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Dysrhythmias Flashcards

(94 cards)

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1
Q
A
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1
Q

Match the lead (V1, 2, 3, 4, 5, 6) to its correct location:
A. 4th intercostal space to the RT of the sternum
B. The 3rd intercostal space to the LT of the sternum
C. The left midaxillary line at the 5th intercostal space
D. 4th intercostal space to the LT of the sternum
E. The left anterior axillary line at the 5th intercostal space
F. The left midclavicular line at the 5th intercostal space

A

A. V1
B. V3
C. V6
D. V2
E. V5
F. V4

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2
Q

Write the views reflected by each lead:
1. lead I
2. II
3. III
4. aVr
5. aVL
6. aVf
7. V1
8. V2
9. V3
10. V4
11. V5
12. V6

A
  1. lateral (R)
  2. inferior (L)
  3. inferior (R)
  4. superior/SVC
  5. lateral (L)
  6. inferior
  7. septal
  8. septal
  9. anterior
  10. anterior
  11. lateral (L)
  12. lateral (L)
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3
Q

normal PR interval

A

0.12-0.20

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4
Q

normal QRS duration

A

0.06-0.1

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5
Q

normal QT interval

A

0.30-0.40

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6
Q

Sinus arrhythmia

A

rate: irregular R-R; 60-100 bpm

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7
Q

sinoatrial arrest/block

A

rate: regular except dropped PQRST

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8
Q

PACs

A

rate: regular except premature beat and noncompensatory pause

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9
Q

Causes of sinus tachycardia

A

stimulants
stress
fever
pain
anxiety
CAD
heart failure
shock, hypovolemia

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10
Q

symptoms of sinus tachycardia

A

symptoms: SOB, dizziness, anxiety, LoC

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11
Q

sinus tachycardia treatment

A

treatment: treat underlying cause, vagal maneuvers, beta blockers

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12
Q

causes of sinus bradycardia

A

increased parasympathetic tone
increased ICP
medication (b-blockers)
IWMI

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13
Q

symptoms of sinus bradycardia

A

symptoms: hypotension, syncope, dizziness, dyspnea, premature beats, chest pain

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14
Q

sinus bradycardia treatment

A
  1. assess BP, mental status, chest pain, RR
  2. notify provider
  3. treat underlying cause
  4. atropine or glucagon (if d/t b-blocker toxicity)
  5. pacemaker
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15
Q

causes of sinus arrhythmia

A

normal variation caused by respirations

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16
Q

causes of sinoatrial block

A

vagal stimulation
digitalis toxicity
hyperkalemia
IWMI
acute myocarditis

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17
Q

treatment for sinus arrhythmia

A

none

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18
Q

symptoms of SA block

A

can lead to asystole or cardiac arrest
symptoms: syncope, skipped beat

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19
Q

treatment for SA block

A
  1. assess patient BP, mental status, RR
  2. treat underlying cause (hyperK - calcium gluconate, insulin, myocarditis - b-blockers, corticosteroids, digitalis - digibind)
  3. atropine, pacemaker
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20
Q

causes of PACs

A

stimulants
hypokalemia
hypoxia
myocarditis
myocardial ischemia
CHF

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21
Q

significance and symptoms of PACs

A

significance: can lead to tachycardia, a-flutter, a-fib
symptoms: dizziness, palpitations, skipped beats

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22
Q

PAC treatment

A
  1. assess patient and frequency
  2. notify provider if symptomatic or increased frequency
  3. treat underlying cause
  4. b-blockers, digitalis, amiodarone
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23
Q

Wandering pacemaker

A

irregular & variable P waves (upright, inverted, always visible)

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24
causes of wandering pacemaker
digitalis toxicity CAD heart disease of the SA node
25
symptoms of wandering pacemaker
- may be asymptomatic - decreased atrial contraction (kick)=syncope, dizziness, SOB, fatigue, weakness
26
wandering pacemaker treatment
1. assess patient: BP, symptoms 2. notify provider if taking digitalis or symptomatic 3. atropine, pacemaker if bradycardia
27
atrial tachycardia
rate: >150
28
causes of atrial tachycardia
HTN heart disease cor pulmonale MI digitalis toxicity stress or fatigue
29
symptoms of atrial tachycardia
palpitations, numbness/tingling, chest pain, pale/cold extremities
30
atrial tachycardia treatment
1. decrease HR -> adenosine, procainamide, amiodarone, digitalis, b-blocker 2. syncronised cardioversion 3. overdrive atrial pacing
31
atrial flutter
SAWTOOTH
32
causes of atrial flutter
catecholamine secretion SA node damage CHF
33
atrial fluttersymptoms
symptoms: dizziness, palpitations, chest pain, syncope
34
atrial flutter treatment
1. assess patient: BP, mental status, perfusion, RR 2. notify provider if sustained or new onset 3. synchronized cardioversion 4. treat tachycardia/bradycardia: amiodarone, b-blockers, CCBs, digitalis
35
atrial fibrillation
unidentifiable P waves, irregular ventricular rate
36
causes of atrial fibrillation
- MI - CAD - CHF - COPD - heart surgery
37
significance and symptoms of atrial fibrillation
significance - increases risk for thromboemboli, ventricular failure, RVR (rapid ventricular rate) symptoms: chest pain, SOB, dizziness, palpitations
38
atrial fibrillation treatment
1. assess patient - BP, HR, mental status 2. notify physician if new onset, symptomatic, or new rhythm 3. amiodarone, cardioversion 4. no interventions except anticoagulant therapy
39
junctional rhythm/escape
HR 40-60; variable P waves, not always visible.
40
What is a junctional rhythm?
Rhythms that arise from the AV node
41
causes of junctional escape rhythm
- increased parasympathetic activation - digitalis - IWMI - ischemia - hypoxia
42
significance and symptoms of junctional escape rhythms
significance - increases risk for bradycardia and decreased CO symptoms - myocardial ischemia, heart failure, dizziness, SOB, chest pain
43
treatment of junctional escape rhythm
1. assess patient 2. notify provider if new onset, down-trending 3. atropine, pacemaker
44
premature junctional complexes
NSR except the premature QRS complex has P-wave that is abnormal or absent.
45
causes of premature junctional complexes
- stress, drugs, alcohol - digitalis - myocarditis - ischemia, HF
46
treatment of premature junctional complexes
1. assess patient, frequency 2. notify provider if symptomatic, taking digitalis, or increasing in frequency 3. treat underlying cause 4. amiodarone, B-blocker, digitalis
47
accelerated junctional rhythm
rate: regular, 60-100 irregular and variable/missing P-waves
48
causes of accelerated junctional rhythm
- increased catecholamine secretion - digitalis - MI - myocarditis - ischemia - HF
49
treatment for accelerated junctional rhythm
1. assess patient, symptoms, meds 2. hold digitalis and notify provider 3. treat underlying cause 4. medications - procainamide 5. cardioversion
50
1st degree AV block
looks like NSR but prolonged PR interval (>0.20)
51
causes of 1st degree AV block
- increased parasympathetic tone - digitalis - MI - myocarditis - ischemia, CAD
52
significance and symptoms of 1st degree AV block
may be benign, increases risk for higher AVBs
53
treatment of 1st degree AV block
1. assess pt 2. hold medications and notify physician 3. atropine if PR >0.28 4. pacemaker
54
2nd degree AV block Type I
increasingly long PR until dropped beat
55
causes of 2nd degree AV block Type I
increased parasympathetic tone digitalis electrolyte imbalance IWMI ischemia acute rheumatic fever
56
treatment for 2nd degree AV block Type I
1. assess pt - BP, HR, mental status, meds 2. usually not needed 3. atropine, pacemaker, hold meds
57
2nd degree AV block Type II
consistent PR interval until dropped beat
58
causes of 2nd degree AV block Type II
- digitalis - MI - CAD - necrosis of conduction pathway
59
treatment for second degree type ii heart block
- assess patient: BP, mental status, RR, HR - notify provider - atropine, pacemaker - treat underlying cause
60
third degree heart block
atrial and ventricular rates regular, but at different rates.
61
causes of third degree heart block
parasympathetic stimulation digitalis toxicity IWMI or AWMI AV node damage
62
significance of third degree heart block
- may lead to HF, shock, ventricular fibrillation, ventricular standstill, anoxia
63
treatment of third degree heart block
atropine pacemaker
64
WPW
QRS interval: >0.11 (wide, funky base)
65
treatment for WPW
1. depends on pt tolerance & ventricular rate 2. amiodarone (afib), atropine (bradycardia), or procainamide 3. ablation of extra conduction pathway
66
what is a characteristic of all ventricular rhythms?
- wide QRS complex - absent P-waves
67
Premature ventricular complexes
wide and large QRS at irregular intervals over the underlying rhythm
68
causes of PVCs
- stress/drugs - digoxin - electrolyte imbalances (hypoK) - myocarditis - ischemia, CAD, CHF - hypoxia
69
PVC treatment
1. assess patient and frequency/characteristic of PVCs 2. notify provider if new or increasing in frequency 3. amiodarone
70
v-tach
wide QRS one after another, without rest
71
v-tach causes
- drugs - meds that prolong QT interval - R on T phenomenon - MI - ischemia, CAD, CHF - CAD
72
v-tach treatment
1. assess for pulse and breathing 2. if pulse - notify provider, cardioversion 3. if pulseless- CODE - defibrillation & CPR
73
v-fib
wiggles
74
v-fib causes
1. drugs 2. prolonged QT 3. R on T phenomenon 4. MI 5. cardiomyopathy 6. CAD, CVA 7. hypothermia
75
v-fib treatment
1. CODE -> defibrillate
76
torsades de pointes
cyclic positive and negative QRS complexes (high rate)
77
causes of torsades de pointes
1. drugs 2. prolonged QT 3. R on T phenomenon 4. electrolyte imbalances (K, Ca, Mg)
78
torsades de pointes treatment
1. assess patient for pulse and symptoms 2. administer magnesium 3. discontinue meds 4. defibrillation
79
ventricular escape rhythm
slow rate, weird and wide QRS
80
causes of ventricular escape rhythm
- drugs - electrolyte imbalance - heart block
81
treatment for ventricular escape rhythm
1. atropine 2. pacing
82
asystole
flat-line, no electrical activity
83
asystole causes
- MI - necrosis - hypoxia
84
asystole treatment
CODE - epinephrine + CPR
85
secondary asystole
rate <20, no P-waves
86
causes of secondary asystole
ischemia due to hypoxia of myocardial muscles
87
secondary asystole treatment
none, already too late
88
RBBB
wide and largely positive QRS complexes with P-waves
89
causes of RBBB
- congenital lesions - digoxin - electrolyte (hypoK) - MI - CAD, CHF
90
RBBB treatment
- treat underlying cause - pacemaker
91
LBBB
wide, large QRS complexes, probably negative
92
LBBB causes
- congenital lesions - digoxin - MI
93
LBBB treatment
- treat underlying cause - pacemaker

critical care (8 decks)

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