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Dysrhythmias Flashcards

1
Q

Dysrhythmias matter bc

A

Impacts on CO

Pts will compensate

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2
Q

Phases of heart beat

A

1 Atrial depolarization/contraction
2 Isovlumetric contraction
3 Rapid ejection
4 Reduced ejection
5 Isovolumetric relaxation
6 Ventricular filling

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3
Q

Atrial Kick

A

The contraction at the end of passive ventircle filing

30% of CO

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4
Q

Two types of myocardial tissue

A

Contractile
Conductive

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5
Q

Conduction system of heart

A

SA, AV, Bundle of His, and Perkinje fibers

Are able to spontaneously discharge electrical impulses WITHOUT stimulation causing a contraction

All dysrthmias originate with a defect in the conduction system

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5
Q

Which nerve is responsible for PSNS of heart

A

Vagus nerve

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6
Q

What is automaticity

A

The way that the heartt repeatedly beats using it;’s conducitve system (SA Node) without any stimulation

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7
Q

What nerves control sympathetic NS of heart?

A

Fibers of SNS

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8
Q

SA node fires in what range

A

60-100 BPM

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9
Q

AV node

A

Has an automaticity associated with it, but lesser than SA

40-60 BPM

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10
Q

Automatic intrinsic rate of purkinje fibers and Bundle of his

A

20-40 BPM

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11
Q

Primary pace maker in the heart

A

SA Node

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12
Q

3 distinct waves in cardiac cycle

A

P wave
QRS complex
T wave

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13
Q

Dysrhythmias

A

Alterations in normal impulses or conduction of normal myocardial beating

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14
Q

Ectopic Pacemakers/Focci

A

Origination of eletrical impulse is occuring somewhere other than SA (Competing with SA)

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15
Q

Two primary causes of dys

A

Ectopic focci
Lack of blood flow to normal conduction systems of heart

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16
Q

Classifaction of dysrhythmias

A

Location: Atrial or ventricular

Type: Flutter (Regular),
fibrillation. (Disorganized), \block (Delay or block of electrical flow through part of heart)

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17
Q

Afib

A

Passive entering of blood into ventricles, no atrial kick

  • Blood sits in atrium, often resulting in clot
18
Q

SS of Dysrhythmias

A

Syncope
SOB
Weakness
Fatigue
Tingling periphres
Decreased exercise tolerance
Palpitation

19
Q

Risk factors for dysrhythmias

A

High cholesterol
Metabolic syndroe
HTN
CAD
Hyper/hypoK
MI
DM
HF

Anyone without a healthy heart

20
Q

Asymptomatic dysrhythmias tx

A

Little or no benefit to treatment with medications

21
Q

Acute dysrhythmias tx

A

In life-threatening cases, medications warranted

22
Q

Prophylaxis of dysrhythmias tx

A

Generally onluy for high risk pts
Avoid drug combinations that increase QT interval

23
Q

Antidysr drugs

A

Prevent impulse conduction problems

Can also CAUSE dysrythmias
- High risk with them

24
Non pharm tx
Cardioversion or Defibrillation - Serious Cardiac ablation - Laser therapy of ectopic cells Cardiac Pacemakers Implantable Cardioverter Defibb (ICDs) - Keeps pt alive
25
Common reasons for Bradydysrhthmias
HR Less than 60 BPM Common in older adults Medication can cause Common types: Sinus bradycardia Sinoatrial node dysfunction (sick sinus syndrome) Atrioventricular (AV) conduction block
26
Normal sinus rhythm
Heart beat originate in sinoatrial node
27
Tachydysrythmias
HR 100 Incidence increases in older adults and those with preexisting cardiac disease Common tachydysrhythmias Atrial tachycardia Paroxysmal supraventricular (Intermittent) tachycardia (PSVT) Atrial flutter Atrial fibrillation Ventricular tachycardia Torsades de pointes Ventricular fibrillation
28
AFib
CHronic or intermittent Totally disorganized atrial electrical activity Loss of CO Tx: - sychronized cardioversion - Anticoagulant - Rate control (Beta blocker, Ca channel blocker) - Long term anticoagulation (CHADS score)
29
CHADS score
Way in which MDs compare risk-benefit for coagulation therapy in Afib COntraindicaitons include: High bleed risk High fall risk
30
Antidysrythmic drugs act in two ways
Blocking ion flow through ion channels Altering Autonomic activity
31
Therapeutic goals are?
Terminate or tx existing dysrythmia Prevent reccurance of abnormal rhythm
32
Dysrthymic drugs Therapeutic range
Have a narrow therapeutic margin between therapeutic and toxic effects and can actually worsen or create further dysthymias.
33
Antidysrhythmia Agent Categories
Sodium Channel Blockers (Class 1) Beta-adrenergic Blockers (Class 2) Potassium Channel Blockers (Class 3) Calcium Channel Blockers (Class 4) Miscellaneous antidysrhythmic drugs
34
Sodium Channel Blockers (Class 1)
Largest group of antidysrhythmics Similar in structure and function to local anesthetics - Prevents depolarization (conduciton of nerve impulses) Lidocaine, procainamide
35
Beta-Adrenergic Antagonists: Class II
Treat HTN, MI, HF, and dysrhythmias Block calcium channels in SA and AV nodes Slow HR ( NEGATIVE Chronotropic effect) Decrease conduction velocity
36
Prototype Drug – Propranolol (Inderal)
Non selective (B1 and B2) For pts as PRN for intermittent PSVT (spontaneous HR racing) Asthmatics should NOT take (Acute asthma attack AE: HTN Bcardia, fatigue, bronchoconstriction
37
Potassium Channel Blockers: Class III
Block potassium ion channels in myocardial cells Delay repolarization (Restoring electrical balance) Prolong refractory period Limited use due to serious adverse effects
38
Prototype Drug – Amiodarone (Cordarone)
K+ Channel blockers Therapeutic effects and uses Atrial and ventricular dysrhythmias Resistant ventricular tachycardia Recurrent fibrillation Mechanism of action Exact mechanism unknown Blocks potassium channels but also blocks sodium ion channels and inhibits sympathetic activity AE Slow to resolve Nausea Vomiting Anorexia Fatigue Dizziness Hypotension Visual disturbances Rashes Photosensitivity Pneumonia like syn
39
Calcium Channel Blockers: Class IV (1 of 2)
Limited number approved as antidysrhythmics: Diltiazem, Verapamil Effects similar to those of beta adreneric antagonists Safe
40
Nursing Considerations for Patients Receiving Antidysrhythmic Therapies
VS. and ECG Educate on self monitoring for dizziness, ortho HOTN Monitoring electrolytes
41
Dysrhythmias associated w/ Acute Coronary Syndrome (ACS)
Typical ECG Changes seen in myocardial ischemia ST segment depression T Wave inversion
42
Syncope
Brief lapse in consciousness accompanied by a loss in postural tone (fainting) Cardiovascular vs noncardiovascular
43
CV causes of syncope
Vasovagal syncope Primary cardiac dysrhythmias Prosthetic valve malfunction Pulmonary emboli Aortic dissection

NURS200 (30 decks)

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