Dysrhythmias

Question 1

parasympathetic influence on heart

Answer 1

Lowers HR

Slows impulse conduction

Decrease force of contraction

Question 2

Sympathetic influence on heart

Answer 2

Increases rate and force of contraction

Question 3

SA node

Answer 3

above right ventricle

60-100bpm

Question 4

AV node

Answer 4

In the right ventricle

40-60bpm

Question 5

Purkinje fibers

Answer 5

20-40bpm

Question 6

3 electrode system

Answer 6

White: Right upper chest
Black: Left upper chest
Red: Left lower chest

WHITE ON RIGHT, SMOKE OVER FIRE

Question 7

5 electrode system

Answer 7

same as 3 electrode plus

Brown right lower sternum

Green lower right (equidistant from red)

Question 8

12 lead EKG placement

Answer 8

4 on limbs

V1 starts just right of mid sternum then kinda makes a line going diagonal and down to the left.

V2 at just left of mid sternum

V3 just up and right of apical pulse spot

V4 at apical pulse

V5 at intercostal space to left of apical pulse

V6 1 rib lower and to the left of V5. Will kind of be on the side.

Question 9

How to determine BPM from ECG

Answer 9

Count number of R waves (tall guys) for 6 seconds

multiply that number by 10

Question 10

How can you tell how long 1 second is in an EKG

Answer 10

5 squares

1 square =.2 seconds

Question 11

ECG measurements (time)

Answer 11

PR interval: .12-.2seconds
QRS complex: .06-.12
QT interval: .34-.43

Question 12

Normal sinus rhythm

Answer 12

Atrial and ventricular rate: 60-100bpm
Rhythm; regular
QRS shape and duration: Normal
P wave: Normal and consistent, always before QRS
PR interval: Consistent between .12-.2 seconds

P:QRS ratio: 1:1

Question 13

If no P wave think

Answer 13

ATRIAL ISSUE

A fib or flutter

Question 14

How to determine ventricular rate

Answer 14

number of QRS in 6 seconds x 10

Question 15

Determine atrial rate

Answer 15

number of P waves in 6 seconds x 10

Question 16

What should the ratio of atrial rate: ventricular rate be

Answer 16

1:1

Question 17

Sinus bradycardia

Answer 17

1:1 P:QRS ratio

regular rhythm

PR interval 0.12-0.2 seconds
QRS interval: <0.12 seconds

Question 18

Sinus bradycardia treatment

Answer 18

Assess if pt is symptomatic

With hold beta blockers

Admin Atropine every 3-5 min if pt is symptomatic

For transcutaneous pacing use defib

Turn to pace mode

Question 19

Sinus Tachycardia

Answer 19

Between 100-180bpm

P:QRS ratio 1:1

Regular rhythm

PR interval 0.12-0.2 seconds

QRS usually normal <0.12 seconds

Question 20

Sinus Tachycardia treatment

Answer 20

Assess if symptomatic

Watch for reduced CO from lower diastolic fill time

If ST prolonged = BAD

Give:

• Beta blockers
• Calcium channel blockers
• Catheter ablation of SA node
• Fluids
• Antipyretics

Question 21

Atrial flutter

Answer 21

Sawtooth shaped

Rapid regular atrial rate between 200-350/min

Associated w/CAD, HTN, valve disorders, pulmonary embolism

PR interval variable and not measurable

QRS normal

Give anticoagulants due to risk of throwing clot

Question 22

Treatment goals for atrial flutter

Answer 22

Calcium channel and beta blockers, antidysrhythmics

Catheter ablation

Question 23

Atrial fibrillation

Answer 23

Loss of atrial contraction

Risk of stroke and death

Atrial rate 30-600
Ventricular rate 120-200

Atrial and ventricular rhythm highly irregular

NO P WAVE

PR interval can’t be measured

P:QRS ratio: Many:1

QRS shape and duration: usually normal

Question 24

Goals of A fib treatment

Answer 24

Decrease ventricular response

prevent stroke

Convert to sinus rhythm

Calcium channel blockers, digoxin, beta blockers, amiodarone

Watch for clots thrown, anticoagulants

Question 25

Acute afib interventions

Answer 25

Determine onset Anticoagulants: -Heparin, warfarin TEE (Transesophageal endocardiography) Cardioversion

Question 26

Chronic Afib interventions

Answer 26

Long term Anticoagulants INR 2.0-3.0 aPTT 1-1.5x control anti arrhythmics Cardioversion AV node ablation

Question 27

Rapid ventricular response from AFIB interventions

Answer 27

Symptomatic if over 100 Determine onset and cause anticoags Cardioversion Beta blockers Watch for infection

Question 28

EKG differences between Flutter and fibrillation

Answer 28

Flutter: Swtooth, lots of sharp points up Fibrillation: -Squigglies betwen QRS waves, no P waves

Question 29

Premature ventricular contraction

Answer 29

Impulse starts in ventricle before next normal sinus impulse P:QRS 0:1 or 1:1 P wave may be absent PR interval: If P wave exists then under 0.12 seconds QRS shape: Wide and bizare Can be caused by caffeine, nicotine, alcohol ``` Abnormal causes: ELECTROLYTE IMBALANCE (Mag, Potassium) ```

Question 30

Premature ventricular contraction manifestations

Answer 30

May feel nothing, or skipped beat Usually not serious Frequent PVCs treated w/ long term meds : - Solatol - amiodarone If too frequent, or MI then Lidocaine may be used NOTIFY MD IF 3 PVC IN A ROW OR MORE THAN 6 IN A MINUTE

Question 31

Ventricular tachycardia

Answer 31

3+ PVCs in a row BPM over 100 WIDE QRS under 0.2 seconds No PR interval Can't determine PQRS Determine if pulse or pulseless! Caused by MI

Question 32

If ventricular tachycardia has pulse what do you do

Answer 32

Cardiovert Anti-arrhythmics Lidocaine Determine cause

Question 33

What does VT look like on EKG

Answer 33

Super big sawtooths down nipples up top

Question 34

Ventricular fibrillation

Answer 34

Ventricular rate over 300bpm Extremely irregular rhythm, no pattern QRS: irregular Ineffective quivering of ventricles No atrial activity on ECG Cardiac arrest Most common cause CAD resulting in MI. untreated VT cardiomyopathy DEFIBRILATE

Question 35

Vfib EKG patterns

Answer 35

looks like pure sawtooth no QRS or really anything

Question 36

Cardioversion vs defibrillation

Answer 36

``` Cardioversion: -Delivers low joule shock -Synchronized on R wave -No metal, med patches, or nipples Yell CLEAR ``` Cardioversion rhythms: (PULSE ONLY) - Afib - A flutter - SVT - Vtach Defibrillation: - High joule shock - Unsynchronized - No metal, med patches, or nipples - Yell CLEAR Defibrillation rhythms: (PULSELESS ONLY) V-Tach V-Fib Torsades (V-fib)

Question 37

Who is Implantable cardioverter defibrilator (ICD) for

Answer 37

For patients that : -survived SCD aka MI - Spontaneous sustained V tach - Syncope with inducible V tach/V fib. - High risk for future life threatening dysrhythmias (QT prolongation)