Dysrhythmias

Question 1

What is normal sinus rhythm

Answer 1

60-100

Question 2

What does the vagus nerve do

Answer 2

slows down heart

Question 3

What can the sympathetic system do to the AV node

Answer 3

let singles passs more often so increases HR

Question 4

What can the parasympathetic do to the AV node

Answer 4

opposite of symp

Question 5

Where does Digoxin work on

Answer 5

AV node

Question 6

What actually matters when looking at an EKG

Answer 6

Heart Rate
1:1 ratio of atrial and ventricular Cx
narrow QRS (less than 0.1-0.12)

Question 7

What does the time that the PR interval takes represent

Answer 7

how much AV resistance

Question 8

What is the normal PR interval time

Answer 8

less than 0.12-0.2

Question 9

On an EKG chart how many secs are the smallest boxs

Answer 9

0.04 secs

Question 10

On an EKG chart how many secs are the big boxs

Answer 10

0.2

Question 11

What is the first thing you should do if the EKG chart shows abnormal rhythms

Answer 11

make sure the leads are still connected

Question 12

If we still have a sinus rhythm but its lower than 60 bpm what is it called

Answer 12

sinus bradycardia

Question 13

Who gets sinus bradycardia

Answer 13

carotid sinus massage 
hypothemia 
increased vagal tone 
parasympathomimetic drugs
Hypothyroidism
Increased intracranial pressure
Obstructive jaundice
Inferior wall MI

Question 14

What do we give when sinus bradycardia is pathologic

Answer 14

atropine bec it reduces AV node resistance

Question 15

What causes sinus Tach

Answer 15

Exercise
Pain
Hypovolemia
Myocardial ischemia
Heart failure (HF)
Fever

Question 16

What symptoms make sinus brady pathologic

Answer 16

Hypotension 
Pale, cool skin
Weakness
Angina
Dizziness or syncope
Confusion or disorientation
Shortness of breath

Question 17

What symptoms make sinus tach pathologic

Answer 17

Dizziness and hypotension due to decreased CO

Increased myocardial oxygen consumption may lead to angina

Question 18

How do we treat sinus tach

Answer 18

fix problem like pain or reduce exercise

beta blockers

Question 19

What ratio are we going to have in atrial flutter

Answer 19

more atrial contractions than vent Cx

Question 20

How much CO do we lose with A flutter

Answer 20

10-20% of CO

Question 21

What are A flutter at higher risk for, why, and what might we do about it

Answer 21

clots because our blood is moving slower so we might give them coumadin

Question 22

Who gets A flutter

Answer 22

CAD
Hypertension
Mitral valve disorders
Pulmonary embolus
Chronic lung disease
Cardiomyopathy
Hyperthyroidism
Drugs: Digoxin, quinidine, epinephrine

Question 23

What are you at risk for with A flutter

Answer 23

High atrial rates (>100) and resultant loss of the atrial “kick” can decrease CO (by 10 to 20%) and precipitate HF, angina
Risk for stroke due to risk of thrombus formation in the atria

Question 24

What drugs are the usually best for A flutter

Answer 24

beta blockers

then calcium channel blockers

Question 25

Who gets defibrillation

Answer 25

V fib A systole pulseless V tach

Question 26

Whats the first thing to check with someone with V tach

Answer 26

see if they have a pulse

Question 27

Difference of cardioversion from defibrillation

Answer 27

much less voltage | the machine reads the ECG and waits to shock until T wave isnt going

Question 28

What are the manifestations of A fib

Answer 28

same as A flutter

Question 29

Who gets A fib

Answer 29

``` Underlying heart disease, such as rheumatic heart disease, CAD Cardiomyopathy HF Pericarditis Thyrotoxicosis Alcohol intoxication Caffeine use Electrolyte disturbance Cardiac surgery ```

Question 30

What do we do for patients going in to get cardioversion for A fib and A flutter

Answer 30

put them on coumadine for 3 days prior

Question 31

How fast is the HR from cells in the middle of the heart

Answer 31

40-60 like AV node (junctional areas of the heart

Question 32

What is a 1 deg block

Answer 32

PR interval greater than .2 | still has 1:1

Question 33

What is a 2nd deg block

Answer 33

PR interval > .2 every QRS has a P but not evwery P has QRS may have QRS's that goes missing

Question 34

What is 3rd deg block

Answer 34

QRS and P are unrelated | For example, Atrium pumping at 60-100 and vents pumping at 20-40

Question 35

What is the progression of AV blocks

Answer 35

they progress into eachother

Question 36

Who gets 1 AV block

Answer 36

``` MI CAD Rheumatic fever Hyperthyroidism Vagal stimulation Drugs: Digoxin, -adrenergic blockers, calcium channel blockers, flecainide ```

Question 37

What is a unique trait about symptoms of 1 AV block

Answer 37

usu asymptomatic

Question 38

What is the first thing to check for with 1 AV block for treatment and why

Answer 38

check there meds bec a new drug may be causing it

Question 39

What causes 2 AV block

Answer 39

Drugs: digoxin, Beta-adrenergic blockers CAD and other diseases that can slow AV conduction rheumatic heart disease Anterior MI

Question 40

What are some treatments of 2 AV block

Answer 40

atropine | temporary pacemaker

Question 41

What are we hoping for after giving atropine for 2 AV block

Answer 41

increased Vent rate

Question 42

What is a common symptoms caused by 2 AV block

Answer 42

hypotension | MI's

Question 43

What are the steps for analyzing an ECG

Answer 43

``` Rates (both atrial and vent) Regularity (do they march out) P wave shape (want it to be sharp) Ratio of P waves to QRS PR interval time QRS time ```