ER Nurse: Cardiovascular Emergencies 1

Question 1

what is the pathophysiology for a disrhytmia

Answer 1

1) rate of SA node D/c is 100><60
2) SA node fails to D/C
3) Conduction is delayed or blocked
4) Aberrant conduction is activated
5) Ectopic foci initiate impulse

Question 2

What are some pathologic conditions for disrhytmias

Answer 2

1) Metabolic derangement (hypoxia, acidosis, alkalosis)
2) e- imbalances (hypo/hyper K+, Hypo Mg/Ca)
3) chronic illness (COPD, CAD, ACS, CHF)
4) Meds (cardiac glycosides & Bronchodialaters)
5) Congenital defects
6) Heavy use of stimulants (nicotine, caffeine, amphetamines, cocaine)

Question 3

Sinus dysrhythmia types

Answer 3

Bradycardia, tachicardia, arrhythmia

Question 4

Atrial dysrhythmia types

Answer 4

1) premature atrial complexes
2) Atrial fibrillation (a-fib)
3) Atrial flutter
4) multiform atrial rhythm

Question 5

Atrial ventricular blocks types

Answer 5

any block of the AV nodes, Bundle of His, Purkinje system
can be 1st, 2nd, 3rd degree blocks

Question 6

Junction dysrhythmia types

Answer 6

1) premature junction complex
2) junction escape beats
3) accelerated junction rhythm
4) Junction tachy

Question 7

ventricular dysrhythmia types

Answer 7

1) premature ventricular contractions
2) ventricular tachycardia
3) ventricular fibrillation

Question 8

Sinus bradycardia

Answer 8

ID: SA node D/c <60 BPM
EKG: normal except rate
Causes: MI, athletes, sleep, vagal nerve stimulation (vomiting/straining), ICP>, anoxia, peds-hypoxia
S/S: AMS, syncope, CP, hypotension
Tx: Atropine, Dopamine drip, epinephrine, transcutaneous pacing

Question 9

Sinus Tachy

Answer 9

ID: SA node D/c 100>
EKG: normal except rate 100>
Causes: homeostatic response that requires O2> ex// volume loss, fever, pain, anxiety, exercise, stimulants, ischemia
Tx: ID & Tx underlying cause

Question 10

Sinus arrhythmia

Answer 10

ID: rate of SA node varies slightly to moderate with at least a 0.12 sec difference between shortest and longest cardiac cycle
EKG: rate varies slightly, rhythm slightly irregular
Causes: common in pediatrics and young adults
Tx:

Question 11

Premature atrial complex (PAC)

Answer 11

ID:
EKG: irregular rhythm. P wave is narrower and earlier (rest of cycle looks good). PR interval can be normal or prolonged.
Causes: stimulants, digitalis toxicity, E- imbalances, hyperthyroidism, ischemia, CHF/pulmonary HTN (increase atrial pressure)
Tx: rarely treated unless accompanied by another more lethal disrhythmia

Question 12

Premature atrial complex (overview)

Answer 12

PAC is an ectopic beat initiated by an irritable atrial focus. It originates in the atria but not the SA node.

Question 13

Atrial Fibrillation

Answer 13

ID: uncontrolled rapid atrial quivering seen with drope in CO & clot risk
EKG: No identifiabole P waves or PR intervals. Irregular ventricle rate w/normal QRS compleces.
Causes: valve disease, cardiomyopathy, CHF, CAD, HTN, PNE, PE, pericarditis, cardiomyopathy
Tx: Meds if hemodynamically stable (CCB cardizem, BB brevibloc), synchronized cardioversion. Anticoagulation to prevent thromboembolism. Meds for new onset (amiodarone, ibutilide, procaniamide)

Answer 14

ID: uncontrolled rapid atrial quivering seen with drope in CO & clot risk
EKG: 4 atrial activations (p waves) occur before QRS. Appears as sawtooth waveforms.
Causes: valve disease, cardiomyopathy, CHF, CAD, HTN, PNE, PE, pericarditis, cardiomyopathy
Tx: Meds if hemodynamically stable (CCB cardizem, BB brevibloc), synchronized cardioversion. Anticoagulation to prevent thromboembolism. Meds for new onset (amiodarone, ibutilide, procaniamide)

Question 15

Multiform atrial pacemaker

Answer 15

ID: 2 or more foci in AS node, atria, or AV jx compete for rhythm control
EKG: P-P & R-R intervals are irregular w/3 different P wave configurations present
Causes: normal in old or young & results from inhibitory vagal (parasympathetic effect of respiration on SA node & AV jx)
S/S: asymptomatic
Tx: withhold digoxin if rhythm is caused by digoxin toxicity

Question 16

Paroxysmal Supraventricular Tachycardia (PSVT)

Answer 16

ID: reentracted tachycardia at AV jx leading to two conduction pathways leading to tachycardia
EKG: narrow QRS complext with ventricular rate 150-250 bpm. distorted P waves & PR interval is less than 0.12 sec or doesnt appear
Causes: e- imbalances, excess stimulants, amphetamines, emotional stress, hyperventilation
S/S:
Tx: stable vagal maneuvers (Valsalva cough, gag, apply ice in face) followed by meds adenoside, amiodarone, BB CCB, cardioversion & ablation

Question 17

Wolff Parkinson White (WPW syndrome)

Answer 17

ID: impulse conduction from atria to ventricle bypassing AV nodes
EKG: short PR interval, widened QRS with slurred upstroke
Cause: preexcitation syndrome w/congenital accessory pathway exist in the heart which permits
S/S: rarely until palpitations or CP occur due to rapid rate
Tx: ablation

Question 18

Premature Junctional dysrhythmias

Answer 18

ID:
EKG:
Cause:
S/S:
Tx:

Answer 19

ID:
EKG:
Cause:
S/S:
Tx:

Answer 19

ID:
EKG:
Cause:
S/S:
Tx: