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406 Exam 3 > Dysrhythmias > Flashcards

Dysrhythmias Flashcards

1
Q

parasympathetic influence on heart

A

Lowers HR

Slows impulse conduction

Decrease force of contraction

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2
Q

Sympathetic influence on heart

A

Increases rate and force of contraction

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3
Q

SA node

A

above right ventricle

60-100bpm

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4
Q

AV node

A

In the right ventricle

40-60bpm

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5
Q

Purkinje fibers

A

20-40bpm

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6
Q

3 electrode system

A

White: Right upper chest
Black: Left upper chest
Red: Left lower chest

WHITE ON RIGHT, SMOKE OVER FIRE

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7
Q

5 electrode system

A

same as 3 electrode plus

Brown right lower sternum

Green lower right (equidistant from red)

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8
Q

12 lead EKG placement

A

4 on limbs

V1 starts just right of mid sternum then kinda makes a line going diagonal and down to the left.

V2 at just left of mid sternum

V3 just up and right of apical pulse spot

V4 at apical pulse

V5 at intercostal space to left of apical pulse

V6 1 rib lower and to the left of V5. Will kind of be on the side.

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9
Q

How to determine BPM from ECG

A

Count number of R waves (tall guys) for 6 seconds

multiply that number by 10

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10
Q

How can you tell how long 1 second is in an EKG

A

5 squares

1 square =.2 seconds

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11
Q

ECG measurements (time)

A

PR interval: .12-.2seconds
QRS complex: .06-.12
QT interval: .34-.43

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12
Q

Normal sinus rhythm

A

Atrial and ventricular rate: 60-100bpm
Rhythm; regular
QRS shape and duration: Normal
P wave: Normal and consistent, always before QRS
PR interval: Consistent between .12-.2 seconds

P:QRS ratio: 1:1

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13
Q

If no P wave think

A

ATRIAL ISSUE

A fib or flutter

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14
Q

How to determine ventricular rate

A

number of QRS in 6 seconds x 10

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15
Q

Determine atrial rate

A

number of P waves in 6 seconds x 10

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16
Q

What should the ratio of atrial rate: ventricular rate be

A

1:1

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17
Q

Sinus bradycardia

A

1:1 P:QRS ratio

regular rhythm

PR interval 0.12-0.2 seconds
QRS interval: <0.12 seconds

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18
Q

Sinus bradycardia treatment

A

Assess if pt is symptomatic

With hold beta blockers

Admin Atropine every 3-5 min if pt is symptomatic

For transcutaneous pacing use defib

Turn to pace mode

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19
Q

Sinus Tachycardia

A

Between 100-180bpm

P:QRS ratio 1:1

Regular rhythm

PR interval 0.12-0.2 seconds

QRS usually normal <0.12 seconds

20
Q

Sinus Tachycardia treatment

A

Assess if symptomatic

Watch for reduced CO from lower diastolic fill time

If ST prolonged = BAD

Give:

  • Beta blockers
  • Calcium channel blockers
  • Catheter ablation of SA node
  • Fluids
  • Antipyretics
21
Q

Atrial flutter

A

Sawtooth shaped

Rapid regular atrial rate between 200-350/min

Associated w/CAD, HTN, valve disorders, pulmonary embolism

PR interval variable and not measurable

QRS normal

Give anticoagulants due to risk of throwing clot

22
Q

Treatment goals for atrial flutter

A

Calcium channel and beta blockers, antidysrhythmics

Catheter ablation

23
Q

Atrial fibrillation

A

Loss of atrial contraction

Risk of stroke and death

Atrial rate 30-600
Ventricular rate 120-200

Atrial and ventricular rhythm highly irregular

NO P WAVE

PR interval can’t be measured

P:QRS ratio: Many:1

QRS shape and duration: usually normal

24
Q

Goals of A fib treatment

A

Decrease ventricular response

prevent stroke

Convert to sinus rhythm

Calcium channel blockers, digoxin, beta blockers, amiodarone

Watch for clots thrown, anticoagulants

25
Q

Acute afib interventions

A

Determine onset

Anticoagulants:
-Heparin, warfarin

TEE (Transesophageal endocardiography)

Cardioversion

26
Q

Chronic Afib interventions

A

Long term
Anticoagulants

INR 2.0-3.0
aPTT 1-1.5x control
anti arrhythmics

Cardioversion
AV node ablation

27
Q

Rapid ventricular response from AFIB interventions

A

Symptomatic if over 100

Determine onset and cause

anticoags

Cardioversion

Beta blockers

Watch for infection

28
Q

EKG differences between Flutter and fibrillation

A

Flutter:
Swtooth, lots of sharp points up

Fibrillation:
-Squigglies betwen QRS waves, no P waves

29
Q

Premature ventricular contraction (PVC) ectopic

A

Impulse starts in ventricle before next normal sinus impulse

P:QRS 0:1 or 1:1

P wave may be absent

PR interval: If P wave exists then under 0.12 seconds

QRS shape: Wide and bizare

Can be caused by caffeine, nicotine, alcohol

Abnormal causes:
ELECTROLYTE IMBALANCE (Mag, Potassium)
30
Q

Premature ventricular contraction manifestations

A

May feel nothing, or skipped beat

Usually not serious

Frequent PVCs treated w/ long term meds :

  • Solatol
  • amiodarone

If too frequent, or MI then Lidocaine may be used

NOTIFY MD IF 3 PVC IN A ROW OR MORE THAN 6 IN A MINUTE

31
Q

Ventricular tachycardia

A

3+ PVCs in a row
BPM over 100

WIDE QRS under 0.2 seconds

No PR interval

Can’t determine PQRS

Determine if pulse or pulseless!

Caused by MI

32
Q

If ventricular tachycardia has pulse what do you do

A

Cardiovert

Anti-arrhythmics

Lidocaine

Determine cause

33
Q

What does VT look like on EKG

A

Super big sawtooths down

nipples up top

34
Q

Ventricular fibrillation

A

Ventricular rate over 300bpm

Extremely irregular rhythm, no pattern

QRS: irregular

Ineffective quivering of ventricles

No atrial activity on ECG

Cardiac arrest

Most common cause CAD resulting in MI. untreated VT cardiomyopathy

DEFIBRILATE

35
Q

Vfib EKG patterns

A

looks like pure sawtooth no QRS or really anything

36
Q

Cardioversion vs defibrillation

A 
Cardioversion:
-Delivers low joule shock 
-Synchronized on R wave
-No metal, med patches, or nipples
Yell CLEAR

Cardioversion rhythms: (PULSE ONLY)

  • Afib
  • A flutter
  • SVT
  • Vtach

Defibrillation:

  • High joule shock
  • Unsynchronized
  • No metal, med patches, or nipples
  • Yell CLEAR

Defibrillation rhythms: (PULSELESS ONLY)
V-Tach
V-Fib
Torsades (V-fib)

37
Q

Who is Implantable cardioverter defibrilator (ICD) for

A

For patients that :
-survived MI

-Spontaneous sustained V tach

-

  • Syncope with inducible V tach/V fib.
  • High risk for future life threatening dysrhythmias (QT prolongation)
38
Q

How will hyperkalemia present on EKG

A

Peaked T waves

39
Q

First degree AV block

A

PR interval over 0.2 seconds

40
Q

Second degree AV block Mobitz 1 (wenkebach)

A

Prolonged PR with an absent QRS

Basically misses an entire QRS

41
Q

Second degree AV block Mobitz II

A

NORMAL PR interval

dropped QRS

42
Q

Third degree heart block

A

Life threatening!!! Need pacemaker

No impulses from atria get through

Atria and ventricles beat separately

can have multiple atrial contractions (P waves) with no ventricular depolarization

43
Q

Ectopic beats

A

PAC generated in atria, have P wave

PJC are generated in AV node- short PR or no P

PVC: generated in ventricle- wide

44
Q

Noninvasive temp. pacemaker

A

External electrodes

Used until more permanent solution installed

Indicated for:

  • Symtpomatic bradysrhythmias
  • 2nd or 3rd degree heart block
  • Asystole
45
Q

Post OP pacemaker care

A

Don’t raise arm on pacemaker side above shoulder level for 3 weeks

No heavy lifting for 3 weeks (more than gallon of milk)

Allow steri strips to fall off on their own

Avoid getting incision wet for 1 week

46
Q

When to contact provider for post op ICD symptoms

A

Fever/chills
Signs of infection
Twitching sensation in chest
Symptoms to pre ICD placement

Single Jolt/strong shock in chest (ICD)

47
Q

What to do if pacemaker is under sensing

A

The sensitivity is too low so it doesn’t sense intrinsic beats

Change from asynchronous (fixed) to synchronous (demand)

406 Exam 3 (10 decks)

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