Dysrhythmias Flashcards
1
Q
Length of time for PR interval
A
0.12-0.2s
2
Q
Length of time for QRS
A
<0.12
3
Q
What two conditions is sinus bradycardia normal?
A
Athletes
During sleep
4
Q
Causes of Sinus Brady
A
Meds: Beta blocker, digoxin Valsava Maneuver Carotid massage Hypothyroid Hypothermia
5
Q
Symptomatic Sinus Brady
A
Hypotension Diaphoresis Chest pain SOB Change in mental status, fatigue Decrease C.O. Decrease O2 Cool skin
6
Q
Treatment for Sinus Brady
A
Do not treat if normal for pt
- Treat underlying cause
- Give O2
- Pacer
- Epinephrine or dopamine gtt
- Atropine helps increase HR (inhibits vagus nerve)
7
Q
Sinus Tachycardia
A
100-149bpm
8
Q
Causes of Sinus Tachy
A
Running or exercise Hypovolemia (dehydration) Pain, Anxiety Fever, Infection CHF (heart thinks its not getting enough O2 out) Hyperthyroid
9
Q
Symptoms of Sinus Tachy
A
Depends on the patients tolerance to the increased HR
May experience dizziness, hypotension, or increase need for CO2
10
Q
Treatment for Sinus Tachy
A
If normal, no treatment
- Treat underlying cause (hydrate pt, treat fever)
- Limit stimulants:
- Give O2
- Give lasix if HF
- Carotid massage (physician only)
- Valsalva maneuvers (bear down) - Meds: CCB, Beta blocker
11
Q
Premature Atrial Contraction (PAC)
A
Contraction originating from ectopic focus in atrium on location other than the sinus node
Travels across atria by abnormal pathway, creating distorted P wave
Is stopped, delayed, or conducted normally at the AV node
12
Q
PAC causes
A
Emotional stress Caffeine, tobacco, or alcohol Infection, inflammation COPD Valvular disease
13
Q
PAC treatment
A
- Depends on symptoms
- Adrenergic blockers may be used to decrease PACs (caution in COPD & asthma pt’s)
- Usually Mg replacement ordered
14
Q
Atrial flutter
A
- Recurring, regular, sawtooth-shaped flutter waves
- Associated with slower ventricular response
15
Q
Atrial flutter causes
A
CAD, MI, HTN Valve problems Rheumatic heart disease HF Hyperthyroid Possible post-CABG Lone Afib Holiday heart Hyperthyroid Mitral valve disease Heart diseases
16
Q
Atrial flutter Symptoms
A
Decreased C.O. Palpitations SOB, chest pain Fatigue, syncope HF Change in mental status
17
Q
Atrial flutter treatment
A
- Heparin drip: to prevent clots
- Meds: digoxin, CCB, Amiodarone (last line)
- Cardioversion
- Coumadin: long term, monitor PT/INR
- Ablation
- Pacemaker
18
Q
Paroxysmal Supraventricular Tachycardia (PSVT)
A
HR greater than 150 bpm
Usually, no P wave identifiable
19
Q
Causes of PSVT
A
Overexertion Emotional stress Stimulants Digitalis toxicity CAD
20
Q
PSVT treatment
A
Vagal stimulation & drug therapy
If hemodynamically unstable, cardioversion may be used
Chemical cardioversion: adenosine
Recurrent PSVT: ablation
21
Q
Atrial Fibrillation
A
Total disorganization of atrial activity without effective atrial contraction
Can’t identify a P wave, always irregular
QRS to QRS is irregular
350-450bpm
22
Q
Causes of A. fib
A
CAD, MI, HTN Valve problems Rheumatic heart disease HF Hyperthyroid Possible post-CABG Lone Afib Holiday heart Hyperthyroid Mitral valve disease Heart diseases
23
Q
A. fib symptoms
A
Decreased C.O. Irregularly irregular pulse Palpitations SOB, chest pain Fatigue, syncope HF Change in mental status
24
Q
A. fib treatment
A
- Heparin drip: to prevent clots
- Meds: digoxin, CCB, Amiodarone (last line)
- Cardioversion
- Coumadin: long term, monitor PT/INR
- Ablation
- Pacemaker
25
Junctional rhythm
Arrythmia that originates in area of AV node
Impulse may move in retrograde fashion, producing abnormal P wave
Impulse usually moves through ventricles
Inverted P wave before, during, or after QRS
Always regular
26
Causes of Junctional rhythm
Uncommon
| Heart damage
27
Junctional Rhythm Treatment
Atropine
| Pacer
28
Premature Ventricular Contractions
```
Non perfusing or no pulse beat
Contraction originating in ectopic focus of the ventricles
Premature occurrence of QRS complex
Early QRS beats
Big, wide QRS wave
Occurs without P wave before it
```
29
Unifocal vs. multifocal
Multifocal is if there is another PVC that looks different (more likely to go into V. tach)
More than 3 non perfusing beats in a row is considered V. tach
30
Causes of PVC
```
Fever
Caffeine, stress
Exercise
Drugs (cocaine)
Hypokalemia, hypovolemia
Metabolic acidosis
Hypoxia
HF, MI
Digoxin toxicity, TCA, amphetamines
Increase or decrease in K+, CA2+, or Mg
```
31
PVC symptoms
1. May be asymptomatic
2. Palpitations
3. Irregular pulse
4. Decreased C.O.
5. Hypotension
6. HR can lead to V. tach --> V. fib --> cardiac arrest if not treated
32
PVC treatment
If asymptomatic, continue to monitor
1. Drugs: anti arrhythmic (amiodarone)
2. Magnesium
3. Treat cause
33
Ventricular Tachycardia
```
3 or more PVCs occur
Life threatening arrhythmia because it is non perfusing and it can lead to V. fib
No p wave before QRS
QRS are wide
150-250bpm
```
34
Causes of V. tach
```
Fever
Caffeine, stress
Exercise
Drugs (cocaine)
Hypokalemia, hypovolemia
Metabolic acidosis
Hypoxia
HF, MI
Digoxin toxicity, TCA, amphetamines
Increase or decrease in K+, CA2+, or Mg
```
35
Symptoms of V. tach
No pulse or fast, light pulse
Pale, unconscious or non-responsive
Low or no BP
36
Treatment of V. tach
Check lead placement first t confirm
1. Call code
2. ABC's, start CPR
3. IV-O2-Monitor
4. Defibrillation
5. Epi/vasopressin
6. Amiodarone, sotolol, procainamide (if pt has pulse)
7. Magnesium replacement
* Be prepared for pt to go into V. fib
37
Idioventricular Rhythm (Ventricular bradycardia)
Worst arrhythmia
Faint pulse or none
Slow, wide QRS complexes
38
Idioventricular Rhythm Treatment
1. Check DNR status
2. Check pt: Call code
3. CPR
4. Epi/vasopressin
5. Do not shock!
39
Ventricular Fibrillation
```
No QRS
No P waves
No C.O.
No pulse
Only fluttering of the heart
```
40
V. fib causes
```
Fever
Caffeine, stress
Exercise
Drugs (cocaine)
Hypokalemia, hypovolemia
Metabolic acidosis
Hypoxia
HF, MI
Digoxin toxicity, TCA, amphetamines
Increase or decrease in K+, CA2+, or Mg
```
41
V. fib symptoms
1. May be asymptomatic
2. Palpitations
3. Irregular pulse
4. Decreased C.O.
5. Hypotension
6. HR can lead to V. tach --> V. fib --> cardiac arrest if not treated
42
V. fib treatment
If asymptomatic, continue to monitor
1. Drugs: anti arrhythmic (amiodarone)
2. Treat cause:
- give O2,
- check chem panel for electrolyte replacement,
- decrease digoxin if caused by toxicity,
- correct acidosis
- treat fever
43
5 H's of Asystole
1. Hypovolemia
2. H ion (acidosis)
3. Hyper/hypo K+
4. Hypoxia
5. Hypothermia
44
5 T's of Asystole
1. Toxins
2. Tamponade
3. Tension pneumothorax
4. Thrombus
5. Trauma
45
Asystole treatment
```
Check pt first
Call code
IV-O2-Monitor
CPR
Epi/Vasopressin
DO NOT SHOCK PT, you will kill pt completely
```
46
Pulseless Electrical Activity
Can be ANY rhythm, but your pt will not have a pulse
| Electrical activity can be observed on ECG, but there is no mechanical activity of ventricles and pt has no pulse
47
Causes of Pulseless Electrical Activity
```
Hypovolemia
Drug overdose
MI
Hyper or hypokalemia
Pulmonary embolus
```
48
Pulseless Electrical Activity treatment
CPR --> intubation and IV therapy with dpi
| Correct underlying cause
