Heart Blocks! Flashcards
what is a HEART BLOCK?
HEART BLOCK is when electrical impulses don’t conduct properly
what happens during 1st DEGREE HEART BLOCK?
**all sinus impulses reach the ventricles; ultimately harmless
what does 1st DEGREE HEART BLOCK look like on EKG strip?
**P WAVE looks normal = harmless
–If you measure PR INTERVAL, it WILL be greater than 0.20 seconds
what causes 1st DEGREE HEART BLOCK?
- MI
- CAD
- fever
- HYPERthyroidism
- electrolyte imbalance: HYPOkalemia
- vagal stimulation
- drugs
how do I help with treating my patients 1st degree heart block?
- *asyptomatic? = NO INTERVENTION NEEDED
- -continue to monitor/document incase it worsens into more serious blocks
what happens during 2nd DEGREE HEART BLOCK - TYPE 1 (wenekebach)
**some impulses reach the ventricles, until eventually there is no impulse conducted
what does 2nd DEGREE HEART BLOCK-T1 look like on EKG strip?
**gradual lengthening of PR interval until QRS is dropped!
“longer, longer, longer, DROP, then you have wenekebach”
**QRS complex missing
**P > P INTERVAL & R > R INTERVAL NOT REGULAR!!!
what will be my patients S/S of 2nd DEGREE HEART BLOCK-T1?
- dizziness
- lightheadedness
- chest pain
- HYPOtension
- ASYMPTOMATIC
how can I help treat my patients 2nd DEGREE HEART BLOCK-T1?
- **ATROPINE; max 3 mg:
0. 5mg bolus, Q 3-5 min until max 3mg has been reached!
—if medications don’t help, might have to offer temporary pacemaking/transq pacing!
what happens during 2nd DEGREE HEART BLOCK - TYPE 2
AV node is NOT conducting all of the P WAVE
what does 2nd DEGREE HEART BLOCK - T2 look like on EKG strip?
**PR interval IS CONSISTENT; there is NO growing interval;
QRS COMPLEX IS STILL DROPPED
what will my patients S/S be with 2nd DEGREE HEART BLOCK - T2?
- ***THIS OFTEN PROGRESSES TO COMPLETE HEART BLOCK!
- HYPOtension
- myocardial ischemia
- syncope (fainting)
should I give ATROPINE to my patient with 2nd DEGREE HEART BLOCK - T2?
NO!!!
how can I help treat 2nd DEGREE HEART BLOCK - T2?
PACING!!!
- transq pacemaker
- temporary pacemaker
- *permanent pacemaker might eventually be necessary
what happens in 3rd DEGREE HEART BLOCK?
**complete disassociation between SA & AV nodes;
SA is releasing impulses BUT AV node is ALSO releasing impulses; everyone is doing their own thing!!!!
what does 3rd DEGREE HEART BLOCK look like on EKG strip?
P > P intervals = regular
QRS complex = regular
BUT there is NOT a P WAVE before every QRS complex!
what S/S will my patient be experiencing with 3rd DEGREE HEART BLOCK?
- **HR could be in the 20s!
- reduced cardiac output
- HYPOtension
- chest pain + ischemia
- shock
- syncope (fainting)
- change in LOC
should I give my HEART BLOCK patient BETA BLOCKERS?
ABSOLUTELY NOT!!! you DO NOT block a block!!!!
what can I do to help my patient experiencing 3rd DEGREE HEART BLOCK??
START PACING!!!!!: think pacemaker, temporary and permenant!!
what is important to know about pacemakers?!
***PACEMAKERS work on the demand: sense + respond to what is needed by the heart!
PACEMAKERS: temporary, invasive, permanent
TEMPORARY PACEMAKERS - think EMERGENT situations
INVASIVE PACEMAKERS - think URGENT
PERMANENT PACEMAKERS - think CHRONIC
what does a PACEMAKER look like on EKG strip?
there will be SPIKES on EKG strip before PQRST, this SPIKE is the firing of the PACEMAKER!
what education does the patient need to be provided with following PACEMAKER placement?
**teach patient how to check their pulse + document how pacemaker is functioning
- –DO NOT lift arm for 3-7 days following placement!
- -NO heavy lifting
- -AVOID magnets
