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NU 304 Med Surg/Adult Health > Types of arrhythmias > Flashcards

Types of arrhythmias Flashcards

1
Q

What is sinus bradycardia?

A

occurs when the SA node creates an impulse at a slower-than-normal rate

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2
Q

What are causes of sinus bradycardia related to lower metabolic needs?

A

sleep
athletic training
hypothyroidism

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3
Q

What are causes of sinus bradycardia related to vagal stimulation?

A

vomiting
suctioning
severe pain

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4
Q

What medications can cause sinus bradycardia?

A

amiodarone
nifedipine
metoprolol

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5
Q

What are misc. causes of sinus bradycardia?

A

idiopathic sinus node dysfunction
increased ICP
CAD

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6
Q

What is a common treatment for bradycardia?

A

atropine

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7
Q

What can we give a pt with sinus bradycardia if they are unresponsive to atropine?

A

dopamine, isoproterenol, or epinephrine

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8
Q

What are causes of sinus tachycardia?

A

Physiologic or psychological stress (e.g., acute blood loss, anemia, shock, hypervolemia, hypovolemia, heart failure, pain, hypermetabolic states, fever, exercise, anxiety)

Medications that stimulate the sympathetic response (e.g., catecholamines, aminophylline, atropine), stimulants (e.g., caffeine, nicotine), and illicit drugs (e.g., amphetamines, cocaine, ecstasy)

Enhanced automaticity of the SA node and/or excessive sympathetic tone with reduced parasympathetic tone that is out of proportion to physiologic demands, a condition called inappropriate sinus tachycardia

Autonomic dysfunction, which results in a type of sinus tachycardia referred to as postural orthostatic tachycardia syndrome (POTS). POTS is characterized by tachycardia without hypotension, and by presyncopal symptoms such as palpitations, lightheadedness, weakness, and blurred vision, which occur with sudden posture changes

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9
Q

What is sinus tachycardia?

A

when the sinus node creates an impulse at a faster-than-normal rate

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10
Q

What are physiological or psychological stressors that can cause sinus tachycardia?

A

acute blood loss,
anemia, shock,
hypervolemia,
hypovolemia,
heart failure,
pain,
hypermetabolic states,
fever,
exercise, anxiety

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11
Q

What medications can cause sinus tachycardia?

A

catecholamines, aminophylline, atropine

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12
Q

What stimulants can cause sinus tachycardia?

A

caffeine, nicotine

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13
Q

What illicit drugs can cause sinus tachycardia?

A

amphetamines, cocaine, ecstasy

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14
Q

What is the treatment of choice for sinus tachycardia?

A

synchronized cadioversion

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15
Q

What medications is used to treat sinus tachy?

A

adenosine

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16
Q

What vagal maneuvers are used to sinus tachy?

A

carotid sinus massage,
gagging,
bearing down against a closed glottis (as if having a bowel movement),
forceful and sustained coughing,
and applying a cold stimulus to the face

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17
Q

What is sinus arrhythmia?

A

when the sinus node creates an impulse at an irregular rhythm; the rate usually increases with inspiration and decreases with expiration

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18
Q

What causes sinus arrhythmia?

A

heart disease and valvular disease

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19
Q

What is a premature atrial complex?

A

A PAC is a single ECG complex that occurs when an electrical impulse starts in the atrium before the next normal impulse of the sinus node

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20
Q

What causes PACs?

A

caffeine,
alcohol,
nicotine,
stretched atrial myocardium (e.g., as in hypervolemia),
anxiety,
hypokalemia (low potassium level), hypermetabolic states (e.g., with pregnancy), or atrial ischemia, injury, or infarction

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21
Q

What dysrhthmias do PACs usually accompany?

A

sinus tachy

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22
Q

How do we treat PACs?

A

treat underlying cause
reduction of caffeine intake, correction of hypokalemia

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23
Q

What is atrial fibrillation?

A

rapid, disorganized, and uncoordinated twitching of the atrial musculature

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24
Q

What are risk factors for a-fib?

A

*Increasing age

*Hypertension

*Diabetes

*Obesity

*Valvular heart disease

*Heart failure

*Obstructive sleep apnea

*Alcohol abuse

*Hyperthyroidism

*Myocardial infarction

*Smoking

*Exercise

*Cardiothoracic surgery

*Increased pulse pressure

*European ancestry

*Family history

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25
Q

What does a-fib put you at risk for?

A

heart failure, myocardial ischemia, and embolic events such as stroke

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26
Q

What assessment is performed for a-fib?

A

H&P
frequency, duration, precipitating factors
12-lead ECG
chest x-ray
stress test
transesophageal echocardiogram

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27
Q

What are pharmacological treatments of a-fib?

A

anticoagulants and antiplatelet drugs
beta blockers
calcium channel blockers
flecainide,
dofetilide,
propafenone,
amiodarone, and IV ibutilide

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28
Q

T or F, Electrical cardioversion can be used to treat a-fib?

A

True

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29
Q

How do we evluate for possible atrial thrombi with cardioversion?

A

a transesophageal echocardiogram

30
Q

How do we treat a-fib if drugs and cardioversion don’t work?

A

catheter ablation, maze or mini-maze procedure, or convergent procedure

31
Q

What is catheter ablation?

A

destroys specific cells that are the cause of a tachyarrhythmia

32
Q

“a special catheter is advanced at or near the origin of the arrhythmia, where high-frequency, low-energy sound waves are passed through the catheter, causing thermal injury, localized cell destruction, and scarring”

What does this describe?

A

catheter ablation

33
Q

What nursing management is done for pt who recieved catheter ablation?

A

the patient is monitored closely to ensure recovery from sedation. Postprocedural nursing interventions include frequent monitoring for arrhythmias and for signs and symptoms of a stroke and vascular access site complications

34
Q

What is a maze procedure?

A

Small transmural incisions are made throughout the atria. The resulting formation of scar tissue prevents reentry conduction of the aberrant electrical impulse

35
Q

What is the mini-maze?

A

making small incisions between the ribs, through which video-guided instruments are inserted. The pulmonary veins are encircled with surgical incisions within the left atrium

36
Q

“surgeon creates a few small incisions in the abdomen so that a special catheter that allows visualization can be inserted through the diaphragm and toward the posterior wall of the heart. The surgeon performs ablation of the epicardial wall in the area around the pulmonary veins and the electrophysiologist performs ablation around the endocardial area of the pulmonary veins”

What procedure does this describe?

A

convergent procedure

37
Q

What is left atrial appendege occlusion?

A

The parachute-shaped device (WATCHMAN) is threaded through to the opening of the LAA, sealing it off and preventing it from releasing clots

38
Q

What is Wolffe-Parkinson White syndrome?

A

An accessory pathway is typically congenital tissue between the atria, bundle of His, AV node, Purkinje fibers, or ventricular myocardium

39
Q

What is an atrial flutter?

A

a conduction defect in the atrium and causes a rapid, regular atrial impulse at a rate between 250 and 400 bpm

40
Q

What are s/s of atrial flutter?

A

chest pain, shortness of breath, and low blood pressure

41
Q

How do we treat atrial flutter?

A

vagal maneuvers
adenosine
antithrombotic therapy,
rate control, and
rhythm control

42
Q

What is a premature juncitonal complex?

A

an impulse that starts in the AV nodal area before the next normal sinus impulse reaches the AV node

43
Q

What causes premature junctional complex?

A

digitalis toxicity, heart failure, and coronary artery disease

44
Q

What is junctional rhythm?

A

junctional or idionodal rhythm occurs when the AV node, instead of the sinus node, becomes the pacemaker of the heart

45
Q

What are s/s of juncitonal rhythm?

A

Junctional rhythm may produce signs and symptoms of reduced cardiac output.

46
Q

What is atriovenctricular reentry tachycardia?

A

an impulse is conducted to an area in the AV node that causes the impulse to be rerouted back into the same area over and over again at a very fast rate

47
Q

What can cause AVNRT?

A

caffeine, nicotine, hypoxemia, and stress
coronary artery disease and cardiomyopathy

48
Q

How do we treat AVNRT?

A

vagal maneuvers
catheter ablation
(can fix itself)

49
Q

What drug is used to treat AVNRT?

A

adenosine

50
Q

What is a premature ventrical complex?

A

an impulse that starts in a ventricle and is conducted through the ventricles before the next normal sinus impulse

51
Q

What causese PVC?

A

ischemia or infarction, increased workload on the heart
caffeine, nicotine, or alcohol

52
Q

How are PVCs treated?

A

amiodarone or beta-blockers

53
Q

What is ventricular tachycardia?

A

as three or more PVCs in a row, occurring at a rate exceeding 100 bpm

54
Q

How do we treat pulseless VT?

A

debifrillation

55
Q

What is ventricular fibrilation?

A

which is a rapid, disorganized ventricular rhythm that causes ineffective quivering of the ventricles

56
Q

When do AV blocks occur?

A

when the conduction of the impulse through the AV node or bundle of His area is decreased or stopped

57
Q

What causes AV block?

A

can be caused by medications (e.g., digitalis, calcium channel blockers, beta-blockers), Lyme disease, myocardial ischemia and infarction, hypothyroidism, or activities that cause an increase in vagal tone

58
Q

What is idioventricular rhythm?

A

occurs when the impulse starts in the conduction system below the AV node

59
Q

What is ventricular asystole?
(flatline)

A

no heartbeat, no palpable pulse, and no respiration

60
Q

How do we treat ventricular asystole?

A

CPR, intubation and establishment of IV access

61
Q

What is first degree AV block?

A

when all the atrial impulses are conducted through the AV node into the ventricles at a rate slower than normal.

62
Q

What is second degree AV type I block?

A

when there is a repeating pattern in which all but one of a series of atrial impulses are conducted through the AV node into the ventricles

63
Q

What is second degree AV type II block?

A

when only some of the atrial impulses are conducted through the AV node into the ventricles

64
Q

What is third degree AV block?

A

when no atrial impulse is conducted through the AV node into the ventricles. In third-degree AV block, two impulses stimulate the heart: one stimulates the ventricles, represented by the QRS complex, and one stimulates the atria

65
Q

What does a-fib put you at risk for?

A

stroke
Rapid ventricular response

66
Q

What two drugs do we use for a-fib?
(they control the HR)

A

diltiazem
verapamil

67
Q

What is it called when we shock a dude with a pulse?

A

cardioversion

68
Q

T or F, can people with a-fib live with is for all their lives

A

true

69
Q

What rhythms do we use defbis for?

A

v fib and pulseless V tach

70
Q

Dowe use defibs for no pulse?

A

yes

71
Q

What is the half life of amiodarone?

A

64 days

NU 304 Med Surg/Adult Health (7 decks)

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