the 5th intercostal space
D. 4th intercostal space to the LT of the sternum
E. The left anterior axillary line at the 5th intercostal space
F. The left midclavicular line at the 5th intercostal space

A

A. V1
B. V3
C. V6
D. V2
E. V5
F. V4

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2
Q

Write the views reflected by each lead:
1. lead I
2. II
3. III
4. aVr
5. aVL
6. aVf
7. V1
8. V2
9. V3
10. V4
11. V5
12. V6

A
  1. lateral (R)
  2. inferior (L)
  3. inferior (R)
  4. superior/SVC
  5. lateral (L)
  6. inferior
  7. septal
  8. septal
  9. anterior
  10. anterior
  11. lateral (L)
  12. lateral (L)
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3
Q

normal PR interval

A

0.12-0.20

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4
Q

normal QRS duration

A

0.06-0.1

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5
Q

normal QT interval

A

0.30-0.40

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6
Q

Sinus arrhythmia

A

rate: irregular R-R; 60-100 bpm

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7
Q

sinoatrial arrest/block

A

rate: regular except dropped PQRST

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8
Q

PACs

A

rate: regular except premature beat and noncompensatory pause

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9
Q

Causes of sinus tachycardia

A

stimulants
stress
fever
pain
anxiety
CAD
heart failure
shock, hypovolemia

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10
Q

symptoms of sinus tachycardia

A

symptoms: SOB, dizziness, anxiety, LoC

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11
Q

sinus tachycardia treatment

A

treatment: treat underlying cause, vagal maneuvers, beta blockers

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12
Q

causes of sinus bradycardia

A

increased parasympathetic tone
increased ICP
medication (b-blockers)
IWMI

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13
Q

symptoms of sinus bradycardia

A

symptoms: hypotension, syncope, dizziness, dyspnea, premature beats, chest pain

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14
Q

sinus bradycardia treatment

A
  1. assess BP, mental status, chest pain, RR
  2. notify provider
  3. treat underlying cause
  4. atropine or glucagon (if d/t b-blocker toxicity)
  5. pacemaker
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15
Q

causes of sinus arrhythmia

A

normal variation caused by respirations

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16
Q

causes of sinoatrial block

A

vagal stimulation
digitalis toxicity
hyperkalemia
IWMI
acute myocarditis

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17
Q

treatment for sinus arrhythmia

A

none

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18
Q

symptoms of SA block

A

can lead to asystole or cardiac arrest
symptoms: syncope, skipped beat

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19
Q

treatment for SA block

A
  1. assess patient BP, mental status, RR
  2. treat underlying cause (hyperK - calcium gluconate, insulin, myocarditis - b-blockers, corticosteroids, digitalis - digibind)
  3. atropine, pacemaker
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20
Q

causes of PACs

A

stimulants
hypokalemia
hypoxia
myocarditis
myocardial ischemia
CHF

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21
Q

significance and symptoms of PACs

A

significance: can lead to tachycardia, a-flutter, a-fib
symptoms: dizziness, palpitations, skipped beats

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22
Q

PAC treatment

A
  1. assess patient and frequency
  2. notify provider if symptomatic or increased frequency
  3. treat underlying cause
  4. b-blockers, digitalis, amiodarone
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23
Q

Wandering pacemaker

A

irregular & variable P waves (upright, inverted, always visible)

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24
Q

causes of wandering pacemaker

A

digitalis toxicity
CAD
heart disease of the SA node

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25
Q

symptoms of wandering pacemaker

A
  • may be asymptomatic
  • decreased atrial contraction (kick)=syncope, dizziness, SOB, fatigue, weakness
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26
Q

wandering pacemaker treatment

A
  1. assess patient: BP, symptoms
  2. notify provider if taking digitalis or symptomatic
  3. atropine, pacemaker if bradycardia
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27
Q

atrial tachycardia

A

rate: >150

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28
Q

causes of atrial tachycardia

A

HTN heart disease
cor pulmonale
MI
digitalis toxicity
stress or fatigue

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29
Q

symptoms of atrial tachycardia

A

palpitations, numbness/tingling, chest pain, pale/cold extremities

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30
Q

atrial tachycardia treatment

A
  1. decrease HR -> adenosine, procainamide, amiodarone, digitalis, b-blocker
  2. syncronised cardioversion
  3. overdrive atrial pacing
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31
Q

atrial flutter

A

SAWTOOTH

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32
Q

causes of atrial flutter

A

catecholamine secretion
SA node damage
CHF

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33
Q

atrial fluttersymptoms

A

symptoms: dizziness, palpitations, chest pain, syncope

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34
Q

atrial flutter treatment

A
  1. assess patient: BP, mental status, perfusion, RR
  2. notify provider if sustained or new onset
  3. synchronized cardioversion
  4. treat tachycardia/bradycardia: amiodarone, b-blockers, CCBs, digitalis
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35
Q

atrial fibrillation

A

unidentifiable P waves, irregular ventricular rate

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36
Q

causes of atrial fibrillation

A
  • MI
  • CAD
  • CHF
  • COPD
  • heart surgery
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37
Q

significance and symptoms of atrial fibrillation

A

significance - increases risk for thromboemboli, ventricular failure, RVR (rapid ventricular rate)
symptoms: chest pain, SOB, dizziness, palpitations

38
Q

atrial fibrillation treatment

A
  1. assess patient - BP, HR, mental status
  2. notify physician if new onset, symptomatic, or new rhythm
  3. amiodarone, cardioversion
  4. no interventions except anticoagulant therapy
39
Q

junctional rhythm/escape

A

HR 40-60; variable P waves, not always visible.

40
Q

What is a junctional rhythm?

A

Rhythms that arise from the AV node

41
Q

causes of junctional escape rhythm

A
  • increased parasympathetic activation
  • digitalis
  • IWMI
  • ischemia
  • hypoxia
42
Q

significance and symptoms of junctional escape rhythms

A

significance - increases risk for bradycardia and decreased CO
symptoms - myocardial ischemia, heart failure, dizziness, SOB, chest pain

43
Q

treatment of junctional escape rhythm

A
  1. assess patient
  2. notify provider if new onset, down-trending
  3. atropine, pacemaker
44
Q

premature junctional complexes

A

NSR except the premature QRS complex has P-wave that is abnormal or absent.

45
Q

causes of premature junctional complexes

A
  • stress, drugs, alcohol
  • digitalis
  • myocarditis
  • ischemia, HF
46
Q

treatment of premature junctional complexes

A
  1. assess patient, frequency
  2. notify provider if symptomatic, taking digitalis, or increasing in frequency
  3. treat underlying cause
  4. amiodarone, B-blocker, digitalis
47
Q

accelerated junctional rhythm

A

rate: regular, 60-100
irregular and variable/missing P-waves

48
Q

causes of accelerated junctional rhythm

A
  • increased catecholamine secretion
  • digitalis
  • MI
  • myocarditis
  • ischemia
  • HF
49
Q

treatment for accelerated junctional rhythm

A
  1. assess patient, symptoms, meds
  2. hold digitalis and notify provider
  3. treat underlying cause
  4. medications - procainamide
  5. cardioversion
50
Q

1st degree AV block

A

looks like NSR but prolonged PR interval (>0.20)

51
Q

causes of 1st degree AV block

A
  • increased parasympathetic tone
  • digitalis
  • MI
  • myocarditis
  • ischemia, CAD
52
Q

significance and symptoms of 1st degree AV block

A

may be benign, increases risk for higher AVBs

53
Q

treatment of 1st degree AV block

A
  1. assess pt
  2. hold medications and notify physician
  3. atropine if PR >0.28
  4. pacemaker
54
Q

2nd degree AV block Type I

A

increasingly long PR until dropped beat

55
Q

causes of 2nd degree AV block Type I

A

increased parasympathetic tone
digitalis
electrolyte imbalance
IWMI
ischemia
acute rheumatic fever

56
Q

treatment for 2nd degree AV block Type I

A
  1. assess pt - BP, HR, mental status, meds
  2. usually not needed
  3. atropine, pacemaker, hold meds
57
Q

2nd degree AV block Type II

A

consistent PR interval until dropped beat

58
Q

causes of 2nd degree AV block Type II

A
  • digitalis
  • MI
  • CAD
  • necrosis of conduction pathway
59
Q

treatment for second degree type ii heart block

A
  • assess patient: BP, mental status, RR, HR
  • notify provider
  • atropine, pacemaker
  • treat underlying cause
60
Q

third degree heart block

A

atrial and ventricular rates regular, but at different rates.

61
Q

causes of third degree heart block

A

parasympathetic stimulation
digitalis toxicity
IWMI or AWMI
AV node damage

62
Q

significance of third degree heart block

A
  • may lead to HF, shock, ventricular fibrillation, ventricular standstill, anoxia
63
Q

treatment of third degree heart block

A

atropine
pacemaker

64
Q

WPW

A

QRS interval: >0.11 (wide, funky base)

65
Q

treatment for WPW

A
  1. depends on pt tolerance & ventricular rate
  2. amiodarone (afib), atropine (bradycardia), or procainamide
  3. ablation of extra conduction pathway
66
Q

what is a characteristic of all ventricular rhythms?

A
  • wide QRS complex
  • absent P-waves
67
Q

Premature ventricular complexes

A

wide and large QRS at irregular intervals over the underlying rhythm

68
Q

causes of PVCs

A
  • stress/drugs
  • digoxin
  • electrolyte imbalances (hypoK)
  • myocarditis
  • ischemia, CAD, CHF
  • hypoxia
69
Q

PVC treatment

A
  1. assess patient and frequency/characteristic of PVCs
  2. notify provider if new or increasing in frequency
  3. amiodarone
70
Q

v-tach

A

wide QRS one after another, without rest

71
Q

v-tach causes

A
  • drugs
  • meds that prolong QT interval
  • R on T phenomenon
  • MI
  • ischemia, CAD, CHF
  • CAD
72
Q

v-tach treatment

A
  1. assess for pulse and breathing
  2. if pulse - notify provider, cardioversion
  3. if pulseless- CODE - defibrillation & CPR
73
Q

v-fib

A

wiggles

74
Q

v-fib causes

A
  1. drugs
  2. prolonged QT
  3. R on T phenomenon
  4. MI
  5. cardiomyopathy
  6. CAD, CVA
  7. hypothermia
75
Q

v-fib treatment

A
  1. CODE -> defibrillate
76
Q

torsades de pointes

A

cyclic positive and negative QRS complexes (high rate)

77
Q

causes of torsades de pointes

A
  1. drugs
  2. prolonged QT
  3. R on T phenomenon
  4. electrolyte imbalances (K, Ca, Mg)
78
Q

torsades de pointes treatment

A
  1. assess patient for pulse and symptoms
  2. administer magnesium
  3. discontinue meds
  4. defibrillation
79
Q

ventricular escape rhythm

A

slow rate, weird and wide QRS

80
Q

causes of ventricular escape rhythm

A
  • drugs
  • electrolyte imbalance
  • heart block
81
Q

treatment for ventricular escape rhythm

A
  1. atropine
  2. pacing
82
Q

asystole

A

flat-line, no electrical activity

83
Q

asystole causes

A
  • MI
  • necrosis
  • hypoxia
84
Q

asystole treatment

A

CODE - epinephrine + CPR

85
Q

secondary asystole

A

rate <20, no P-waves

86
Q

causes of secondary asystole

A

ischemia due to hypoxia of myocardial muscles

87
Q

secondary asystole treatment

A

none, already too late

88
Q

RBBB

A

wide and largely positive QRS complexes with P-waves

89
Q

causes of RBBB

A
  • congenital lesions
  • digoxin
  • electrolyte (hypoK)
  • MI
  • CAD, CHF
90
Q

RBBB treatment

A
  • treat underlying cause
  • pacemaker
91
Q

LBBB

A

wide, large QRS complexes, probably negative

92
Q

LBBB causes

A
  • congenital lesions
  • digoxin
  • MI
93
Q

LBBB treatment

A
  • treat underlying cause
  • pacemaker

critical care (8 decks)

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