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Cardiac HAPS > HAPS--Cardiac Rhythms > Flashcards

HAPS--Cardiac Rhythms Flashcards

1
Q

Conduction

A 
SA Node
AV Node
Supra ventricular
Bundle of His (A/V bundle)
Purkinje fibers
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2
Q

SA node

A

normal pacemaker of the heart

intrinsic rhythm 60-100

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3
Q

AV node

A
  • receives electrical impulse of SA node
  • delays impulse before conduction
  • enables atrial contraction to be completed before ventricles contract
  • can become the pacemaker
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4
Q

Supraventricular

A

-area of AV junctional tissue located above the ventricles

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5
Q

bundle of his (A/V bundle)

A
  • branches into right and left bundles

- continues into purkinje fibers

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6
Q

purkinje fibers

A
  • conduct impulse to ventricular muscle cells

- cause ventricular depolarization and contraction

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7
Q

P wave

A

atrial depolarization

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8
Q

QRS complex

A

ventricular depolarization

-P wave and QRS wave follow each other (married)

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9
Q

T wave

A

ventricular re-polarization (resting state of the heart)

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10
Q

EcG rules

A

rhythm, rate, P waves, P-R interval, QRS interval

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11
Q

Cardiac measurements

A
  • each small square = 0.04 seconds

- each large square (surrounds 5 small squares) =0.20 seconds

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12
Q

How to determine the rate for irregular rhythms

A
  • count the number of complexes in 6 seconds of time and multiply by 10. This will equal bpm.
  • markings are on the top of strip indicating 3 seconds
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13
Q

How to determine the rate for regular rhythms

A

-count the number of small squares between the R-R (top of QRS complex) and divided by 1500

OR
-count the number of big blocks between R-R and divide into 300.

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14
Q

Analyze the P waves

A
  • P waves indicate atrial depolarization usually from 1 focus–the SA node
  • are p waves present
  • is there 1 P wave for every QRS
  • are p waves regular
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15
Q

Measure the PR interval

A
  • start at beginning of P wave to the R wave (normally 0.12 to 0.20 seconds)
  • this measures the electrical impulse through the atria and the delay that normally occur at the AV node
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16
Q

QRS duration

A
  • measure from the at the Q and end of S
  • normal duration is 0.04-0.10 seconds
  • do all QRS segments measure within limits
  • do all QRS look the same
  • the QRS represents ventricular depolarization
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17
Q

Normal Sinus Rhythm

A
  • rhythm is regular
  • rate is 60-100
  • P waves are rounded and come before each QRS and all look alike
  • PR interval is between 0.12-0.20 seconds
  • QRS interval is less than 0.10 seconds
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18
Q

Sinus Dysrhythmias

A

Bradycardia

Tachycardia

19
Q

Bradycardia

A
  • slower than normal heart rate
  • beat is originating from SA node
  • rhythm is regular, but rate is less than 60
  • P waves are smooth and regular, QRS 0.06-0.10
  • no symptoms unless its so slow that cardiac output is reduced
20
Q

Tachycardia

A
  • heart rate is greater than 100 bpm, originating from SA node
  • rate is regular, P waves are regular and rounded, PR interval 0.12-0.20, QRS is 0.06-0.10
  • if HR is rapid for long period, patient may experience angina or dyspnea.
21
Q

Atrial dysrhythmias

A

PAC
supraventricular tachycardia
atrial fibrillation

22
Q

Ventricular dysrhythmias

A

PVC
Bigeminy PVC
ventricular tachycardia
ventricular fibrillation

23
Q

First Degree AV block

A
  • PRI greater than 0.20
  • rhythm remains regular
  • martial problems start
24
Q

Second degree AV block

A
  • progressive lengthening of PRI until one P wave is not conducted through to the ventricles
  • separation of the couple begins
25
Q

Third Degree AV block

A
  • no conduction of atrial impulses
  • atria and ventricles beat independently and P:QRS have no sequential relation
  • now divorced
26
Q

Cardioversion

A
  • used for dysthythmias that do not respond to drug therapy
  • pads are placed where you would listen to S1 and S2
  • patient is sedated and shocks start with a range of 25-50 joules
  • consent is required and patient is sedated
  • assess cardiac response after first synch has been delivered
  • turn oxygen back on if it had been turned off
27
Q

defibrillation

A
  • delivers an electrical shock to reset the hearts rhythm
  • indicated in V-Fib or pulse less V-tach
  • pads are placed on patients chest to prevent burning and promote conduction of electrical charge
  • pads are placed where you would listen to s1 and s2
  • total of 3 shocks can be initially given
28
Q

Medications used for Atrial Fibrillation

A

Calcium channel blockers

  • diltiazem ( Cardizem)
  • amiodarone (Cordarone)
29
Q

What is digoxin given for?

A

CHF and atrial fibrillation

30
Q

PAC’s

prematrue atrial contractions

A
  • “early beat” that atria fires an impulse due to irritability and a premature beat results
  • impulse does not always originate from SA node. rate has irregularities
  • P wave often looks different or it may be buried in the T wave.
31
Q

Causes and treatments of PAC’s

A
  • stress, fatigue, anxiety, inflammation, infection, caffeine/nicotine/alcohol.
  • treatment is aimed at cause
  • usually no symptoms but will feel palpitation
  • medications used are anti-dysrhythmic medications and teach to avoid stress and caffeine.
32
Q

Supraventricular Tachycardia

A
  • occurs with rapid stimuation of atria at a rate of 100-280
  • P waves may not be visible
  • depending on whether it is sustained or not sustained will determine if patient is symptomatic or not
33
Q

Atrial fibrillation

A
  • atrial rate of 350-500 can occur
  • AV node blocks most impulses so ventricular rate is much lower than atrial rate
  • no definable P waves because the atria are fibrillating or quivering
  • there is increased risk for thrombus formation which can result in stroke d/t heart dilation and blood pooling
  • usually tell if patient has this as their pulse is irregular and thready
  • cardio-version or medications are usually indicated.
34
Q

Atrial fibrillation

A
  • occurs with patients who have HTN, heart failure, CAD, have had TIA’s or strokes
  • cardiac output can decreased as much as 20-30%
  • treatment includes anti-dysrhythmic medications such as beta blockers, diagxin, cardizem or amiodarone.
  • anticoagulants are given d/t increased risk for embloli
35
Q

premature ventricular contractions

PVC’s

A
  • originate in ventricles from an ectopic focus (a site other than SA node)
  • ventricles are irritable and fire prematurely before the SA node normally would–result is widened strange looking QRS complex
36
Q

Bigeminy PVC’s

A
  • bigeminy=every other beat is a PVC
  • trigeminy=every 3rd beat is a PVS
  • couplet=there is a pair of PVC’s
  • can be felt by patient and usually cause by too much caffeine, nicotine, or alcohol
37
Q

PVC’s

A
  • make special concerns with patients who are having PVC’s and have a history or current issue of MI’s as this could potentially progress to life threatening v-tach or v-fib
  • palpate peripheral pulses during an episode to ensure adequate perfusion
38
Q

V-tach

A
  • occurs when there are 3 or more PVC’s in a row
  • ventricles become pacemaker of heart
  • is serious depending on how long it lasts
  • intermittent is less than 15 seconds
  • sustained is longer than 15-30 seconds
39
Q

V-Tach

A
  • V-tach can cause cardiac arrest
  • assess patients ABC’s, LOC, and oxygen level
  • administer oxygen
  • amiodarone, lidocaine and magnesium sulfate are used
40
Q

V-fib

A
  • when many ectopic ventricular foci fire at same time
  • ventricular activity is chaotic with no definite waves
  • there is NO contraction
  • no cardiac output or pulse
  • fatal if not ended with 3-5 minutes
41
Q

V-fib

A
  • patient will become faint, lose consciousness, pulse-less, and apneic
  • NO HEART SOUNDS
  • seizures can occur and pupils become fix and dilated
  • defibrillation is REQUIRED
  • medications include: vasopressin, epinephrine, amiodarone, lidocaine, magnesium sulfate
42
Q

Asystole

A
  • FULL CARDIAC ARREST
  • no shocking
  • medication:epinephrine and atropine
43
Q

medications for PAC’s

A

epinephrine

Cardiac HAPS (2 decks)

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