Dysrhythmias part 2 Atrial Flashcards
Explain why these things can be a risk factor for a dysrhythmia
electrolyte abnormalities
fluid volume imbalance
hypoxemia
altered body temp
degenerative conduction changes:
congenital effects
MI
drug toxicity
electrolytes : potassium and magnesium
fluid volume imbalance: can affect kidneys
hypoxemia : not enough o2 in the blood to perfuse the heart
altered body temp: tachycardia can be caused by dehydration that results from fever
conduction issues just in general
Congenitive effects in general
MI
toxicity
What category of dysrhythmia is Supraventricular Tachycardia?
What can trigger an SVT?
Atrial. It says ventricular - but it says SUPRA. This is above the bundle of his.
PAC or premature atrial contraction
What is the HR range for SVT?
160-220 bpm
Your patient has supraventricular tachycardia going on. What symptoms do you anticipate them complaining of?
Heart palpitations
SOB
Angina
T/F
It is uncommon for supraventricular tachycardia to occur in young people
False.
SVT is common in young adults. For them, it is more unpleasant than dangerous.
Why: may occur during vigorous exercise and stress.
Treatment routes for SVT?
Vagus nerve stimulation
Drugs if needed
Causes for SVT?
Rigorous exercises
Stress
Rheumatic fever
Stimulants
Dig toxicity
CAD
Cor Pulmonale - enlargement of the R side of the heart
How does the SVT affect the patient’s CO?
What does this. do to BP?
The HR is high but this means the ventricles can’t fill all the way so not enough blood is being contracted
Hypotension
What does SVT do to the patient’s physical symptoms?
Angina, SOB, Palpitations (already mentioned these but just checking)
Identify what type of rhythm this is.
The strip shows that the p wave and t wave sort of run into one another and look the same because the HR is too fast. So, this is SVT.
Your patients been identified to have a Supraventricular tachycardia.
Explain the paramters of SVT and how you know its one.
List the medicine for SVT?
List the alternative treatment?
You can tell it is supraventricuclar due to the rate of it being between 160-220 bpm but also the p and t wave will look smooshed.
Treatment :
Vagal response
Adenosine IV
Verapamil (CCB)
Lastly, Direc Current cardioversoin
Patient has been identified to have SVT. Before giving Adenosine for an SVT, what should you do that concerns the patient and the family’s knowledge?
(- What is the SVT? What does Adenosine do?)
What do you need to bring with you to the room?
Make sure to educate the family on how Adenosine is going to work.
The heart will be put into asytole (stop) and then restart.
Bring the crash cart
When administering Adenosine for a supraventricular tachycardic patient - how would you do this?
- So think .. what is SVT?
- How do I use Adenosine?
SVT is characterized by HR between 160-220 and the issue is atril (despite it saying ventricular).
First, 6 mg of Adenosine will be administered fast. Then flush with 20 mg NS bolus fast.
Wait 1-2 minutes. If it doesn’t work, give 12 mg Adenosine, flush, and then wait.
What is a Premature atrial contraction or PAC?
What is the main characteristic on an ekg?
PAC is when the atrium contracts too early (but not due to the SA node). It is from an abnormality or ectopic focus causing an abnormal pathway.
Distorted P wave on the ekg
Common causes of PAC
(often the same causes of any dysrythymia)
Hypoxia
Caffine, tobacco, or alcohol
drugs
Electrolyte imbalances (think mag and potassium)
COPD
Valve diseases
What will a PAC strip look like?
The P wave is coming too early. And so the R interveals will be too close together.
|…….|…….|...|.……|
Bold is the PAC section
COME BACK TO THIS ONE
When dealing with a PAC and you go through your questions
1) Regular?
2) PQRST?
3) RATE
what will your most likely response be
Due to the p wave causing the intervals to be too close, it’ll look regular for the MOST part.
HR - can be listed as irregular
i’m just confused on why evans was norm sinus but the one on the slide is irregular ?
Main goal of treatment for a PAC?
Treatments for PAC?
Main goal is to slow conduction through the AV node
Beta blockers
Diltizaem
Amiodarone
Magnesium (check labs after administration)
Can also reduce caffeine
Which is the patho behind a PAC?
PAC or premature atrial contractions - travels across atria by abnormal pathways to distort the P wave
What is the difference between a. fib and a flutter?
What will both cause?
A fib means the atria is quivering irregularly.
A flutter is when there’s an increase in the amount the atria is contracting.
Both cause decreased CO.
So, what is the defintion of A. flutter?
A flutter is when you have too many atrial beats compared to the amount of ventricular beats.
It should be 1:1 in ratio but it can end up being 4:1 if there are four atrial beats for one ventriclle beat.
What is the HR range for A flutter patients? (hint - think about where the extra beats are coming from)
The atrial rate will be high between 250-350 bpm.
T/F
The QRS on the ekg is represented by the atria.
False.
QRS shows the ventricle activity ! Which is why the QRS can be normal here (it can also be irregular but just understand this for now).
What does an A. flutter ekg look like?
How do you decide the ratio?
Saw tooth shapes in between the QRS (shows an extra p wave kinda)
Decide the ratio by counting how many saw tooths are in between.
Your a. flutter patient’s ventricular rate is above 100. And due to the a. flutter, you know the heart isn’t pumping out adequate blood supply.
What symptoms do you anticipate your patient will expereince?
What risks are they at and what intervetions do you anticipate?
Due to the decrease in CO & high ventricular rate,
Heart failure
Angina
Stroke risk due to blood stasis since the heart isn’t able to pump all the blood out. Will be on anticoagulant therapy (blood thinner)
- heparin drip & coumadin/warfarin at home
Common occurences that can cause atrial stretching which leads to a flutter?
Alcoholism, CAD, Chronic lung disease, Cardiomyopathy
Drugs like digoxin and epinephrine
Hypertension & Hypothyroidism
Mitral valve disorders
Pericarditis
Pulmonary Emboli
When treating A. Flutter what is the goal?
What drugs are we going to use?
Goal is to slow ventricular response by increasing AV block. So, we want drugs to slow HR. We also may want a drug to do a reset of the heart to get it back into sinus rhythm.
Slow HR : Calcium channel blockers, Beta blockers
Convert heart : Antidysrhythmic drugs such as Amiodarone (don’t confuse w other A drugs)
List other drugs that can help to treat a . flutter
Diltiazem (CCB - relaxes blood vessels so less work for the heart)
Propafenone (antiarythmic - helps heart rhythm)
Amiodarone (antidysrhytmic - heart reset)
Flecainide (antiarythmic - heart rhythm help)
Clonidine (can lower BP)
Alternative treatment for A flutter patients?
Synchronized Cardioversion
Radiofrequency Catheter (purposefully producing scarring to help redirect the electrical signal)
A flutter ins and outs
What will be unrecognizable on the ekg?
What rhythm will there be?
What is the range for atrial rate? Wb ventricular?
The P wave on the ekg will be unrecognizable. This makes sense since the p wave symbolizes atrial activity.
Irregular rhythm with a a flutter
The atrial rate should be between 250-350. Ventricle rate above 100 is when things get compicated but the ventricle rate can always vary.
What other condition does A. fib share clinical associations with?
A. flutter
Describe what the patho of a. fib?
The atrium is quivering. There’s some blood pumpoing but not enough so a decrease in CO occurs.
What often causes AFIB?
Caffeine
Electrolytes being off
Cardiac surgery
- like a heart cath insertion
What will the graph appear as for a. fib?
Small squiggles in between QRS bc there won’t really be a good pwave.
What is a big concern with A.FIB and A flutter?
Treatment
Clot formation due to blood stasis.
Treat with heparin or coumadin.
What drugs can be used for a. fib?
What about for a. fib with RVR?
What alternatives are there?
Heparin for short term/Coumadin long term.
Beta blockers
CCB
Digoxin to slow the ventricle rate in RVR (so the atria can catch up).
Conversion drugs : amiodarone, propefanone
DC cardioveresion: if a fib has been longer than 48 hours, the patient needs to be put on warfarin for a 3-4 weeks first. And then after for 4-6 weeks.
