Dysrhythmias Overview Flashcards by Jade Ring

Parasympathetic NS

____ rate of SA Node
____ impulse conduction of AV node

Sympathetic

___ Rate of SA node
____ impulse conduction of AV node
___ cardiac contractility

Parasympathetic

Decrease/ Slow

Sympathetic

Increase

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Intrinsic heart rate

SA…

AV….

Purkinje Fibers….

SA 60 - 100

AV 40 - 60

Fibers 20 - 40

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Causes of Dysrhthmias

H (6)

T (5)

Hypovolemia
Hypoxia
Hydrogen ion
Hyper/hypokalemia
Hypoglycemia
Hypothermia

Toxins
Tamponade
Thrombosis
Tensión pneumonia thorax (Tracheal deviation/ Chest Tube)
Trauma

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5 lead EKG set up

Right

White
Brown - near sternum
Green

Left

Black
Red

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What do the following represent

P wave
QRS complex
T wave

P wave: Atrial Depolarization/ Contraction

QRS complex Ventriclar Depolarization/ Contraction

T wave Ventriclar Filling/ Repolarization

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PR Interval:

Time for atrial depolarization and conduction through the AV node to the ventricles.

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ST Segment:

Early phase of ventricular repolarization.

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QT Interval:

Total time for ventricular depolarization and repolarization.

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U Wave (if present):

Late repolarization of the Purkinje fibers (not always visible).

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How to find HR from a EKG

Multiply # of QRS segments in a 30 box strip (6 Seconds) by 10.

1 big box = 0.20 Seconds
5 big boxes = 1 second

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Interval measurements normals

PR (SA - AV)….

QRS (Through Ventricle) …

QT (Ventricle through Repolarization) ….

Assess ST segment for….

PR (SA - AV) 0.12 - 0.20

QRS (Through Ventricle) 0.06 - 0.10

QT (Ventricle through Repolarization) 0.34 - 0.43

Assess ST segment for Isometric (FLAT) Is normal.

NO elevation or depression- MI

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How to measure PR interval (From which points on ECT)….

Normal time….

What abnormal represents….

Beginning of P to Beginning of QRS complex

Normal 0.12 - 0.20

Longer = 1st degree heart block

Progressively longer = 2nd Degree Heart block, Wenckebach

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Sinus Bradycardia is normal rhythm with rate <60

Causes…

Vagal stimulation (Vomiting, Suctioning, Valsalva)
Hypoxia
Beta blockers
Electrolyte disturbances
Hypothyroidism
Well trained athlete

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Vagal stimulation (Vomiting, Suctioning, Valsalva)
Hypoxia
Beta blockers
Electrolyte disturbances
Hypothyroidism
Well trained athlete

Causes which Rhythm…

Sinus Bradycardia

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Syncope
Dizziness
Confusion
Weakness
Hypotension
Diaphoresis
SOB
Chest pain / Angina

Sinus Bradycardia

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S S for Sinus Bradycardia (8)

Syncope
Dizziness
Confusion
Weakness
Hypotension
Diaphoresis
SOB
Chest pain / Angina

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Atropine
IV fluids
Ox
If Beta-Blockers OD is the cause Glucagon can be given
Transcutaneous / Transvenous pacing

Sinus Brady cardia

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Treatment for Sinus Bradycardia (5)

Atropine
IV fluids
Ox
If Beta-Blockers OD is the cause Glucagon can be given
Transcutaneous / Transvenous pacing

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AV blocks

Describe ECG

1st degree..

2nd degree Winkebach….

2nd degree Mobitz…

3rd Degree….

1st degree: PR >0.20 All P waves present

2nd degree Winkebach: Progressive prolongation of PR interval until QRS is dropped

2nd degree Mobitz: Constant PR interval with occasional dropped QRS

3rd Degree: No association between P waves & QRS Interval

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PR >0.20 All P waves present

1st degree heart block

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2nd degree Winkebach: Progressive prolongation of PR interval until QRS is dropped

Constant PR interval with occasional dropped QRS

2nd degree Mobitz:

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No association between P waves & QRS Interval

3rd Degree heart block

Chest discomfort
Restlessness, anxiety, nerves
Palpitations
SOB
JVD
S³ / S4
Hypotension
Pale, cool, skin

Sinus Tachycardia

Sinsu Tachycardia SS (8)

Chest discomfort
Restlessness, anxiety, nerves
Palpitations
SOB
Hypotension
JVD
S3 / S4

Difference in rhythm strips for SVT & Sinus Tachycardia

SVT the P wave is "embedded" in the T wave

SVT Causes & Symptoms

Causes Digoxin toxicity >2 Stimulants Symptoms Angina Palpation weakness Fatigue SOB Anxiety Hypotension

Vagal stimulation IV adenosine PUSH 2 Secs BB/ CCB Amiodarone- helps with rhythm- controls QT interval Synchronized Cardioversion- Sedate if possible

SVT Treatment

SVT Treatment (5)

Vagal stimulation IV adenosine PUSH 2 Secs BB/ CCB Amiodarone- helps with rhythm- controls QT interval Synchronized Cardioversion- Sedate if possible

Difference in appearance between A Fib & A Flutter.

No defined P wave. A Fib has Squiggly lines A Flutter has a Sawtooth appearance

HTN HF CAD Genetic component

Causes of A fib & A Flutter

HTN CAD HF Genetics

Irregular Heart beat Heart Palpation Lightheadedness Extreme fatigue SOB Angina

A fib / A Flutter

Symptoms of A fib / A Flutter (6)

Irregular Heart beat Heart Palpation Lightheadedness Extreme fatigue SOB Angina

Goals Restore blood flow through atrium Prevent embolism & increase cardiac output This disease

A fib / A Flutter

Drug therapy CCB Beta-Blockers Cardiac Glucosode - Digoxin Antiarrhythmics- Flecainide Anticoagulants If drugs dont help Synchronized Cardioversion Ablation

A fib / A flutter

Meds & treatment for A fib / A Flutter Meds (5) Treatment (2)

CCB Beta-Blockers Cardiac Glucosode - Digoxin Antiarrhythmics- Flecainide Anticoagulants If drugs dont help Synchronized Cardioversion Ablation

Occasional wide QRS complexes is suggestive of... Describe level of concern...

PVC Benign if isolated >6 in 1 minute or 2 or more in a row can be dangerous

Increased age MI HF COPD Anemia Hypo mag/ K Stimulates

PVC

PVC Causes (7)

Increased age MI HF COPD Anemia Hypo mag/ K Stimulates

Bigeminy & Trigeminy Couplets Describe...

Bigeminy = every 2nd beat is PVC * Caution can turn into V Tach Trigeminy = every 3rd beat is PVC Couplet = 2 PVC contractions next to eachother * Can turn into V TACH

V Tach can be intermittent or sustained With or without Pulse Describe appearance...

No P Wide QRS Tombstone appearance

Ischemic heart disease MI Hypo mag/K Heart disease HF (Echocardiogram, Troponin, BNP) Drug toxicity Steroids Cocaine Causes of....

V tach

V Tach causes (8)

Ischemic heart disease MI Hypo mag/K Heart disease HF (Echocardiogram, Troponin, BNP) Drug toxicity Steroids Cocaine

Treatment for V Tach With Pulse Without Pulse: Doseage if applicable

Pulse: Cardioversion - > Implamtable Cardioversion/ defibrillator No Pulse: Defibrillator, CPR, Epinephrine 1mg IVP, 3 - 5 M (No Limit), Amiodarone 300mg IV × 1

Placement of Cardioversion/ Defibrillator pads...

Right upper / left rib cage under breast

Describe appearance of V Fib Is there a pulse?

No P, QRS Pure squiggly lines. No Pulse, its only Purkinje Fibers firing

Causes: MI Hypokalemia Hemorrhage Treatment Defibrillation, CPR, Epinephrine 1mg 3 - 5 min (No Limit)

V fib

Causes, treatment, and appearance of V Fib...

MI Hypokalemia Hemorrhage Treatment Defibrillation, CPR, Epinephrine 1mg 3 - 5 min (No Limit) Appearance: No P, QRS complexes. Squiggly lines

Asystole Describe appearance ... Interventions....

Flatline CPR & Epinephrine 1mg 3 - 5 min (No Limit)

Describe Pulseless Electrical Activity Treatment Causes

Appearance of ECG is fine but they have no pulse & are unresponsive Treatment: CPR & Epinephrine 1mg IVP 3 - 5 min Causes Hs & Ts

Dabigatran (Pradaxa): Direct thrombin inhibitor. Apixaban (Eliquis): Factor Xa inhibitor. Edoxaban (Savaysa): Factor Xa inhibitor. Rivaroxaban (Xarelto): Factor Xa inhibitor. Vitamin K Antagonist (VKA): Requires INR monitoring to maintain therapeutic range (2.0–3.0). Warfarin (Coumadin): Inhibits Vitamin K-dependent clotting factors (II, VII, IX, X Examples of which type of medication given for a fib / A flutter

Anticoagulants

Give examples of anticoagulants given for A fib / A flutter

Dabigatran (Pradaxa): Direct thrombin inhibitor. Rivaroxaban (Xarelto): Factor Xa inhibitor. Apixaban (Eliquis): Factor Xa inhibitor. Edoxaban (Savaysa): Factor Xa inhibitor. Warfarin (Coumadin): Inhibits Vitamin K-dependent clotting factors (II, VII, IX, X).

Sinus Tachycardia interventions (4)

Oxygen if <95% Vagal maneuvers CCB/ BB TREAT UNDERLYING CAUSE