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RTH 235 > Atrial Rhythms > Flashcards

Atrial Rhythms Flashcards

1
Q

What are the atria?

A

thin walled, low pressure chambers that receive blood from the systemic circulation and lungs

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2
Q

What is atrial kick?

A

additional contribution of blood because of atrial contraction

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3
Q

What are atrial dysrhythmias?

A

reflections of abnormal electrical impulse formation and conduction in the atria

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4
Q

What do atrial dysrhythmias result from?

A
  • altered automaticity
  • triggered activity
  • reentry
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5
Q

What is altered automaticity?

A

both normal pacemaker cells and myocardial working cels that fire and initiate impulses before a normal SA node impulse

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6
Q

What are the causes of altered automaticity?

A
  • hypocalcemia
  • ischemia
  • imbalance of electrolytes
  • drug toxicity
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7
Q

What is triggered activity?

A

when escape pacemaker and myocardial working cells fire more than once after stimulation by a single impulse

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8
Q

What does triggered activity cause?

A

atrial or ventricular beats that can occur alone, in pairs, in runs or as a sustained ectopic rhythm

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9
Q

What is reentry?

A

when an impulse returns to stimulate tissue that was previously depolarized

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10
Q

What three conditions does reentry require?

A
  • a potential conduction circuit or circular conduction pathway
  • a block within part of the circuit
  • delayed conduction within the remainder of the circuit
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11
Q

What atrial rhythms are associated with reentry?

A
  • atrial flutter
  • AVNRT
  • AVRT
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12
Q

True/False: most atrial dysrhythmias are life threatening and some may be associated with extremely slow ventricular rates

A

false: not life-threatening and fast rates

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13
Q

True/False: an excessively fast heart rate can lead to decreased cardiac output

A

true

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14
Q

What are premature atrial complexes (PACs)?

A

premature beats that originate in the atria

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15
Q

What patterns can premature beats occur in?

A
  • couplet (two)
  • bursts (three or more)
  • bigeminy (every other)
  • trigeminy (every third)
  • quadrigeminy (every fourth)
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16
Q

When do PACs occur?

A

when an irritable site (i.e., focus) within the atria fires before the next SA node impulse is expected to fire

17
Q

What kind of P wave and QRS complex does a PAC have?

A
  • positive P wave

- normal QRS complex

18
Q

How are PACs identified?

A
  • early (premature) P waves
  • positive (upright) P waves (in lead II) that differ in shape from sinus P waves
  • early P waves that may or may not be followed by a QRS complex
19
Q

Is a PAC an entire rhythm?

A

no, it is a single beat. therefore, you must identify the underlying rhythm and ectopic beats

20
Q

What is a non-compensatory pause?

A

a delay during which the SA node resets its rhythm for the next beat. it is the period between the complex before and after a premature beat and is less than two normal R-R intervals?

21
Q

What is a compensatory pause?

A

when the period between the complex before and after a premature beat and is the same as two normal R-R intervals

22
Q

What causes PACs?

A
  • acute coronary syndromes
  • atrial enlargement
  • digitalis toxicity
  • electrolyte imbalance
  • emotional stress
  • heart failure
  • hyperthyroidism
  • mental and physical fatigue
  • stimulants such as coffee, tobacco and cocaine
  • valvular heart disease
23
Q

What may PACs be the result of?

A
  • altered automaticity

- reentry

24
Q

Who do PACs very frequent occur in and what do they mean?

A

older adults - does not necessarily imply underlying cardiac disease

25
Q

How do you treat PACs?

A
  • infrequent do not require treatment
  • frequent treat underlying cause (correct electrolyte imbalances, reduce stress, reduce stimulant intake, treat heart failure)
26
Q

What is wandering atrial pacemaker?

A
  • multiformed atrial rhythm

- size, shape and direction of the P waves vary, sometimes from beat to beat

27
Q

What is wandering atrial pacemaker associated with?

A

normal or slow rate and irregular P-P, R-R and PR intervals because of the different sites of impulse formation. QRS duration 0.11 seconds or less

28
Q

Who is wandering atrial pacemaker usually seen in?

A
  • normal, healthy hearts (athletes) and during sleep
  • some types of underlying heart disease
  • digitalis toxicity
29
Q

How do you treat wandering atrial pacemaker?

A

it is usually a transient rhythm that resolves on its own when the firing rate of the SA node increases and the sinus resumes pacing responsibility. drug should be withheld if due to digitalis toxicity

30
Q

What ventricular rate is wandering atrial pacemaker associated with?

A

more than 100 beats/min

31
Q

What are the causes of wandering atrial pacemaker?

A
  • severe COPD
  • acute coronary syndromes
  • hypokalemia
  • hypomagnesemia
32
Q

How do you treat wandering atrial pacemaker?

A
  • directed at the underlying cause
  • vagal maneuvers
  • intravenous adenosine
33
Q

What are vagal maneuvers?

A

methods that are used to stimulate receptors located in the internal carotid arteries and the aortic arch

34
Q

How do vagal maneuvers work?

A

stimulation of receptors results in reflex stimulation of the vagus nerve and release of acetylcholine. acetylcholine slows conduction through the AV node, thereby resulting in the slowing of the heart rate

RTH 235 (2 decks)

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