dysrhythmias Flashcards
Mean Arterial Pressure
tells average pressure in artery
need be higher than 60
P wave
located in atrium
imp but will not die
QRS
located in ventricle
will die if inadequate
Cardiac Output (CO)
amt blood pumped from LV/min
= HR x SV
increase HR
= decrease SV –> decreased CO
heart beating too fast, ventricle doesn’t fill enough (low stroke volume), not enough blood in ventricle leads to low cardiac output
preload
dependent on amt blood going to heart
kidney failure and not excreting –> fluid overload –> large volume
afterload
difficult pump blood out heart
BP 200/100
contractility
force/effectiveness of each pump
force cardiac contraction independent of preload
BP
= CO x peripheral vascular resistance
cardiovascular system manifestations
pain discomfort cough SOA dyspnea DOE orthopnea PND - when lay down, fluid shift from legs to heart edema fatigue weakness palpitations dizziness syncope leg/calf pain
med hx of pt w/ cardiovascular problems
angina, MI, meds, allergies, DM
best indicator of fluid balance is weight
2.2 lb = 1 kg = 1 L fluid
takes 10-15 lbs before see edema
imp do daily wt on cardiac pts
labs - cardiac markers
troponin T and I
creatine kinase - MB specific to heart muscles
myoglobin - see heart damage sooner but gone w/in 7 hrs
labs - electrolytes affecting heart
Ca, Mg, K
lead to fatal dysrhythmia
can lead to death
labs - BNP
stretching of ventricles causes BNP released
labs - total cholesterol
labs - triglyceride
labs - LDL
Labs - HDL
> 40
labs - anticoags
PT/INR, PTT
labs - ABG
if heart not pumping, fluid going to lungs
labs - D-Dimer
tell if have clots
good lab use if having stroke
diagnostic tests
EKG
ECHO - look at structure of heart
TEE
holter monitor - look at every min of day
stress test - how much can tolerate stress on heart
angiography - look see how blocked vessels are
heart conduction - SA node
pacemaker of ehart
P wave
heart conduction - AV node
PR segment
heart conduction - Bundle of His
right and left bundle branch system
P wave
1 P per QRS complex
multiple indicates a-fib
different origination if P waves look diff
QRS
ventricular depolarization
tall and narrow b/c pump fast and hard
J point
end of QRS segment
ST segment
elevation - actively having MI
depression - K, Ca, Mg too high
T wave
repolarization
tombstone T wave = active heart attack
Normal Sinus Rhythm
Rate - 60-100/min Rhythm - normal P wave - present, consistent PR - 0.12-0.2 QRS duration - 0.04=0.1 second and constant
sinus tachy
Rate - >100/min
Rhythm - regular
P wave - present, consistent
PR -
sinus brady
Rate -
atrial dysrhythmias
Rate - Rhythm - P wave - PR - QRS -
Supraventricular Tachy
Rate - Rhythm - P wave - PR - QRS -
A-fib
Rate - Rhythm - irregular P wave - PR - n/a QRS -
ventricular dysrhythmia
rate - rhythm - P wave - PR - QRS -
ventricular fibrillation
nothing to count
cardiac interventions - meds
beta blocker ca channel blocker ACE inhibitors diuretics antidysrhythmics antilipids inotropes - dobutamine, dopamine, Epi, digoxin
cardiac intervention - MONA
morphine
oxygen
nitro
ASA
cardiac intervention - surgical tx
CABG
surgical valve repair
heart transplant
cardiac cath
cardiac intervention - devices
pacemaker
icd
cardioversion - conscious
synchronized shock w/ QRS
requires to have rhythm
defibrillation - unconscious
emergency
pt in v-fib/v-tach
management of cardiac arrest
perform CPR first
defibrillate b/c no rhythm
pacemaker
controls heart rate instead of SA node
icd
shocks heart back into rhythm when heart forgets to
HTN
60+ - `150/90
causes of essential HTN
obesity
smoking
stress
fam hx
cause of secondary HTN
renal disease
primary aldosteronism
cushing’s syndrome
meds
malignant HTN
BP 200/150
need rapid intervention
malignant HTN manifestations
HA
blurred vision
dyspnea
malignant HTN - lifestyle modifications
sodium restriction wt reduction reduce etoh intake exercise decrease stress smoking cessation
malignant HTN - med care
diuretics ca channel blockers ACE inhibitor ARBs aldosterone receptor antagonist beta-adrenergic blockers renin inhibitors
malignant HTN - nursing care -
daily wt I&O urine output response of B/P electrolytes take pulses ischemic episodes (TIA) complications w/ 4 C's - CAD, CRF, CHF, CVA
