Dysrhythmias

Question 1

What indicated MIs?

Answer 1

ST is elevated (ST segment is usually on the baseline)

ST is depressed

Question 2

Treatment for bradycardia

Answer 2

Only tx if symptomatic 
Atropine 0.5-1mg IVP
Epi 2-10 mcg/min
Transcutaneous pacemaker 
Dopamine 5-20 mcg/kg/min

Question 3

Treatment for Tachycardia

Answer 3

Treat underlying cause (fever, anxiety, hypovolemia, CHF, pain)

Question 4

Tx goal for Aflutter?

Answer 4

Aimed at decreasing HR and ventricular response since rapid HR decreases ventricular filling and CO

Question 5

Medications used to tx aflutter

Answer 5

Digitalis
Diltiazem/Verapamil (Ca channel blockers) - AV block and decreases conduction through the AV node, thus decreases ventricular rate

Question 6

Complication of Afib

Answer 6

Thrombi formation in atria due to dilated state of the atria and stagnation of blood in the atria
May take ASA or coumadin

Question 7

Tx for Afib

Answer 7

Amiodarone
Diltiazem/ Verapamil (Ca Channel blockers)
Digitalis - blocks AV node conduction to allow more time for ventricular filling
Synchronized cardioversion

Question 8

Characteristics of SVT

Answer 8

HR > 150 bpm

Question 9

S/S of SVT

Answer 9

Dizziness
Palpitations
Chest Pain
SOB/Dyspnea
Syncope (temporary loss of consciousness)
Hypotension

Question 10

Tx of SVT

Answer 10

Vagal maneuvers
If symptomatic: Adenosine 6mg IVP, if no change adenosine 12mg IVP
Ca Channel blockers
B-blokers
Amiodarone 
Synchronized cardioversion

Question 11

Long-term tx for SVT

Answer 11

Avoid caffeine, smocking, stimulants(drugs)
Digoxin, Ca channel blockers, B-blockers
Radio frequency ablation treatment

Question 12

Characteristics of First Degree AV block

Answer 12

PR interval > 0.20sec (each complex looks the same)

1:1 P to QRS ration

Question 13

Causes of First Degree AV block

Answer 13

Digoxin Toxicity
B-blockers
CAD

Question 14

Tx of First Degree AV block

Answer 14

Monitor

check serum levels

Question 15

Characteristics of Second Degree AV block Type 1

Answer 15

Progressive lengthening of PR interval until a QRS complex is missed

Question 16

Causes of Second Degree AV block Type 1

Answer 16

Any drug or disease affecting AV node
Myocarditis
MI

Question 17

Tx of Second Degree AV block Type 1

Answer 17

Monitor signs of decreased CO and signs of progressive block

Question 18

Characteristics of Second Degree AV block Type 2

Answer 18

Occurs usually below AV node, usually bundle branches;
PR interval may be > 0.20sec or normal but not progressive in length.
Misse QRS complexes after P wave
QRS greater then 0.10sec if BBB (bundle branch block): 0.11 sec is incomplete BBB, 0.12sec is complete BBB

Question 19

Causes of Second Degree AV block Type 2

Answer 19

Anterior MI

Fibrotic disease of conduction system

Question 20

Tx of Second Degree AV block Type 2

Answer 20

Watch for S/S of complete heart block
Cardiac monitoring
Transcutaneous Pacemaker

Question 21

Characteristics of Third Degree AV block (Complete Heart Block)

Answer 21

P wave is not related to QRS (Shark Fan appearance)
No arterial impulses are conducted to the ventricles
Block occurs at AV node, bundle of His, or bundle branches.
Atria and Ventricle beat independently of each other

Question 22

Tx of Third Degree AV block

Answer 22

Transcutaneous Pacemaker
Dopamine
Epi
Schedule OR for permanent pacemaker

Question 23

Characteristics of Premature Ventricular Contractions (PVC)

Answer 23

A beat that occurs anywhere in the ventricle prior to the time of the expected beat.
Rate is irregular
QRS > 0.10sec
No P wave
Followed by a compensatory pause
ST segment of PV is in the opposite direction of the QRS

Question 24

Tx of PVCs

Answer 24

Check electrolytes (K ang Mg)
#1 Tx Mg
#2 Tx Amiodarone
If there are more than 6 PVCs per minute may bolus with Lidocaine 1mg/kg followed by continuous infusion of lidocaine 2-4mg/min or Amiodarone.

Question 25

Tx of Ventricular Tachycardia

Answer 25

Stable Pt: O2, Amiodarone, if meds don’t work cardioversion
Unstable Pt: Cardioversion
Pt with NO pulse need to be treated as VF and defibrillate immediately

Question 26

Tx of Ventricular Fibrillation

Answer 26

Defibrillate immediately

Follow ACLS protocol

Question 27

Tx of Asystole

Answer 27

CPR
Intubation
Epi 1mg IVP

Question 28

Explain Pulseless Electrical Activity (PEA) and the treatment

Answer 28

A rhythm on the monitor but no pulse
Tx same as asystole
Look for underlying causes H’s and T’s