Types of arrhythmias Flashcards
What is sinus bradycardia?
occurs when the SA node creates an impulse at a slower-than-normal rate
What are causes of sinus bradycardia related to lower metabolic needs?
sleep
athletic training
hypothyroidism
What are causes of sinus bradycardia related to vagal stimulation?
vomiting
suctioning
severe pain
What medications can cause sinus bradycardia?
amiodarone
nifedipine
metoprolol
What are misc. causes of sinus bradycardia?
idiopathic sinus node dysfunction
increased ICP
CAD
What is a common treatment for bradycardia?
atropine
What can we give a pt with sinus bradycardia if they are unresponsive to atropine?
dopamine, isoproterenol, or epinephrine
What are causes of sinus tachycardia?
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
What is sinus tachycardia?
when the sinus node creates an impulse at a faster-than-normal rate
What are physiological or psychological stressors that can cause sinus tachycardia?
acute blood loss,
anemia, shock,
hypervolemia,
hypovolemia,
heart failure,
pain,
hypermetabolic states,
fever,
exercise, anxiety
What medications can cause sinus tachycardia?
catecholamines, aminophylline, atropine
What stimulants can cause sinus tachycardia?
caffeine, nicotine
What illicit drugs can cause sinus tachycardia?
amphetamines, cocaine, ecstasy
What is the treatment of choice for sinus tachycardia?
synchronized cadioversion
What medications is used to treat sinus tachy?
adenosine
What vagal maneuvers are used to sinus tachy?
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
What is sinus arrhythmia?
when the sinus node creates an impulse at an irregular rhythm; the rate usually increases with inspiration and decreases with expiration
What causes sinus arrhythmia?
heart disease and valvular disease
What is a premature atrial complex?
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
What causes PACs?
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
What dysrhthmias do PACs usually accompany?
sinus tachy
How do we treat PACs?
treat underlying cause
reduction of caffeine intake, correction of hypokalemia
What is atrial fibrillation?
rapid, disorganized, and uncoordinated twitching of the atrial musculature
What are risk factors for a-fib?
*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
What does a-fib put you at risk for?
heart failure, myocardial ischemia, and embolic events such as stroke
What assessment is performed for a-fib?
H&P
frequency, duration, precipitating factors
12-lead ECG
chest x-ray
stress test
transesophageal echocardiogram
What are pharmacological treatments of a-fib?
anticoagulants and antiplatelet drugs
beta blockers
calcium channel blockers
flecainide,
dofetilide,
propafenone,
amiodarone, and IV ibutilide
T or F, Electrical cardioversion can be used to treat a-fib?
True
How do we evluate for possible atrial thrombi with cardioversion?
a transesophageal echocardiogram
How do we treat a-fib if drugs and cardioversion don’t work?
catheter ablation, maze or mini-maze procedure, or convergent procedure
What is catheter ablation?
destroys specific cells that are the cause of a tachyarrhythmia
“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?
catheter ablation
What nursing management is done for pt who recieved catheter ablation?
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
What is a maze procedure?
Small transmural incisions are made throughout the atria. The resulting formation of scar tissue prevents reentry conduction of the aberrant electrical impulse
What is the mini-maze?
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
“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?
convergent procedure
What is left atrial appendege occlusion?
The parachute-shaped device (WATCHMAN) is threaded through to the opening of the LAA, sealing it off and preventing it from releasing clots
What is Wolffe-Parkinson White syndrome?
An accessory pathway is typically congenital tissue between the atria, bundle of His, AV node, Purkinje fibers, or ventricular myocardium
What is an atrial flutter?
a conduction defect in the atrium and causes a rapid, regular atrial impulse at a rate between 250 and 400 bpm
What are s/s of atrial flutter?
chest pain, shortness of breath, and low blood pressure
How do we treat atrial flutter?
vagal maneuvers
adenosine
antithrombotic therapy,
rate control, and
rhythm control
What is a premature juncitonal complex?
an impulse that starts in the AV nodal area before the next normal sinus impulse reaches the AV node
What causes premature junctional complex?
digitalis toxicity, heart failure, and coronary artery disease
What is junctional rhythm?
junctional or idionodal rhythm occurs when the AV node, instead of the sinus node, becomes the pacemaker of the heart
What are s/s of juncitonal rhythm?
Junctional rhythm may produce signs and symptoms of reduced cardiac output.
What is atriovenctricular reentry tachycardia?
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
What can cause AVNRT?
caffeine, nicotine, hypoxemia, and stress
coronary artery disease and cardiomyopathy
How do we treat AVNRT?
vagal maneuvers
catheter ablation
(can fix itself)
What drug is used to treat AVNRT?
adenosine
What is a premature ventrical complex?
an impulse that starts in a ventricle and is conducted through the ventricles before the next normal sinus impulse
What causese PVC?
ischemia or infarction, increased workload on the heart
caffeine, nicotine, or alcohol
How are PVCs treated?
amiodarone or beta-blockers
What is ventricular tachycardia?
as three or more PVCs in a row, occurring at a rate exceeding 100 bpm
How do we treat pulseless VT?
debifrillation
What is ventricular fibrilation?
which is a rapid, disorganized ventricular rhythm that causes ineffective quivering of the ventricles
When do AV blocks occur?
when the conduction of the impulse through the AV node or bundle of His area is decreased or stopped
What causes AV block?
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
What is idioventricular rhythm?
occurs when the impulse starts in the conduction system below the AV node
What is ventricular asystole?
(flatline)
no heartbeat, no palpable pulse, and no respiration
How do we treat ventricular asystole?
CPR, intubation and establishment of IV access
What is first degree AV block?
when all the atrial impulses are conducted through the AV node into the ventricles at a rate slower than normal.
What is second degree AV type I block?
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
What is second degree AV type II block?
when only some of the atrial impulses are conducted through the AV node into the ventricles
What is third degree AV block?
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
What does a-fib put you at risk for?
stroke
Rapid ventricular response
What two drugs do we use for a-fib?
(they control the HR)
diltiazem
verapamil
What is it called when we shock a dude with a pulse?
cardioversion
T or F, can people with a-fib live with is for all their lives
true
What rhythms do we use defbis for?
v fib and pulseless V tach
Dowe use defibs for no pulse?
yes
What is the half life of amiodarone?
64 days
