cardiac dysrhythmia OLOL 11/18

Question 1

geminal patterns are associated with what type of dysrhythmia

Answer 1

PAC’s

Question 2

What are 10 causes of PAC’s?

Answer 2

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

Question 3

how are PAC’s treated?

Answer 3

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.

Question 4

PAC’s may initiate what?

Answer 4

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

Question 5

what are the EKG signs of a wandering pacemaker?

Answer 5

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

Question 6

what causes a wandering pacemaker?

Answer 6

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

Question 7

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

Answer 7

multifocal atrial tachycardia or MAT

Question 8

name seven examples of Vagal maneuvers

Answer 8

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

Question 9

Supraventricular Arrhythmias begin where?

Answer 9

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

Question 10

what is Paroxysmal atrial tachycardia?

Answer 10

atrial tachycardia that starts or ends suddenly

Question 11

what causes atrial tachycardia?

Answer 11

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

Question 12

what are some treatments of SVT?

Answer 12

Vagal maneuvers, Adenosine, calcium channel blockers, beta blockers

Question 13

what is atrial flutter?

Answer 13

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

Question 14

what causes atrial flutter?

Answer 14

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

Question 15

what is a paroxysmal rhythm?

Answer 15

something that starts and suddenly stops abruptly

Question 16

what are some conditions that are associated with atrial flutter?

Answer 16

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

Question 17

how is atrial flutter treated?

Answer 17

vagal maneuvers

synchronized cardioversion- RRT may cardiovert on the floor

Question 18

what causes atrial fibrillation?

Answer 18

altered automaticity or reentry

Question 19

what are 13 clinical conditions that can contribute to A fib

Answer 19

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

Question 20

what is reentry?

Answer 20

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

Question 21

how is atrial fibrillation treated?

Answer 21

anticoagulation, rate control, and rhythm control

Question 22

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

Answer 22

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

Question 23

what are some Beta Blockers used to control A Fib?

Answer 23

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

Question 24

what are some side effects of Digoxin?

Answer 24

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

Question 25

what is Digoxin and what does it do?

Answer 25

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

Question 26

where is the AV node located?

Answer 26

in the lower portion of the right atrium

Question 27

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

Answer 27

the bundle of HIS

Question 28

the bundle of HIS has a pacemaker rate of

Answer 28

40 to 60 beats per minute

Question 29

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

Answer 29

AV junction

Question 30

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

Answer 30

P waves may occur before, during or after the QRS

Question 31

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

Answer 31

Premature Junctional Complexes, or PJC's

Question 32

how do you identify a PJC?

Answer 32

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

Question 33

describe a P wave in a PJC

Answer 33

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

Question 34

is a PJC a rhythm?

Answer 34

no, it is a single beat

Question 35

what heart disease originates from strep throat?

Answer 35

rheumatic heart disease

Question 36

what are some causes of PJC's?

Answer 36

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

Question 37

what is a junctional escape beat?

Answer 37

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

Question 38

how do you identify a junctional rhythm?

Answer 38

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

Question 39

what are some drugs to treat Junctional rhythm?

Answer 39

Dopamine, atropine, Epi

Question 40

what are the characteristics of accelerated junctional rhythm?

Answer 40

a junctional rhythm with a rate of 61-100

Question 41

what are the causes of Accelerated junctional rhythm?

Answer 41

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

Question 42

what are the characteristics of Junctional tachycardia?

Answer 42

a junctional rhythm with a rate of 101-150

Question 43

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

Answer 43

0.04 seconds

Question 44

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

Answer 44

0.20 seconds

Question 45

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

Answer 45

5

Question 46

what is the difference between a segment and an interval?

Answer 46

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

Question 47

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

Answer 47

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

Question 48

what is the normal duration of a QRS complex interval?

Answer 48

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

Question 49

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

Answer 49

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

Question 50

a ventricular rhythm originates from where?

Answer 50

the purkinje fibers

Question 51

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

Answer 51

20 - 40 beats per minute

Question 52

where dose a PVC come from

Answer 52

an irritable focus within a ventricle

Question 53

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

Answer 53

couplet

Question 54

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

Answer 54

every other beat is a PVC

Question 55

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

Answer 55

every 3rd beat is a PVC

Question 56

what is the definition of sustained V tach?

Answer 56

a run of 30

Question 57

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

Answer 57

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

Question 58

what is an interpolated PVC?

Answer 58

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

Question 59

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

Answer 59

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

Question 60

Ventricular escape rhythm is also called what?

Answer 60

Idioventricular rhythm or IVR

Question 61

How do you identify IVR?

Answer 61

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

Question 62

What is an agonal rhythm?

Answer 62

a ventricular rate of less than 20 beats per minute

Question 63

what causes IVR or Idioventricular Rhythm?

Answer 63

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

Question 64

what is the treatment of idioventricular rhythm?

Answer 64

TCP or transcutaneous pacing

Question 65

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

Answer 65

Accelerated Idioventricular rhythm or AIVR

Question 66

what causes AIVR?

Answer 66

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

Question 67

what are some of the causes of AIVR?

Answer 67

``` Subarachnoid hemorrhage digitalis toxicity cocaine acute myocarditis hypersensitive heart disease dilated cardiomyopathy ```

Question 68

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

Answer 68

ventricular tachycardia

Question 69

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

Answer 69

whether its shorter or longer than 30 seconds

Question 70

an unconscious person in VT is treated with what?

Answer 70

defibrillation

Question 71

VT with uniform beats is said to be what?

Answer 71

monomorphic

Question 72

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

Answer 72

polymorphic

Question 73

Torresades is an example of what?

Answer 73

polymorphic VT

Question 74

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

Answer 74

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

Question 75

a depressed S - T interval is due to what?

Answer 75

possibly a past MI or ischemia

Question 76

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

Answer 76

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