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ACLS > cardiac dysrhythmia OLOL 11/18 > Flashcards

cardiac dysrhythmia OLOL 11/18 Flashcards

mastery

1
Q

geminal patterns are associated with what type of dysrhythmia

A

PAC’s

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2
Q

What are 10 causes of PAC’s?

A 
emotional distress
CHF
acute coronary syndromes
mental and physical fatigue
atrial enlargement
digitalis toxicity
valvular heart disease
electrolyte imbalance
hyperthyroidism
stimulants like caffeine, nicotine, and cocaine
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3
Q

how are PAC’s treated?

A

PAC’s are not clinically significant in persons with healthy hearts and do not require treatment. A patient may be told to cough and drink water.

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4
Q

PAC’s may initiate what?

A

episodes of atrial fibrillation, flutter, or PSVT or paroxysmal supraventricular tachycardia. Resolutions can be found by treating the underlying cause

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5
Q

what are the EKG signs of a wandering pacemaker?

A

P waves vary in size, shape, and direction, look for 3 or more different morphologies in a rhythm strip

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6
Q

what causes a wandering pacemaker?

A

can occur in healthy hearts and during sleep, and caused by digitalis toxicity

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7
Q

a wandering pacemaker with a rate over 100 beats per minute is called what?

A

multifocal atrial tachycardia or MAT

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8
Q

name seven examples of Vagal maneuvers

A

coughing, squatting, breath-holding, carotid sinus pressure, application to cold stimulus to the face, Valsalvas maneuver, and gagging

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9
Q

Supraventricular Arrhythmias begin where?

A

above the bifurcation of the bundle of HIS such as the SA node, atrial tissue, and the AV junction

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10
Q

what is Paroxysmal atrial tachycardia?

A

atrial tachycardia that starts or ends suddenly

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11
Q

what causes atrial tachycardia?

A

stimulants such as caffeine, infection, electrolyte imbalance, acute illness with excessive catecholamine release, MI

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12
Q

what are some treatments of SVT?

A

Vagal maneuvers, Adenosine, calcium channel blockers, beta blockers

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13
Q

what is atrial flutter?

A

an ectopic atrial rhythm in which an irritable site fires at an extremely rapid rate, expressed in ratios of atrial to ventricular rate such as 3:1 or 4:1

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14
Q

what causes atrial flutter?

A

usually precipitated by a PAC and may last seconds to hours, chronic A flutter is very unusual

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15
Q

what is a paroxysmal rhythm?

A

something that starts and suddenly stops abruptly

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16
Q

what are some conditions that are associated with atrial flutter?

A

hypoxia, pulmonary embolism, chronic lung disease, valve stenosis or regurgitation, PNA, MI complications, ischemic heart disease, cardio myopathy, hyperthyroid, digitalis or quinidine toxicity, cardiac surgery, pericarditis/ myocarditis

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17
Q

how is atrial flutter treated?

A

vagal maneuvers

synchronized cardioversion- RRT may cardiovert on the floor

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18
Q

what causes atrial fibrillation?

A

altered automaticity or reentry

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19
Q

what are 13 clinical conditions that can contribute to A fib

A

HTN, MI, CAD, abnormal heart valves, congenital heart defects, overactive thyroid or other metabolic imbalance, exposure to stimulants such as ETOH, tobacco, caffeine, or medications, Lung disease, previous heart surgery, viral infections, stress due to PNA or surgery, sleep apnea

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20
Q

what is reentry?

A

is when an impulse returns to stimulate tissue that was previously depolarized

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21
Q

how is atrial fibrillation treated?

A

anticoagulation, rate control, and rhythm control

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22
Q

what are some anticoagulation medications for atrial fibrillation? (4)

A

Eliquis/ apixaban, Pradaxa/ dabigatran, Xarelto/ rivaroxaban, Coumadin/ warfarin

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23
Q

what are some Beta Blockers used to control A Fib?

A

Metoprolol, Propranolol, Esmolol, slows conduction velocity, decreases automaticity, prolongs refractory period

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24
Q

what are some side effects of Digoxin?

A

AV block, Sinus pauses, ventricular arrhythmias, drug toxicity, multiple drug to drug interactions

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25
Q

what is Digoxin and what does it do?

A

cardiac glycoside, slows conduction, increases the force of contraction, used in left ventricle dysfunction

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26
Q

where is the AV node located?

A

in the lower portion of the right atrium

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27
Q

the thing that connects the AV node with the bundle branches is the what?

A

the bundle of HIS

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28
Q

the bundle of HIS has a pacemaker rate of

A

40 to 60 beats per minute

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29
Q

the AV node and the nonbranching portion of the bundle of HIS is known as the what?

A

AV junction

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30
Q

if the AV junction is to pace the heart, the stimulus must travel in a retrograde direction to fire the atria, therefore the P waves will be

A

P waves may occur before, during or after the QRS

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31
Q

what has reverse impulse P waves and is kind of like a PAC?

A

Premature Junctional Complexes, or PJC’s

32
Q

how do you identify a PJC?

A

it arises from an irritable site within the AV junction that fires before the next expected sinus beat. It is often followed by a noncompensatory or incomplete pause

33
Q

describe a P wave in a PJC

A

may or may not be present, if it is it will be retrograde, and therefore inverted, and may precede or follow the QRS

34
Q

is a PJC a rhythm?

A

no, it is a single beat

35
Q

what heart disease originates from strep throat?

A

rheumatic heart disease

36
Q

what are some causes of PJC’s?

A

CHF, acute coronary syndromes, mental and physical fatigue, valvular heart disease, digitalis toxicity, electrolyte imbalance, rheumatic heart disease, stimulants such as caffeine and cocaine

37
Q

what is a junctional escape beat?

A

a beat that originates in the AV junction, preventing cardiac standstill

38
Q

how do you identify a junctional rhythm?

A

it is several sequential junctional escape beats, has a rate of 40 - 60, is very regular, and will have retrograde inverted P waves if any

39
Q

what are some drugs to treat Junctional rhythm?

A

Dopamine, atropine, Epi

40
Q

what are the characteristics of accelerated junctional rhythm?

A

a junctional rhythm with a rate of 61-100

41
Q

what are the causes of Accelerated junctional rhythm?

A

digitalis toxicity, acute MI, cardiac surgery, rheumatic fever, COPD, hypokalemia

42
Q

what are the characteristics of Junctional tachycardia?

A

a junctional rhythm with a rate of 101-150

43
Q

what is the value of a small square in an EKG strip?

A

0.04 seconds

44
Q

what is the value of a large square in an EKG strip?

A

0.20 seconds

45
Q

how many large squares in an EKG strip does it take to add up to one second?

A

5

46
Q

what is the difference between a segment and an interval?

A

a segment is the space between two waves, an interval involves one or more waves and possibly a segment

47
Q

what is a P-R interval and how long is it normally?

A

it starts at the beginning of the P wave and ends with the downward deflection of the Q wave, normally 0.12-0.20 seconds

48
Q

what is the normal duration of a QRS complex interval?

A

0.06 - 0.10 seconds. Anything more than 0.10 seconds is considered wide.

49
Q

what is the normal duration and parameters of the Q-T interval?

A

the beginning of the QRS to the end of the T wave, lasting less than half of the R - R interval.

50
Q

a ventricular rhythm originates from where?

A

the purkinje fibers

51
Q

what is the rate of a ventricular rhythm in beats per minute?

A

20 - 40 beats per minute

52
Q

where dose a PVC come from

A

an irritable focus within a ventricle

53
Q

a pair of two sequential PVC’s is called a what?

A

couplet

54
Q

bigeminal PVC’s, or ventricular bigeminy, are identified by what?

A

every other beat is a PVC

55
Q

trigeminal PVC’s, or ventricular trigeminy, is identified as what?

A

every 3rd beat is a PVC

56
Q

what is the definition of sustained V tach?

A

a run of 30

57
Q

PVC’s look the same if they are what? and if they look different what is it called?

A

they look the same if they are from the same site. If they look different, they are from different focal points and are called multifocal

58
Q

what is an interpolated PVC?

A

a PVC that does not have an full compensatory pause, and is squeezed in between two regular complexes

59
Q

what is an R on T PVC, and why is it significant?

A

the R of the PVC falls on the T of the preceding beat, it can cause VT or VF

60
Q

Ventricular escape rhythm is also called what?

A

Idioventricular rhythm or IVR

61
Q

How do you identify IVR?

A

three or more ventricular escape beats occurring in a row at a rate of 20 - 40 beats per minute

62
Q

What is an agonal rhythm?

A

a ventricular rate of less than 20 beats per minute

63
Q

what causes IVR or Idioventricular Rhythm?

A

the SA and AV are firing at a rate that is slower than the ventricles, initiating escape beats, may also be because of MI, digitalis toxicity, or metabolic imbalances. Basically nothing else is working

64
Q

what is the treatment of idioventricular rhythm?

A

TCP or transcutaneous pacing

65
Q

what is it called when three or more escape beats occur in a row at a rate of 41 - 100?

A

Accelerated Idioventricular rhythm or AIVR

66
Q

what causes AIVR?

A

usually considered a benign escape rhythm and is often seen during the first 12 hours of an MI and is common after reperfusion therapy

67
Q

what are some of the causes of AIVR?

A 
Subarachnoid hemorrhage
digitalis toxicity
cocaine 
acute myocarditis
hypersensitive heart disease
dilated cardiomyopathy
68
Q

three or more PVC’s in a row with a rate greater than 100 is called what?

A

ventricular tachycardia

69
Q

what is the difference between sustained and non-sustained ventricular tachycardia?

A

whether its shorter or longer than 30 seconds

70
Q

an unconscious person in VT is treated with what?

A

defibrillation

71
Q

VT with uniform beats is said to be what?

A

monomorphic

72
Q

VT with beats that are not uniform are said to be what?

A

polymorphic

73
Q

Torresades is an example of what?

A

polymorphic VT

74
Q

what are some causes of PEA or pulseless electrical activity? (10)

A 
most commonly hypovolemia,
pulmonary embolism
acidosis 
tension pneumothorax 
cardiac tamponade
hypoxia
hyper or hypothermia
MI
hyper or hypokalemia
drug overdoses
75
Q

a depressed S - T interval is due to what?

A

possibly a past MI or ischemia

76
Q

what is atropine use to treat and what does it do?

A

it blocks the chemicals at the endings of the vagus nerve. This allows more sympathetic nervous system activity, and an increased SA rate and AV conductivity

ACLS (6 decks)

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