Module 4: part 5 - A Fib Flashcards
What are arrhythmias?
Abn electrical conduction in the heart
What do arrhythmias effect?
The normal HR and cardiac rhythm
What conditions are associated w arrhythmias
CAD, MI, HTN, valve dysfx, digoxin toxicity, low K+, CHF, CVA, pulmonary disease etc
At what rate do we begin to be concerned about abn HR?
less than 50 or greater than 100
What rate is the normal sinus rhythm?
~ 75 bpm
What is the HR during A Fib?
~ 150-300 bpm
Risk factors for developing A Fib?
There are a LOT, just know at least 5
- Advanced age with valvular heart disease (mitral/tricuspid)
- HTN
- Inflammatory or infiltrative disease
- CAD
- Congenital disorder
- HF
- Diabetes
- Obesity
- Hyperthyroidism
- Pulmonary Hypertension
- Embolism
- Obstructive sleep apnea (OSA)
- Moderate to heavy ETOH
- Following open heart Sx
What is the A Fib triad?
- Racing heart/fluttering/palpitations
- SOB
- Feeling lightheaded
Other S+S of A Fib:
- Irregular pulse
- Dizzy
- Weakness
- Fainting
- Decreased BP if not compensating
Which organ systems should you keep an eye on if pt has A Fib?
Hepatic and renal
Which ‘lytes should you keep and eye on if your pt has A Fib?
K, Na, Ca
Why is there an inc risk for thrombosis in pts w AFib?
Because if the atria are not pump properly, the blood can pool and form a clot
Dx tools for AFib?
- ECG
- Holter monitor
What is a Holter monitor?
Records heart activity for 24 hours
a portable ECG
What lab test should you run for Dx AFib?
- Platelets
- PTT
- PT-INR
- Digoxin level
- Electrolyte
How does defibrillation help w AFib?
It extinguishes all electrical activity, allowing the normal sinus rhythm to restart and take over again
How does cardioversion help w AFib?
Restores normal sinus rhythm by sending electrical shocks to the heart through electrodes placed on the chest
What is the difference between defibrillation and cardioversion?
- Cardioversion is a shock that is synchronized to the QRS complex
- Defibrillation is a shock delivered randomly
Why should cardioversion be done within the first 48 hours of onset of AFib?
Because there is a high risk for clotting after 48 hours and cardioversion started after 48 hours runs a high risk of dislodging the possible clots
What s the Maze procedure and how does this help restore a normal sinus rhythm?
Using surgical ablation, this is the creation of lines of scar tissue that block the abnormal impulses causing AFib. No AFib = normal sinus rhythm
3 drug classes you should give during AFib?
1) Beta-blockers
- eg metoprolol
2) Anti-arrhythmics
- eg Digoxin, Amiodarone
3) Anticoags
- Warfarin, Heparin, Apixban, Dalteparin
What is the effect of anti-arrhythmic drugs?
- Alter electrophysiological properties of the heart
- Slows the progression or conduction of electrical activity.
5 reasons why a pt may be on anticoags?
- Immobility (post surgical)
- Hx DVT/pulmonary embolus
- Dysrhythmias (AFib)
- Mechanical heart valve
- Post MI or CVA
T or F:
Anticoags dec clotting time to prevent thrombi from forming or growing larger
F, they inc clotting time to do this
