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ACI 2 > Exam 2 Heart Rhythms > Flashcards

Exam 2 Heart Rhythms Flashcards

1
Q

Order of the heart rhythm

A

P-QRS-T-U

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2
Q

P wave

A

Atrial Depolarization

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3
Q

P-R Interval Start

A

Beginning of P to beginning of QRS

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4
Q

P-R Interval Time

A

0.12 to 0.20 second

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5
Q

Vertical small box

A

1mm (0.1 mV)

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6
Q

Vertical Large box

A

5 mm (0.5 mV)

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7
Q

Horizontal small box

A

.04 sec (40 m sec)

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8
Q

Horizontal large box

A

.2 sec (200 m sec)

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9
Q

QRS Complex

A

Ventricular Depolarization

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10
Q

QRS Interval start and end

A

Beginning of QRS to end of QRS

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11
Q

QRS Interval time

A

less than or equal to 0.10 seconds (0.06 to 0.10 sec)

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12
Q

T wave

A

Ventricular repolarization, follows QRS complex

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13
Q

QT Interval start and end

A

Beginning of Q wave to end of T wave

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14
Q

QT Interval time

A

0.34 to 0.43 seconds

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15
Q

U wave

A

Rare, after T wave, indicates Hypokalemia

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16
Q

Isoelectric Line

A

No electrical activity, straight line, waves upright or downward from isoelectric line

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17
Q

ST Segment start and end

A

End of QRS to beginning of T wave

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18
Q

ST depression with….

A

Ischemia

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19
Q

ST elevation with….

A

Cardiac injury

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20
Q

Six step process of interpretation

A
  1. R-R (regularity and rhyme)
  2. Heart Rate
  3. P wave?
  4. P-R interval length
  5. QRS Complex
  6. QT Interval length
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21
Q

Sinus Bradycardia Treatment

A

Oxygen
Stable: Atropine, Dopamine, Epinephrine
Unstable: Pacemaker

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22
Q

Sinus Tachycardia Treatment

A

Treat cause

-Digoxin, CCB, BB

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23
Q

Sinus Tachycardia Symptoms

A

None, angina or dyspnea, elderly more sensitive

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24
Q

Premature Atrial Contractions

A
  1. Rhythm: PAC interrupts
  2. HR: per underlying rhythm
  3. P waves: Early beat, abnormal shape
  4. P-R interval: Usually normal
  5. QRS: normal
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25
PAC signs and symptoms
NONE
26
PAC interventions
None, treat cause, BB (lol)
27
Atrial Flutter Steps
1. Rhythm: Atrial Rhythm regular 2. HR: Varies 3. P waves: None, only F waves, sawtooth 4. P-R: None measurable 5. QRS: Normal
28
Atrial Flutter S&S
Ventricular normal rate: None | Ventricular rapid rate: Palpitations, angina, dyspnea
29
Atrial Flutter Treatment
- Cardioversion, rapid atrial pacing, ablation | - CCB, BB, Digoxin
30
Atrial Fibrillation Steps
1. Irregularly irregular 2. HR: Atrial rate not measurable, Ventricular rate <100 controlled response, >100 rapid ventricular response 3. P waves: not identifiable 4. P-R: None 5. QRS: normal
31
Atrial fibrillation S and S
Palpitations, Faint radial pulse (decreased SV and CO can lead to left HF)
32
A fib treatment
- Synchronized cardioversion - Meds: Digoxin, BB, CCB, Amiodarone or Dronedarone, Warfarin, Ablation, bi-atrial pacing, implantable atrial, defibrillators, maze procedure
33
Supraventricular Tachycardia (SVT) Steps
1. Regular, very rapid 2. >160 bpm 3. No P waves 4. P-R: Not measurable 5. QRS: Normal
34
SVT S and S
Palpitations, faint radial pulse
35
SVT treatment
- Synchronized cardioversion | - Medications: Valsalva, Adenosine (6mg, then 12 mg IVP), CCB (diltiazem or verapamil), treat pt symptoms
36
Junctional rhythms steps
1. Regular rhythm 2. HR: < 60 (40-60 unless accelerated) 3. P waves: may follow QRS, be inverted or absent 4. P-R: may not be present 5. QRS: Normal
37
Junctional rhythm treatment
- Few, rare, usually after MI - No action needed - Monitor for S and S and keep on telemetry
38
1st Degree AV block
Slowing of conduction, PR interval prolonged > 0.20 sec
39
2nd Degree AV block Type 1 (Wenkebach, Mobitz 1)
A progressive prolongation until a QRS is blocked, benign
40
2nd Degree AV block Type 2 (Mobitz 2, Classic)
More P waves than QRS's, can deteriorate to no QRS's=no ventricular activity
41
3rd Degree AV Block (Complete)
P waves and QRS's, NO RELATIONSHIP, Ventricular rate slow
42
Premature Ventricular Contractions (PVC) steps
1. PVC interrupts rhythm 2. HR: underlying rhythm 3. P waves: Absent to PVC 4. P-R: None for PVC 5. QRS Interval: PVCs > 0.10 seconds
43
PVC signs and symptoms
Palpitations, fatigue, dizziness, sever dysrhythmias
44
PVC interventions
- None | - Antidysrhythmics: Amiodarone (Cordarone, Pacerone) and BB
45
Ventricular Tachycardia Steps
1. Regular 2. Hr: 150-250 ventricular bpm, slow VT <150 bpm 3. P waves: Absent 4. P-R: None 5. QRS: >0.10
46
Ventricular Tachycardia Signs and symptoms
Dyspnea, palpitations, light headedness, angina, cardiac arrest
47
V tachycardia treatments
If Pulseless then: CPR, Defibrillation, vasopressors, anti-arrhythmics -Amiodarone, 300 mg IVP, then 1mg/min gtt -Lidocaine: 1-1.5 mg/kg IVP, then 1-4 mg/min gtt If stable: Amiodarone 150 mg over 10 min, monitor on tele
48
Amiodarone dose for V tachy if pulseless
300 mg IVP, then 1 mg/min gtt
49
Lidocaine dose for V tachy if pulseless
1-1.5 mg/kg IVP, then 1-4 mg/min gtt
50
Ventricular fibrillation steps
1. Chaotic, extremely irregular | 2-5. None
51
V fib signs and symptoms
Unconscious, No heart sounds, peripheral pulse or BP, respiratory arrest, cyanosis, pupil dilation
52
V fib Treatment (ACLS Protocol)
Immediate defibrillation - CPR - Epinephrine 1 mg, conc 1 to 10,000 IVP - Amiodarone, Magnesium - Endotracheal intubation
53
Asystole
Absence of ventricular activity, occasionally P waves
54
Asystole signs and symptoms
Unconscious, No heart sounds, peripheral pulses or BP, respiratory arrest, cyanosis, pupil dilation
55
Do you defib asystole?
NOO!
56
Asystole interventions
- CPR, Endotracheal intubation - Epi 1 mg. 1 to 10,000 every 3-5 mins - Vasopressin
57
Pacemaker Education
- Incision care - Take radial pulse - ID Card - Avoid magnets and ungrounded appliances and metal detectors - Periodic pacemaker checks
58
What wave does synchronized cardioversion sync to?
R waves
59
Do you sedate for cardioversion?
YES! with Versed
60
Aminophylline
Bronchodilator, can cause PVCs
61
Leads II, III, aVF
Inferior MI
62
Leads V1, V2
Septal
63
Leads V3, V4
Anterior
64
Leads I, aVL, V5, V6
Lateral
65
Drug of choice for Prinzmetal's angina
Nifedipine (CCB) | and nitrates
66
Cardiac marker that rises first in response to cardiac damage?
Myoglobin
67
Cardiac marker that stays present the longest after cardiac injury?
Troponin
68
What order does blood flow through the valves?
Tricuspid, Pulmonic, Mitral, Aortic
69
Put the measurements of the cardiac cycle in order
1. 0.12-0.2 2. 0.6-0.1 3. 0.34-0.43 4. Varies
70
Name the conduction pathway
SA node, AV node, Bundle Branches, Purkinje fibers
71
Follow the blood flow through the heart
Right ventricle, Pulmonary artery, Pulmonary vein, Left ventricle
72
Beta blocker antidote
IV Glucagon
73
Calcium channel blockers antidote
Calcium Gluconate IV
74
Nipride antidote
Sodium thiosulfate
75
Norepi, dopamine, epi, dobutamine, vasopressin antidote
Phentolamine
76
Heparin antidote
Protamine sulfate
77
Warfarin antidote
Vitamin K
78
Digoxin toxicity signs and symptoms
N/V, vision changes (diplopia, blurred, photophobia, green/yellow halos), bradycardia
79
Digoxin antidote
Digoxin immune fab (Digibind)
80
Normal digoxin levels
0.8 to 2.0 ng/mL
81
Who do we use TTM (therapeutic temperature management) on?
Comatose adults with ROSC (return of spontaneous circulation) after cardiac arrest (Vfib/pulseless VT, "nonshockable")
82
TTM temp range
32-36 degrees C
83
TTM for how long?
24 hours at 32-36 degrees C
84
Does TTM require sedation?
Yes!
85
How long during TTM should you passively rewarm?
Over 12 hours once cooling period is complete
86
Is TTM ever contraindicated?
No
87
If someone is actively or rapidly warming should they have TTM?
No
88
Would you rather lose the left or right side of the heart?
Right because the RN can drive it with a pacer
89
Non modifiable CAD risk factors
Age, gender (more common in men), ethnicity, genetic predisposition and family history
90
C reactive Protein
Produced by the liver, nonspecific marker of inflammation
91
Troponin levels
- Elevated 4-6 hours after damage - Peaks in 10-12 hours - Remains elevated for 10-14 days
92
Creatine Kinase (CK)
CK-MB is in cardiac muscles - Rise 4-6 hours after damage - Peaks at 12-18 hours - Normal within 24-36 hours
93
Myoglobin
Not site specific, indicates damage before CK MB | -Levels rise 1 hour after damage
94
Blood lipids in cardiac blood studies
- Triglycerides - Cholesterol - Phospholipids
95
Electrocardiogram
Records electrical activity
96
Echocardiogram
Records motion | -Heart structures, valves, size, shape, position
97
Cardiac tamponade symptoms (triad)
- Narrow pulse pressure - JVD - Muffled heart tones
98
Hallmark sign of an MI
Chest pain that is sever, immobilizing, and not relieved by interventions
99
Prinzmental's Angina
Rare form of chest pain that occurs at rest, usually response to a spasm of the major coronary artery
100
PQRST method for angina
- Precipitating events - Quality of pain - Radiation - Severity of pain - Timing
101
Coronary artery disease (CAD) definition
Coronary arteries become narrow and hardened
102
Acute Coronary syndrome
Prolonged ischemia to the coronary arteries (STEMI and NSTEMI)
103
ACS treatments
- Oxygen - ACE inhibitors (PRIL) - ARB's (TAN) - BB (LOL) - Diuretics (check electrolytes) - Inotropes (Glycosides/Digoxin) - Vasodilators (Nitro)
104
ACS signs and symptoms
- Angina - SOB - Pain in jaw, neck , back - Dizzy - Nausea - Sweating
105
Acute HF
- Happens suddenly, | - PINK FROTHY SPUTUM
106
Heart failure signs and symptoms
Weakness, faintness, orthopnea, edema, palpitations, weight gain, irregular heart beat, JVD, crackles/rales

ACI 2 (1 decks)

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