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NURS 3512 - Class 1-6 > Week 3 - Cardiac Dysrhythmias > Flashcards

Week 3 - Cardiac Dysrhythmias Flashcards

1
Q

what are dysrhytmias

A
  • abnormal cardiac rhythmns
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2
Q

describe how to electrical conduction system works

A
  • SA node (upper RA) –> AV node –> bundle of His –> right and left bundle branches –> perkinje fibers
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3
Q

what does the cardiac impulse in the SA node cause

A
  • atria contract
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4
Q

what is the function of the AV node

A
  • delays the passage of elecrical impulses

= ensure the atria have ejected all blood, give ventricles time to fill

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5
Q

what is an ECG

A
  • graphic tracing of the electrical impulses produced the heart
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6
Q

what is the pacemaker of the heart

A

SA node

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7
Q

what does the P wave on an ECG represent

A
  • atrial contraction (deporalization)
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8
Q

what does the P-R segment represent on an EK

A
  • time it takes for the impulse to travel from the SA node to the bundle of his, bundle branches,and purkinje fibers to a point immediately before ventricular contarction
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9
Q

what does the QRS complex represent

A
  • firing of the AV node

& ventricular depolarization (conraction)

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10
Q

what does the S-T segment represent

A
  • time between ventricular depolarization and repolarization
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11
Q

what does the T wave represent

A
  • ventricular repolarization before ventricular diastole
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12
Q

what can cause dysrhythmias

A
  • disorders of impulse formation
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13
Q

what are some common cardiac causes of dysrhythmias (6)

A
  • CHF
  • MI
  • myocardial cell degeneration
  • conduction defects
  • accessory pathways
  • hypertrophy of heart muscle
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14
Q

what are some other conditions that can cause dysrhythmias (13)

A
  • acid-base imbalance
  • alcohol
  • coffee, tea
  • CT disorders
  • drug effects, toxicity
  • electric shock
  • electrolyte imbalances
  • hypoxia
  • shock
  • emotional shock
  • metabolic conditions
  • near-drowning
  • poisoning
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15
Q

what is a high priority with management of dysrhythmias

A
  • determination of rhtyhmn by cardiac monitoring
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16
Q

what can be done to evaluate cardiac dysrhytmias (5)

A
  • continuous ECG monitoring
  • electrophysiological test (invasive)
  • holter monitoring
  • event recorder monitoring
  • exercise treadmill testing
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17
Q

what is an electrophysiological test

A
  • involves introducing several electrode catheters transvenously thru the femoral vein to the R side of the heart
  • then electrical stimulation is done to induce dysrhythmia
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18
Q

what may be required w electrophysiological test

A
  • immediate cardioversion or defibrillation bc it may induce serious dysrhythmias
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19
Q

what is a holter monitor

A
  • device that record the ECG while the pt is ambulatory

- can record heart rhythmns for 24-48 hrs

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20
Q

what must a pt do when having a holter monitor

A
  • keep diary where actvities and symptoms are recorded
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21
Q

what is holter monitor useful for (3)

A
  • detecting signif dysrhythmias
  • evaluates the effects of drugs during a pts normal normal activities
  • can detect ischemia via the ST segment
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22
Q

what is a limitation of the holter monitor

A
  • pts w serious ventricular dysrhytmias may not experience them during the monitored time
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23
Q

what are event monitors

A
  • recorders activated by the pt & can only be used when they are experiencing symptoms
  • pt then transmits the rhythm to a central monitoring company via phone
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24
Q

what is a pro to event monitors

A
  • easier method of documenting a dysrhythmia than the 24 hr method, especially if symptoms are not occurring daily
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25
Q

what is exercise treadmill testing used for

A
  • evaluation of cardiac rhythmn in response to exercise
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26
Q

what is important to assess after we know the rhythmn and HR

A

BP
- some dysrhythmias cause rlly low BP –> if low for long period of time = more & more bradycardia = eventually astolic and MI

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27
Q

what is sinus bradycardia

A
  • conduction pathway is the same as in sinus rhythm

- but SA node fires at less than 60 beats/min

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28
Q

what can cause sinus bradycardia (9)

A
  • sleep
  • carotid sinus massage
  • hypothermia
  • increased intraocular pressure
  • increased vagal tone
  • hypothyroidism
  • increased ICP
  • obstructive jaundice
  • inferior wall MI
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29
Q

what are signs of sinus bradycardia (8)

A
  • pale & cool skin
  • hypotension
  • weakness
  • agina
  • dizziness
  • syncope
  • confusion & disorientation
  • SOB
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30
Q

what is sinus tachycardia

A
  • conduction pathway is same as normal sinus rhythmn

- but SA node firing at faster than 100 beats/min

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31
Q

what can cause sinus tachy (13)

A
  • exercise
  • fever
  • hypotension
  • hypovolemia
  • anemia
  • hypoxia
  • hypoglycemia
  • MI
  • HF
  • hyperthyroidism
  • anxiety
  • fear
  • effect of drugs (epi, norepi, caffeine, atropine)
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32
Q

what are signs of sinus tachy (5)

A
  • dizzy
  • dyspnea
  • hypertension
  • increased MI consumption
  • angina
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33
Q

what is atrial fibrillation

A
  • characterized by total disorganization on atrial electrical activity , resulting in loss of effective atrial contractionw
    = atria beat irregularly (quiver) = do not beat effectively to push fluid into ventricles
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34
Q

what is the focus of treatment for afib

A
  • rapid assessment on potential hemodynamic instability

- treat underlying cause

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35
Q

what is the most common dysrhytmia

A
  • afib
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36
Q

what are risk factors for afib (13)

A
  • increasing age
  • CAD
  • rheumatic heart disease
  • cardiomyopathy
  • HTN heart disease
  • HF
  • pericarditis
  • alcohol
  • caffeine use
  • electrolyte disturbances
  • stress
  • cardiac surgery
  • thyrotoxicotis
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37
Q

what does an ECG look like during afib (3)

A
  • v high atrial rate
  • high or low ventricular rate
  • P waves replace by chatoic, fibrillatory waves
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38
Q

what can afib result in (4)

A
  • decreased CO
  • thrombi formation
  • stroke
  • low BP
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39
Q

how does afib result in decreased CO & BP (4)

A
  • ineffective atrial contraction
  • loss of atrial kick
  • rapid ventricular response
  • heart and atria not able to fill and contract to move blood to ventricles like it should
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40
Q

how does afib lead to clot formation

A
  • d/t blood stasis
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41
Q

what is the goal of treatment for afib (5)

A
  • decrease & control ventricular response
  • prevent thrombi –> cerebral embolic response (stroke)
  • get back into normal sinus rhythm
  • treat cause
  • treat low BP
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42
Q

what may be used to convert afib back to NSR (3)

A
  • cardioversion
  • antidysrhytmia drugs
  • long term anticoag treatment
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43
Q

before cardioverting a pt with afib, what must the nurse do? why?

A
  • determine that the pt has had afib for less than 48 h

- cardioversion can cause clots to dislodge = increased risk of stroke

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44
Q

when is cardioversion contraindicated

A
  • if clot is present
45
Q

what is done to avoid a stroke during afib

A
  • anticoag treatment
46
Q

describe how afib presents chronically

A
  • chronic on and off

- body goes from NSR to afib, etc.

47
Q

what can trigger the flip to afib (4)

A
  • body under stress
  • illness
  • fluid overload
  • stressors
48
Q

what is AV heart block

A
  • partial or complete interuption of impulse transmission from the atria to ventricles
49
Q

what are the types of AV blokc

A
  • first degree
  • second degree (type 1 and 2)
  • third degree
50
Q

what is first degree AV block

A
  • type of AV block in which every impulse is conducted to the ventricles
  • but the duration of AV conduction is prolonged
51
Q

1st degree AV block is associated w (6)

A
  • MI
  • CAD
  • rheumatic fever
  • hyperthyroidism
  • vagal stimualtion
  • drugsd
52
Q

what drugs can cause 1st degree AV block (3)

A
  • beta blockers
  • calcium channel blockers
  • flecainide
53
Q

what ECG characteristics are seen during 1st degree AV block (5)

A
  • HR normal
  • rhythmn regular
  • P wave normal
  • PR interval prolonged
  • QRS normal shape and duration
54
Q

what is the clinical signif of 1st degree AV block (3)

A
  • not serious
  • may be a precursor for higher degree AV blocks
  • no symptoms
55
Q

what us treatment for 1st degree AV block (3)

A
  • no treatment
  • modification to causative meds
  • continue to monitor
56
Q

what is 2nd degree AV block , type 1

A

= mobitz 1 or wenckebach’s heart block

  • includes gradual lengthening of PR interval
  • occurs d/t prolonged AV conduction time until an atrial impulse is not conducted & a QRS complex is blocked
57
Q

what can cause 2nd degree AV block, type 1 (3)

A
  • drugs
  • CAD
  • diseases that slow AV conduction
58
Q

what drugs can cause 2nd degree AV block, type 1 (2)

A
  • digoxin

- beta blockers

59
Q

what ECG characteristics are seen with 2nd degree AV block, type 1 (6)

A
  • atrial rate normal
  • ventricular rate slower d/t unconducted atrial impulses or blocked QRS complexes
  • lengthened PR interval until another QRS is blocked
  • irreg. ventricular rhythmn
  • P wave normal shape
  • QRS normal shape and duration
60
Q

what is 2nd degree AV block, type 1 usually caused by

A
  • MI or myocardial ischemia
61
Q

what is the clinical signif of 2nd degree AV block type 1

A
  • may be a warning signal for a more serious SV block
62
Q

what is the treatment for 2nd degree AV block type 1 if they have symptoms

A
  • meds (atropine) to increase HR

- temp pacemaker

63
Q

if the pt has no symptoms w 2nd degree AV block type 1, what is the treatment

A
  • closely monitor rhythm

- monitor for hypotension

64
Q

what is 2nd degree AV block, type 2

A
  • a P wave is not conducted w progressive antedecent PR interval lengthening
    = certain number of impulses from the SA node are not conducted to the ventricles = get ratios of 2:1, 3:1 etc.
65
Q

what usually causes 2nd degree AV block, type 2

A
  • block in one of the bundle branches
66
Q

what is associated w 2nd degree AV block, type 2 (4)

A
  • rheumatic heart disease
  • CAD
  • anterior MI
  • digitaliz toxicity
67
Q

what are ECG characteristics of 2nd degree AV block, type 2

A
  • atrial rate normal
  • ventricular rate varies on degree of block
  • ventricular rhythm irregular
  • atrial rhythm regular
  • PR interval normal or prolonged
  • QRS complex duration increased (d/t bundle brach block)
68
Q

what is the clinical signif of 2nd degree AV block, type 2

A
  • often progresses to 3rd degree

- associated w poor prognosis

69
Q

what s/e are seen with 2nd degree AV block, type 2 (3)

A
  • reduced HR = reduced CO
  • hypotension
  • myocardial ischemia
70
Q

type 2 AV block is an indication for…

A
  • therapy w a permanent pacemaker
71
Q

what is treatment for type 2 AV block

A
  • temporary treatment before placement of pacemaker if symptomatic ex. temporary pacemaker
72
Q

what is type 2 AV block called

A
  • mobitz 2 heart block
73
Q

what is 3rd degree AV Block

A
  • complete heart block
  • no impulses from the atria are conducted to the ventricles
  • atria are stimulated and contract independently from the ventricles
  • very serious & severe, emergency
74
Q

what can cause 3rd degree AV block

A
  • heart disease
  • CAD
  • MI
  • myocarditis
  • cardiomyopathy
  • meds
75
Q

what meds can cause 3rd degree heart block

A
  • digoxin
  • beta blockers
  • calcium channel blockers
76
Q

what ECG characteristics are present in 3rd degree heart block

A
  • P wave normal shpe
  • variable PR intervak
  • no time relationship between P and QRS complex
77
Q

what does 3rd degree heart block result on (5)

A
  • reduced CO
  • ischemia
  • HF
  • cardiogenic shock w/in 30 sec
  • syncope
78
Q

what is treatment for 3rd degree heart block if they have symptoms

A
  • temporary pacemaker –> permanent

- meds to increase HR and support BP until pacemaker is initiated

79
Q

what meds are used to treat 3rd degree heart block (4)

A
  • atropine
  • epi
  • isoproterenol
  • dopamine
80
Q

what is ventricular fibrillation

A
  • severe derangement of the heart rhythm where the ventricles are “quivering” and have no effective contarction
81
Q

what can cause v fib (9)

A
  • acute MI
  • myocardial ischemia
  • CAD
  • cardiomyopathy
  • accidental electric shock
  • hyperkalemia
  • hypoxemia
  • acidosis
  • drug toxicity
82
Q

what ECG characteristics are present in v fib (4)

A
  • HR not measureable
  • rhythm irregular and choatic
  • PR and QRS intervals not measureable
    = no T wave seen
83
Q

what signs are seen in a pt w v fib (5)

A
  • pt unresponsive
  • pulseless
  • apneic state
  • no contraction of ventricles = no BP = no CO
  • if not rapidly treated, pt will die
84
Q

what is treatment of v fib (6)

A
  • assess circulation
  • assess ABCs
  • if no pulse found = advanced cardiac life support
  • CPR
  • defibrillation
  • ACLS meds
85
Q

what is an example of an ACLS med

A
  • epi
86
Q

what is asystole

A
  • represents the total absence of ventricular activity
  • the pt has died = code blue
  • lethal & requires immediate treatment
87
Q

what can cause asystole (3)

A
  • advanced cardiac disease
  • severe cardiac conduction system disturbance
  • end stage HF
88
Q

what ECG characteristics are seen in asystole

A
  • no activity

- on occassion P waves detected

89
Q

describe pts during asystole (3)

A
  • unresponsive
  • pulseless
  • apneic

poor prognosis

90
Q

what is treatment of asystole (5)

A
  • CPR
  • advanced cardiac life support (ACLS) such as:
  • intubation
  • transcutaneous pacing
  • IV therapy w epi and atropine
91
Q

is asystole shockable

A
  • no
92
Q

what is sudden cardiac death (SCD)

A
  • unexpected death resulting various causes, including cardiac arrest
  • refers to death from a cardiac cause
93
Q

what are most SCDS caused by (3)

A
  • ventricular dysarhythmias (specifically v tachy or v fib)
  • also by primary left ventricular outflow obstruction
  • extreme slowing of the heart
94
Q

describe the onset of SCD

A
  • often not sudden

- most have awareness of cardiac symptoms in the hour before

95
Q

what are acute symptoms of SCD (cardiac arrest)

A
  • angina
  • palpitation
  • SOB
96
Q

what occurs in SCD (5)

A 
- cardiac fnxn disrupted abruptly 
= immediate loss of CO & cerebral blood flow 
= decreased BP
= stopped HR
= pass out
97
Q

describe the hx of a patient with SCD

A
  • may or may not have history of CAD
98
Q

death from SCD usually occurs…

A
  • 1 hr from onset of acute symptoms
99
Q

people who experience SCD d/t CAD are categorized as..

A
  • those who did not have an acute MI

- those who did have an acute MI

100
Q

what category of SCD accounts for most cases of SCD? why?

A
  • those who did not have an acute MI

- bc get no warning signs or symptoms

101
Q

what are risk factors for SCD (7)

A
  • male sex
  • FHx of premature atherosclerosis
  • tobacco use
  • DM
  • hypercholesterolemia
  • HTN
  • cardiomyopathy
102
Q

what interventions have helped increased survival rate r/t SCD

A
  • CPR

- defib with an AED

103
Q

pts who survive SCD require (5 ish?)

A
  • diagnostic workup to determine if they had a MI
    = ECG, cardiac markers, cardiac catheterization (to determine extent of CAD)
  • PCI
  • CABG
  • and then treatment is planned accordingly
104
Q

most pts with SCD have…

A
  • a lethal ventricular dysrhytmia that has a high incidence of recurrence
    = useful to know when they are most likely to have a recurrence and what drug therapy is most effective
105
Q

what is done to assess dysrhytmias in a pt who survived SCD

A
  • 24-hr holter monitoring
  • event recorders
  • exercise stress testing
  • signal-averaged ECG
  • electrophysiological study performed w fluroscopy
  • pacing electrodes to attempt to produce dysrhytmias
106
Q

what is the most common approach to prevent recurrence of SCD

A
  • use of an implantable cardioverter-defibrillator (ICD)
107
Q

what is an ICD

A
  • small battery-powered device placed in your chest to detect and stop abnormal heartbeats (arrhythmias)
  • continuously monitors your heartbeat and delivers electric shocks, when needed, to restore a normal heart rhythm
108
Q

what else is used to prevent recurrence of SCD

A
  • meds (ex. amiodrone) to decrease ventricular dysrhytmias
109
Q

when caring for pts who have survive SCD, what is included in nursing care (5)

A
  • alert to pts psychosocial adaptation to this sudden “brush w death”
  • help manage anxiety and depression (d/t time bomb mentality)
  • possible driving restriction
  • possible change in occupation
  • emotional support

NURS 3512 - Class 1-6 (47 decks)

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