Rhythm Interpretation Flashcards
Where is the heart located? Base? Apex?
Set to the left; Superior; Anterior 5th ICS
Which cells are responsible for mechanical heart function?
Cardiomyocytes
Which cells are responsible for electrical heart function?
Pacemaker
What separates the ventricles?
Interventricular septum
What are the 3 functions of the fibrous skeleton?
Separate the atrial and ventricular muscle bundles; anchor heart valves; electrical insulation
Systemic Blood Flow
LUNGS - PULM VEINS - LA - BICUSPID VALVE - LV - AORTIC VALVE - AORTA - BODY
Pulmonic Blood Flow
BODY - SVC/IVC - RA - TRICUSPID VALVE - RV - PULMONIC VALVE - PULMONARY ARTERY - LUNGS
Atrial Contraction
Atrial systole
Atrial Relaxation
Atrial diastole
Ventricle Contraction
Ventricular systole
Ventricular Relaxation
Ventricular diastole
S1
Closure of AV valves at beginning of ventricular systole
S2
Closure of SL valves at end of ventricular systole
Electrical conduction pathway
SA - AV node - AV bundle - BB - Purkinje Fibres
Pacemaker Cells
Non-neural cells
Heart initiates impulses on its own - the nervous system does not _______ the heart to beat, but plays role in regulation of cardiac function via ___________ nervous system
cause; autonomic
Chronotropy
Heart rate
Inotropy
Contractility
Dromotropy
Speed of conduction
SNS - _______ is released to cause an __________ in chronotropy, inotropy, and dromotropy
Norepinephrine; increase
PNS - _______ is released to cause a __________ in chronotropy, inotropy, and dromotropy
Acetylcholine; decrease
PNS does NOT innvervate ___________, therefore has no impact on __________ ______________
ventricles; ventricular contractility
SA Node is the __________ _________, it generates _______ bpm, and is located in the _____
main PM; 60-100 bpm; RA
____ node receives impulse from SA node and takes over if SA node does not work; HR _______, located in _______ _____
AV node; 40-60 bpm; lower RA
Purkinje fibres
Can act as PM if needed, 20-40 bpm
Sinus arrhythmia
Irregular rhythm; no treatment if no symptoms present (decreased CO)
Junctional Escape Rhythm: Always _______, HR ________, P-wave _________, QRS _________
Treatment: (1) Asymptomatic (2) Symptomatic
regular; 40-60 bpm; absent/inverted; narrow;
(1) Assess for decreased CO, 12-lead ECG, treat underlying cause
(2) If symptomatic: APE —> atropine, pacing, epinephrine
Accelerated Junctional Rhythm: Junctional rhythm in which the HR is > __________
Treatment:
60 bpm
Treatment 2* to cause - do not suppress rhythm
Ventricular Escape Rhythm: Always ________, HR ________; P-wave _________, QRS ______
Treatment
Do NOT give _________
regular; 20-40; absent; WIDE
- Notify MD STAT
- PED –> pacing, epi, dopamine
Lidocaine - will cause ASYSTOLE
Accelerated Ventricular Rhythm: Ventricular rhythm in which the HR is > ___ bpm
Treatment:
40 bpm
Treat underlying cause and assess for decreased CO
PAC: Underlying ______ rhythm with _________ beat
Caused by altered __________
Treatment:
regular; irregular atrial
SA automaticity
Treat underlying cause; assess for decreased CO
Can develop into urgent atrial arrhythmia
PJC: Underlying ______ rhythm with _________ beat
Caused by altered __________
Treatment:
regular; irregular junctional
AV automaticity
Treat underlying cause; assess for decreased CO
Can develop into urgent atrial arrhythmia
PVC: Underlying ______ rhythm with _________ beat
Caused by altered __________
Treatment:
regular; irregular ventricular
ventricular automaticity
1) Assess for decreased CO + treat the underlying cause
2) Worry about frequent PVCs/run of PVC turning into V-Tach (decreased perfusion)
3) BCA –> BB, CCB, Amiodarone
Sinoatrial Block and Arrest:
1) What’s the difference?
2) Treatment
Block - impulse is block; rhythm resumes regularity
Arrest - impulse not generated; rhythm does not resume regularity
Treatment: Atropine and Pacing
1st Degree Block: delay in conduction from ____ to ___ node
PR interval: ______
Treatment:
SA to AV node
> 0.20s
Assess for decreased CO
12-lead ECG
Check electrolytes
can develop into 2nd degree block
2nd Degree Block Type 1: _________ PR intervals
An increasing _______ of conduction at level of AV node until a _____ is dropped
“Longer, longer, longer drop”
QRS ______ when present
Treatment:
Lengthening
Delay; QRS
Narrow
1) Assess for decreased CO, 12-lead
2) Check electrolytes, adjust medications
3) AIP - atropine, isuprel, pacing
2nd Degree Block Type 2: _____ ventricular rate
P-waves with missing QRS complexes
Treatment:
NO ________
Irregular
Treatment:
1) Assess for decreased CO
2) 12-lead, check electrolytes + medications
3) Pacing and Pacemaker
4) Prep the crash cart!!!
NO ATROPINE
3rd Degree Block: P-P regular & R-R regular
Asymptomatic treatment:
Symptomatic treatment:
Asymptomatic: monitor patient and prep to pace
Symptomatic: PIED – pacing, isoprel, epinephrine, dopamine
Atrial flutter: ______ rhythm with ______ appearance
QRS ______
Stable:
Unstable:
Atrial flutter: REGULAR rhythm with SAWTOOTH appearance
QRS narrow
Stable: BB, CCB, antiarrhythmic
Unstable: synch cardioversion
Atrial fibrillation: ________ rhythm
QRS _______
Stable:
Unstable:
Anticoagulation if a-fib is > ____hrs or unk
Atrial fibrillation: IRREGULAR rhythm
QRS narrow
Stable: antiarrhythmic
Unstable: synched cardioversion
Anticoagulation if a-fib is > 48hrs or unk
SVT: impulse generated ______ ventricles, regular
HR > ______ bpm
Treatment:
SVT: impulse generated ABOVE ventricles, regular
HR > 150 bpm
Treatment:
1) Assess for decreased CO
2) Adenosine, BB, CCB
3) Synch cardioversion if unstable
Ventricular Tachycardia: WIDE QRS, REGULAR RHYTHM
PULSE:
PULSELESS
Ventricular Tachycardia: WIDE QRS, REGULAR RHYTHM
PULSE: synch cardioversion, adenosine, amiodarone
PULSELESS: CPR, defibrillate + epi/amiodarone
Torsades de Pointe: Irregular
Caused by prolonged _____ interval
Treatment
Torsades de Pointe: Irregular
Caused by prolonged _____ interval
Treatment:
1) 2mg Mg IVP
2) If it does not revert, then SHOCK
Ventricular Fibrillation:
Treatment
SHOCK, EPI, AMIODARONE
Asystole and PEA:
Both are _____-_______ rhythms!!!
Immediate ______ and continue until transition to a ______ rhythm
Administer ______
Asystole and PEA:
Both are non-shockable rhythms!!!
Immediate CPR and continue until transition to a SHOCKABLE rhythm
Administer Epi!!
Pulseless V-Tach vs PEA
Pulseless V-tach: ____ is the issue and requires a _____ to reset
PEA: ______ is not the issue and therefore it is ______-__________
Pulseless V-Tach vs PEA
Pulseless V-tach: CONDUCTION is the issue and requires a SHOCK to resert
PEA: CONDUCTION is not the issue and therefore it is non-shockable
5 Hs
Hypovolemia
Hypoxia
Hydrogen Ions
Hypo/Hyper-kalemia
Hypothermia
5 Ts
Tension pneumothorax
Tamponade
Toxins
Thrombosis, pulmonary
Thrombosis, cardiac
When is pacing used?
Bradycardic arrhythmias
Escape rhythms
Heart Blocks
Sinoatrial arrest and block
When is cardioversion used?
Tachy-arrhythmias
Atrial Fibrillation
Atrial Flutter
SVT
Ventricular Tachycardia w/ pulse
When is defibrillation used?
ONLY with pVT and VF
What do you do with a patient with asystole or PEA?
You start CPR and attach pads until a shockable rhythm is detected + administer Epi/Amiodarone
For which rhythm do you NOT administer LIDOCAINE?
Ventricular escape rhythm - can worsen bradycardia
For which rhythm do you NOT administer ATROPINE?
2nd Degree Type 2 - can progress to 3rd degree block
What part of the complex does cardioversion sync with?
R-wave
What is atropine used for?
Treat bradycardia/asystole
What is lidocaine used for?
Ventricular tachyarrhythmias (VT, VF, PVCs)
What is the 1st line of defense for hypotension?
What is recommended before administering this medication?
When is it contraindicated?
Levophed (Norepinephrine) - causes vasoconstriction
Treat hypovolemia first - administer bolus
In patients with heart failure
How is Epi administered?
First-line medication treatment for bradycardias/asystole
Give 1mg IVP q3-5 minutes until ROSC or code is called
What does sympathomimetic mean? What is an example and what are the manifestations?
Sympathomimetics are drugs that mimic the stimulation of the sympathetic nervous system
Ie - Epi
Hyperglycemia, HTN, arrhythmias
When is dopamine used (x4)? Mid dose vs high dose?
What to do before administering dopamine?
Hypotension + heart failure + increased renal perfusion
Also used for bradycardia (ventricular escape rhythm, 3rd degree block)
Mid-dose: Inotropic effect - increase contractility
High-dose: Vasoconstriction - hypotension
Treat hypovolemia first - administer a bolus
What is lidocaine?
What is it used to treat?
What do you need to watch out for when administering lidocaine?
Lidocaine is an antiarrhythmic
Used to treat ventricular tachyarrhythmias (VT, VF, PVCs)
Lidocaine toxicity cause lead to bradycardia –> cardiac arrest –> Stop immediately
What is amiodarone?
What does it treat?
What is the recommended alternative to amiodarone?
First-line anti-arrhythmic
Tachyarrhythmias (VT, VF, pVT, a-fib)
Lidocaine is the recommended alternative
What is used to treat hypertensive emergencies?
How should it be infused?
Nursing considering during infusion?
Labetalol - used to decrease BP and preload/afterload
Infuse slowly
Pt should remain supine for 3 hours
What is adenosine used for?
Treat tachyarrhythmias - helps to lower HR
