Dysrhythmias part 3 Ventricular Flashcards
What is a PVC?
What does it look like?
Premature ventricular Contraction
Causes a wide looking QRS
What is it called when there’s two PVCs?
What if there are three pvcs?
Couplet
Automatically becomes Ventricular tach
What strip is this? (PVC)
..
Types of substances that can cause PVC?
What meds?
Caffeine
Alcohol
Nicotine
DIGOXIN
Aminophylline
Epinephrine
Isoproterenol
Disease states that can cause a PVC?
MI
Mitral valve prolapse
Heart failure
CAD
What body states can cause a PVC?
Electrolyte imbalance
Hypoxia
Fever
How can a coronary procedure cause PVCs?
Acute MI patient (not perfusing) has stents placed. And when it was opened up, the reperfusion was too much for her and t=she threw PVCs
Where is the focus of pvcs?
Ventricular wall below the bifurcation of the Bundle of His
Are PVCS always dangerous?
Not always
T/F
PVCs and MI have no relatoin
False.
If a patient is throwing PVCs regularly, they could be due to MI.
Do PVCS increase or decrease CO?
And this typically can cause what?
PVC’s decrease cardiac output
Angina and HF (know this for any decrease in CO actually)
Best course of initial treatment for PVCs?
If the PVC is problematic, how do we go about treating it?
Monitor the patient frequently
Treat pvc based on cause!
- hypoxia, electrolytes, caffeine, etc.
Again, how do we go about treating PVC?
What meds can we use to address PVCs?
Treat the cause!
- fever ; antipyretic
- hypoxia; o2
- electrolytes; replace them
- caffeine; sustain
Beta blockers
Amiodorane
What is Ventricular Tachycardia? The nature of it?
Rate and rhythm?
When there are 3 or more PVCs thrown. Deadly
150-240 bpm
regular rhythm
Types of Ventricular tachycardia?
What if they’re the 3rd one?
Monomorphic - uniform
Polymorphic - not uniform
Sustained - no pulse
Non-sustained
You go into a code and start CPR
What if Ventricular tachycardia a precursor of?
Ventricular Defibrillation
- very very poor prognosis
Clinical associations of Vtach
MI CAD Hypoxia Bradycardia Drugs Electrolytes -mag & potassium
Can Ventricular tachycardia patients BP be stable?
Yes - but can also be unstable from coding.
Get BP!
“Ventricular tachycardia may occur if not treated prophylactically”…
What does this mean?
Remember - the precursor to Vtach is PVC’s. So if you’re seeing those, then maybe you should have been trying to keep them from getting to vtach in the first place.
T/F
There is still cardiac output with Vtach.
False. There’s none due to the ventricles contracting way too fast to fill.
(sort of like a. flutter does)
Do you think vtach will cause hypertension or hypotension?
Why pulmonary edema?
Hypotension - makes sense.
With tachy they’re often in hypotension.
Fluid can accumulate in lungs due to lack of perfusion
How does ventricular tachycardia affect perfusion to the brain?
Decreased cerebral blood flow due to not enough perfusion from low CO
Your Vtach patient is pulsatile. How would you go about treating this?
You would want to fix the underlying cause.
You see your pulsatile Vtach patient become hemodynamically unstable (Bp). What meds do you want to grab?
What if meds aren’t working?
IV Amiodarone
Lidocaine
Cardioversion
You see your patient is in Vtach. You check their pulse and it is gone.
What do you do?
What meds can you turn to? Second line?
Call code and start CPR
Then do rapid defibrillation
If defibrillation doesn’t work use ..
Vasopressin
Epinephrine
Consider the amiodarone or lidocaine
What is Ventricular fibrillation?defined as?
Prognosis?
No cardiac output happening due to ineffective quivering ventricles.
Very poor prognosis
T/F
Ventricular fibrillation patients don’t have a pulse
True no pulse here - which makes it very dangerous
Procedures that can actually cause ventricular fibrillation?
Med therapy that can cause ventricular fibrillation?
Cardiac Pacing
Cardiac Catheterization
(Just know they can bring them back a lot easier)
After fibrolytic therapy due to the reperfusion
You see a a lineman on the cardiac floor. What heart issue do you bet they have?
Ventricular Fibrillation related to shock or burn
(asystole could be possible_
What symptoms of ventricular fibrillation can you expect your patient to present with?
Unresponsive
No pulse
Apneic - snoring
Treatment for Ventricular Defibrillation?
CPR
Defibrillation
Epi, Vasopression
Ameridarone, Lidocaine, Magnesium*
What is astyole?
Treatment?
No electrical activity anywhere in the heart
CPR + meds (no rhythm to shock)
Main cause for asytole?
Already having advanced cardiac disease or problems of some sort
Trauma as well
A reason elderly patients often go in to asytole? or anyone?
Job wise?
Electrolytes
Electrocution as well
What will you do if your CPR works on your asytole patient?
They’ll be in bradycardia - so give atropine/epi/dopamine.
Hang amiodorone as well
What is a PEA ?
How to catch this?
Pulseless electrical activity - where you see activity on monitor but then there’s no pulse on your patient
Don’t just look at the monitor!!! Go in and touch your patient and see if they’re doing ok!
PEA treatment?
What if ventricular rate is slow?
CPR > intubation > IV epi
Atropine
What does AV block stand for?
How many degrees?
Atrioventricular block
1, 2, 3 degrees
What is going on the AV block 1st degree?
Looks and acts a lot like normal sinus but the p wave is farther away. (same PR interval)
Type of patient that has AV block a lot and is unaffected/ no symptoms?
Will other patients have symptoms?
Athletes
No and yes. Point is it isn’t dangerous - its just the synapse taking longer to get to ventricles.
Common associations to av block 1st degree?
MI CAD Rheumatic heart disease Hyperthyroidism Vagal stimulation Drugs that lower BP (beta, CCB, flecinaide)
Treatment for 1st degre av block?
Treatment isn’t required. But it should be monitored to see if it progresses
