Week 1 (exam 2) Flashcards
Sinus Brady causes
Meds such as Beta blockers
Vagal stimulation
Runners
Sleep
Tx for sinus Brady (only if pt is symptomatic)
Possibly a pace maker
Atropine
Dopamine
Causes of sinus tachycardia
Exercise, anxiety, hypovolemia, shock, caffeine, nicotine, Tylenol
Tx of sinus tachycardia
eliminate cause, BB, CCB (calcium channel blocker), exercise.
Supraventricular Tachycardia is when the…
Tx is…
P&T wave are together
BB, adenosine, vagal stimulation
Premature Atrial Contraction (PAC) is….
Causes are…
Skipped or extra heartbeat that occurs when the atria contract to early, frequent PACs lead to AFIB
Caused by stimulants, stretched atrium
Atrial Fibrillation (afib) cause
post open heart surgery, valve disease, HF, cardiomyopathy, CAD, HTN R/F – CVA,
AFIB clinical manifestations
decreased BP, SOB, fatigue, Loose atrial kick. Left atrial appendage (blood pools in there, clots form)
AFIB Tx Meds
Cardizem/dilt, digoxin, amiodarone, tikosyn, BB, anticoagulant
ACE/ARBs decrease incidence of afib
AFIB non medication Tx
Vagal stimulation, adenosine (chemical cardioversion), ablation
Cardioversion if unstable
In afib > 48 hrs concern for clot. Do TEE
Ablation:
scars the electrical impulse in R atrium to try and redirect flow of electricity
Atrial flutter
saw tooth appearance
3 atrial beats to 1 ventricular beat
PEA
pt has no pulse
tx: CPR and EPI
Asystole
flat line
tx: CPR, EPI
PVC (premature ventricular contractions)
_____ or more in a row is considered _____________
PVC is due to _________________, _______________, or _______________
3; a run of VT
This is due to electrolytes being abnormal, may be seen in HF pts or pts with decreased ejection fraction
VT (Ventricular Tachycardia) causes
HF, EF < 35%, MI
pt may or may not have a pulse
no pulse treat as a code
Tx of Ventricular Tachycardia
Amiodarone, lidocaine
cardioversion, defibrillators
Ventricular fibrillation (VF/vfib) tx
CPR, EPI, Defib
if no pulse code pt
Cardioversion Elective
- client is awake and fully sedated
- synchronized with QRS
- 50- 200 Joules
- pt must sign consent form
- on EKG monitor
Cardioversion Emergency
Done with V-fib or V-tach
- no cardiac output
- begin with 200 joules and go up to 360
- client is unconscious
- on EKG monitor
The heart block poem
If the R is far from P you have first degree
Longer longer longer drop! then you have a Wenkebach
If some Ps don’t get through then you have a Mobitz II
If Ps and Qs don’t agree then you have a third degree
Transvenous Pace maker
Invasive
temporary
run pacemaker to RA or RV
goes trough the jugular, subclavian, or femoral vein
Transcutaneous pace maker
Non invasive
hooked to defibrillator pads, gives them a little jolt 60 times per min
Epicardial pacemaker
Invasive
post open heart
Permanent pace maker where is it inserted
typically left upper chest, assess incision site, get EKG to make sure pacer is working properly, don’t want arm moving above their head, assess breathing for possible pneumothorax
if pt have a pacemaker they should carry a card with them
difference between pace maker and ICD
pace maker produces a pulse
ICD will defibrillate a pt
What are the only two shockable rhythms?
V-tach and V-fib
If your pt has V-tach and a pulse you should…
give amiodarone and lidocaine and cardioversion
If your pt has V-Tach and NO pulse you should…
defibrilate
systole is the closure of
tricuspid and mitral valves
diastole is the closure of
pulmonic and aortic valves
Things that affect HR
nerves, and hormones
things that affect stroke volume
blood volume, and vascular resistance
Preload is increased with
hypervolemia
regurgitation of cardiac valves
heart failure
after load is increased with
hypertension and vasoconstriction
ejection fraction is
the amount of blood pumped out of the ventricle divided by the total amount of blood in the ventricle
Transducer goes in the
phlebostatic axis
Arterial line (pressure measurement)
Continuous invasive blood pressure measurement
Placed in artery (radial, femoral, brachial)
Map > 65
Systolic HF
problem w the contraction of the heart. Pt will have low ejection fraction
(normal is 60%-65%)
BNP levels should be
<100
BNP tells us the stretch of the heart
used to help dx HF
Diagnostics for MI
troponin: <0.1
CKMB: <240
Myoglobin: <90
EKG
Angina types
Stable: arteries can’t increase blood supply- goes away w rest
Unstable: can occur at rest and shows worsening CAD; pt is at risk for damage
Variant: Arterial spasms that come at the same time and last the same amt of time, no damage
