atrial Flashcards by Christine Deihl

Name three causes of atrial dysrhythmias

Altered automaticity
Triggered activity
Reentry

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Disorders of impulse formation in atrial dysrhythmias include:
a. Altered autmotacity
B. Triggered activity
C. Reentry

A & B

Altered automaticity and triggered activity are disorders of impulse formation

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What conditions predispose cardiac cells to altered automaticity?

Ischemia
Drug Toxicity
Hypocalcemia
Electrolyte imbalance

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What does altered automaticity produce?

Produce atrial dysrhythmias
premature atrial complexes
supraventricular tachycardia
atrial flutter
atrial fibrilation

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This is an abnormal condition of myocardial cells or non pacemaker which causes cells to depolarize more than once after stimulation by a single electrical impulse; sometimes happens during repolarization after the cells are normally quiet
A. altered automaticity
B. Triggered activity
C. Re-entry

Triggered activity

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This occurs in normal pacemaker cells or myocardial cells that do not normally function as pacemaker cells; causes cells to fire before a normal SA node such as with sinus tachycardia
A. Altered automaticity
B. Triggered activity
C. Reentry

A. Altered automaticity

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Name 4 causes of triggered activity

Hypoxia
Increased catelcholamines
Myocardial Ischemia
Medications

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Name a medication associated with triggered activity

Quinidine

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Triggered activity can result in:
A.  Atrial Beats
B.  Ventricular Beats
C.  patterns in which they occur in pairs, or 3 or more
D.  Sustained ectopic rhythm
E.  All of the above

E. all of the above

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Condition in which an impulse returns to stimulate tissue that was previously depolarized and results in a single premature beat, or repetitive electrical impulses resulting in short periods of rapid rhythms.
A. Altered automaticity
B. Triggered activity
C. Reentry

C. Reentry

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Causes of reentry include:

Hyperkalemia
Myocardial Ischemia
Antidysrhythmia medications

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Name 3 things required for reentry to occur.

Potential conduction circuit or circular conduction pathway
block within the circuit
Delayed conduction

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Atrial dysrhythmias include what two things?
A. PAC’s
B. SVT or paroxysmal supraventricular tachycardia
C. None of the above
D. All of the above

D. All of the above

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T or F: atrial dysrhythmias are not usually life threatening but may compromise cardiac output

True

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T or F: atrial dysrhythmias may produce very fast atrial rates

False; they produce very fast ventricular rates

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How do you recognize a PAC?
A.  Shortened P-R interval
B.  QRS is extended beyond 0.10
C.  P-waves are premature and occur earlier then expected and may appear different in shape
D.  QRS are inverted

C. P waves are premature

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WHen you see a pause which follows PVC this is known as:
A. Compensatory Pause
B. non compensatory pause

B. compensatory pause

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When you see an incomplete pause often following a PAC and causes a delay in which SA node resets its rhythm this is
A. Compensatory pause
B. Non compensatory pause

B. Non compensatory pause

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This type of PAC is associated with a wide QRS complex and conduction through ventricles is abnormal?

Aberrantly conducted PAC

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This type of PAC occurs prematurely and close to T-wave of preceeding beat; only p wave may be seen with no QRS after it (appears as pause)

Non conducted or blocked PAC

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What might cause a blocked PAC
A.  P wave occurred too early to be conducted
B.  AV junction is still refactory and unable to conduct impulses
C.  Pause is compensatory
D.  Pause is non compensatory
E  Both A &amp; B
F.  Both ABC
G  Both ABD

E. Both a & B

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If you see a hump which might indicate a hidden p wave and the pwave appears early in the t wave & t wave is of higher amplitude what do you probably have?
A. Aberrantly conducted PAC
B. Non conducted or blocked PAC
C. non compensatory pause

B. Non conducted or blocked PAC

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Name the causes of PAC’s

(EVA HAS CF not ED)
Emotional Stress
Valvular heart disease
Acute coronary syndrome
hyperthyroidism
Atrial enlargement
Stimulants
CHF
Fatigue
Electrolyte imbalance
Digitalis toxicity

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These are characterized by at least 3 different p waves seen in same lead and has multiple pacemakers that shift back & forth?

Multi Formed atrial rhythm or wandering atrial pacemaker

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T or F: MAR's have normal rates and rhythms.

False: the rhythm is irregular

When a multiformed atrial rhythm is greater than 100 bpm it is called?

Multifocal atrial tachycardia (MAT)

The MAT looks very similar to what?

A Fib

Name 3 types of supraventricular tachycardia

AT (atrial tachycardia) AVNRT (atriventricular nodal reentrant tachycardia) AVRT (atrioventricular reentrant tachycardia)

This type of atrial rhythm causes a series of rapid beats from an atrial ectopic focus & often follows a PAC, its rapid rate overrides the SA node and becomes pacemaker A. AT B. AVNRT C. AVRT

A. AT

When you have an AT that starts and ends suddenly this is called?

Paroxysmal Atrial Tachycardia

Causes of AT include:

``` IS MEA infection stimulant use(albuterol, cocaine) myocardial infarction Electrolyte imbalance Acute illness with excessive catecholamines released ```

Name the symptoms of AT

``` APFCDFDS Asymptomatic Palpitations Flutter in heart Chest pressure Dizziness Fatigue Dyspnea Syncope ```

How can you treat AT?

Vagal maneuvers Adenosine Calcium Channel blockers Beta Blockers

What is the drug of choice for treating AT

Adenosine

This type of arrhythmia begins above bifurcation of bundle of HIS and includes rhythms that begin in SA node atrial tissue or av junction

Supraventricular arrhythmia

Name 6 examples of a vagal maneuver

``` Coughing Squatting Carotid sinus pressure cold stimulus to face valsalva's maneuver gagging ```

what is the maximum time a vagal maneuver should be applied?

no more than 10 seconds

what happens when vagal maneuvers are used?

baroreceptors in internal carotid arteries and aortic arch are stimulated causes release of catecholamine slows conduction through av node

This type of SVA will result when an impulse originates as wave of excitation that spins around AV nodal, the p waves may be buried in the qrs A. AT B. AVNRT C. AV

B. AVNRT

This type of SVA is a reentrant mechanism, causes a circus movement or bypass tract A. AT B. AVNRT C. AV

C. AV

This type of SFV causes a firing outside of SA node at a rapid rate, fires automatically A. AT B. AVNRT C. AV

A. AT

Name causes of the MAT (multifocal atrial tachycardia)

``` CHAD RE H&H COPD Hypoxia Acute Coronary Syndrome Rheumatic heart disease Electrolyte imbalance: hypokalemia, hypomagnesemia Digoxin toxicity ```

If your patient is symptomatic but you are unsure if it is MAT vs a fib what can you do?

Vagal maneuver | Adenosine

What medications can be given for MAT?

Calcium channel blocker | Beta blockers

THis type of pattern is a result of random & chaotic firing of multiple sites in atria and does not involve reentry through AV node, adenosine or vagal maneuvers may slow down temporarily

MAT

What are 3 main types of atrial rhythms in this unit?

MAT PAC SVT

What are the 3 types of SVT's?

AT AVNRT AVRT

What is the drug of choice used for AT?

Adenosine

What drugs are used for MAT

Ca or Beta blockers

What 3 things can frequent PAC's initiate?

Atrial fibrillation Atrial Flutter PSVT

How do you treat PAC's?

Treat underlying cause

The MAT is also known as?

Wondering Atrial Pacemaker

T or F: PAC's are a very significant problem in a healthy heart and must be treated immediately

False

This type of atrial rhythm may appear in runs or bursts?

PAC

Name the types of patterns seen with PAC, 4 patterns

Coupled or pairs Runs or bursts which is greater than 3 PAC's Atrial bigeminy, in which every other beat is a PAC Atrial Trigeminy, every 3rd beat is a PAC

If you see premature p-waves of different shape than normal, a rate wnl, normal P-R interval and normal QRS what do you have? A. PAC B. MAT C. SVT

A. PAC

If you see a regular rhythm, but your rate is 100-250 bpm where one positive p wave preceeds each qrs complex in lead II but P waves differ in shape, you see an isoelectric baseline between 2 p waves what is this? A. PAC B. AT C. SVT

B. AT

If you have a rate at 60-100 bpm or is greater than 100 bpm with "irregular rhythm" in which size shape, & direction of P wave changes direction from beat to beat and 3 different p wave configurations occur in same lead with variable p-r intervals what do you probably have?

MAT or wandering atria pacemaker

what is a key difference between MAT and a fib?

The p waves are clearly visible with MAT

This pattern is often observed in athletes and during sleep?

Wandering atrial pacemaker | multi formed atrial rhythm

``` Atrial tachycardia is a type of? A. SVA B. MAT C. MAR D. PAC ```

A. SVA

This type of SVT is the most common; caused by reentry in the area of AV node? A. AT B. AVNRT C. AVRT

B. AVNRT