Atrial Dysrhythmias pt.1 (Exam 2)

Question 1

Atrial Dysrhythmias

Answer 1

Premature atrial contraction (PAC)

Atrial fibrillation

Atrial flutter

Paroxysmal supraventricular tachycardia (PSVT)

Question 2

Premature Atrial Contraction

Answer 2

Isolated premature atrial beat

One time early discharge of ectopic beat outside of the SA node

Question 3

What causes PAC’s?

Answer 3

Usually benign

ELETRYOLYTES

Stress

Cardiac stimulants (caffeine)

May indicate atrial pathology

-Pre-cursor to afib

Question 4

When seeing new onset PAC’s or they are increasing in frequency, what should we do next?

Answer 4

CHECK ELECTROLYTES

mag - calc - potassium

Could mean the patient is about to convert to atrial fibrilation

Question 5

Increasing frequency of PAC’s may be an indication

Answer 5

that the patient is about to convert to a-fib

Question 6

What will the patient look like with PAC’s and how do we treat them?

Answer 6

Begin = do not do anything

Pathologic = treat as if they are in A-fib

Question 7

Atrial Fibrillation

Answer 7

Total disorganization of atrial electrical activity due to multiple ectopic foci, resulting in loss of effective atrial contraction

Atrial rate > 400 bpm

Ventricular rate 100-175 bpm

R to R = irregularly irregular

Question 8

Is the SA node in charge in A fib?

Answer 8

No

The SA node is taken over by all the other irritable foci in the atrium that want to be the pacemaker

Question 9

What is the most common dysrhythmia?

Answer 9

Atrial Fibrillation

Question 10

Prevalence of afib increases with

Answer 10

age

Question 11

T/F: A person can live with atrial fibrillation?

Answer 11

Yes because what really matter in the ventricular rate (powerhouse)

Ventricular rate has to be controlled

Question 12

What causes Atrial Fibrillation?

Answer 12

Occurs with underlying heart disease

Electrolyte imbalance

Hypoxia

Cardiac surgery

Question 13

Atrial Fibrillation is a problem because

Answer 13

Atria is not contracting properly so pooling of blood happens

This pooling of blood leads to clot formation

Increase risk for embolus

STROKE

Question 14

What will a patient with atrial fibrillation look like?

Answer 14

Depends on ventricular rate, how long rhythm has been present, and the patients CV status

Typically, onset is FAST - so s/s are those of tachydysrhythmia

Question 15

Atrial Flutter

Answer 15

Atrial tachydysrhythmias identified by recurring, regular, saw-tooth-shaped flutter waves

Originates from a SINGLE ectopic focus; reentry impulse is repetitive and cyclic

R to R interval is regular or irregular

Atrial rate may be >250

Ventricular rate slower

Question 16

Does atrial flutter originate from multiple or a single ectopic focus

Answer 16

a single

Question 17

Does atrial fibrillation originate from multiple or a single ectopic focus?

Answer 17

multiple

Question 18

The sawtooth waves we see in atrial flutter are

Answer 18

F waves

Question 19

What causes Atrial Flutter?

Answer 19

Rarely occurs in healthy heart = underlying heart condition

Electrolyte imbalance

Question 20

What will a patient with atrial flutter look like?

Answer 20

Depends on ventricular rate, how long rhythm has been present, and the patients CV status

Typically, onset is FAST rate- so s/s are those of tachydysrhythmia

Question 21

T/F are patient with atrial flutter at risk for emobli?

Answer 21

True

Both patient with atrial flutter and atrial fibrillation are at risk

Question 22

Atrial Fib / Flutter: How do we treat?

Answer 22

Goal = Ventricular rate control

Rhythm control

Prevent embolic stroke

Question 23

Rate control drugs for Atrial Fib / Flutter

Answer 23

B-adrenergic blockers (metoprolol)

Calcium channel blockers (diltiazem - verapamil)

initially IV route

Question 24

Rhythm control drugs for atrial fib / flutter

Answer 24

Amiodarone

doFETilide

initially IV route

Question 25

What is priority for atrial fib / flutter, rate or rhythm?

Answer 25

Rate takes priority

Question 26

Patient with atrial fibrillation or flutter that is stable, but symptomatic

Answer 26

Slow ventricular rate with IV CCB or Beta blocker or Digitalis or Amiodarone Start bolus and a drip

Question 27

If patient with atrial fibrillation or flutter is unstable and hemodynamically compromised

Answer 27

Synchronized cardioversion (life pack)

Question 28

Synchronized Cardioversion

Answer 28

Choice of therapy for hemodynamically unstable supraventricular tachydysrhythmias Synchronize circuit delivers a countershock on the R wave of the QRS complex of the ECG Synchronizer switch must be turned ON

Question 29

Anytime we have a hemodynamically unstable patient with a tachy dysrhythmias that originated above ventricle, we treat with

Answer 29

Synchronized cardioversion

Question 30

In order to cardiovert a patient, the patient must have a

Answer 30

R wave in the QRS complex

Question 31

Synchronized cardioversion nonemergency

Answer 31

The patient is sedated before the procedure

Question 32

Synchronized cardioversion is started with

Answer 32

initial energy at 50 to 100 joules: increased if needed

Question 33

Before discharging cardioversion

Answer 33

Be sure that all personnel are all clear No one touching bed

Question 34

If patient becomes pulseless after cardioversion

Answer 34

Turn the synchronizer switch off (loss of R wave) and perform defibrillation

Question 35

Cardioversion: Nursing care

Answer 35

Maintain patent airway Administer oxygen Assess V.S and LOC Monitor for dysrhythmias Provide emotional support Document result of cardioversion

Question 36

If patient has a-fib for > 48 hours

Answer 36

Anticoagulation therapy with warfarin is recommended for 3 to 4 weeks before cardioversion and for 3 to 4 weeks after successful cardioversion

Question 37

Before cardioverting somewith a-fib/flutter a _____ may be performed to make sure no clots are in the atrium

Answer 37

TEE

Question 38

In emergent cardioverion a

Answer 38

low-molecular weight heparin or heparin drip will be initiated

Question 39

If treatment for a fib/flutter doesn't work then

Answer 39

long term anticoagulation is required (warfarin) Alternative anticoag drugs: -dabigatran-apixaban twice daily -ribaroxaban, eboxaban once daily

Question 40

Disadvantage of using warfarin with long term treatment of afib / flutter

Answer 40

Have to monitor INR regularly

Question 41

Alternative anticoag drugs for patients with non-vlavular afib

Answer 41

dabigatran, apixaban = twice daily rivaroxaban, eboxaban = once daily

Question 42

Advantage and disadvantage of alternative long term drug therapy for afib / aflutter

Answer 42

Advantage: Do not require routine lab testing Disadvantage: Cost more than once daily dosing and contraindicated with impaired renal function

Question 43

Non pharmacologic treatments for Afib and Aflutter

Answer 43

Catheter ablation -radiofrequency or cryothermal therapy Maze procedure

Question 44

Catheter Ablation

Answer 44

Invasive procedure that destroys a irritable focus causing the dysrhythmias Must undergo EP studies and mapping procedures to locate the focus

Question 45

Maze procedure

Answer 45

Surgical procedure consist of creating incisions in atrium to disrupt the circuits that creates a one way path from the SA node to the AV node