ECG Arrhythmias pt. 2 Flashcards by Hannah McMahon

What happens in atrial flutter? Hint: 2

1) Instead of starting in SA node the electrical signal gets “Stuck” in a loop in RA
2) Abnormal electrical impulse comes out ok but typically forms loop (reentry circuit) around tricuspid valve instead of coming down to AV node

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What does the abnormal electrical impulse in A-flutter cause?

Causes atria to beat fast (250-350 bpm) → NOT a fibrillation it is a BEAT

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What is the role of the AV node in A-flutter?

AV node acts like a gatekeeper & blocks some of the signals, so ventricles don’t beat as fast, usually reg rate (150 bpm) → 2:1, 3:1, 4:1 conduction

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What does ECG strip look like with A-flutter? Hint: 6

1) Rate → atrial rate btwn 220-359 bpm; ventricular rate bwtn 75-150 bpm
2) Rhythm → usually reg but can be irreg b/c of AV conduction change
3) Flutter waves “sawtooth” or “F waves”
4) PR interval → not measurable (no P waves)
5) QRS duration → normal
6) R to R usually regular

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How would we interpret this A-flutter ECG strip?

4 F waves for every QRS complex so it is a normal rhythm

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Why do we not need the AV node to kick in in A-flutter?

The SA node is fine (has not failed)

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When are patients able to tolerate A-flutter?

If they have a decent ventricular response

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Tx for A-flutter Hint: 3

1) Control rate meds (BB, CCBs, Digoxin)
2) Ablation to burn away the loop & get back to sinus rhythm
3) Determine & Tx cause then cardioversion

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Explain how SVT occurs Hint: 2

1) Electrical impulse above ventricles → tissue at bundle of his & above
2) AV node cannot control it so every beat goes thru → if node is going at 175 bpm we see ventricular rate of 175 bpm

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What do the atrial/ ventricular rates look like in SVT?

> 100 bpm at rest

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What type of tachycardia is SVT considered?

A narrow tachycardia → above the ventricle

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List 6 clinical manifestations of SVT

1) Palpitations
2) Chest pain
3) SOB
4) Dizziness
5) Syncope
6) Panicky

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List 5 management options for SVT

1) Vagal maneuvers
2) Adenosine
3) Unstable SVT → cardioversion
4) IV meds → BB, CCBs
5) Oral meds → BB, CCBs

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How is Adenosine given?

IV push → elevate client’s appendage to get med to the heart faster

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List 2 other arrhythmias adenosine can be used for besides SVT

1) A fib
2) A flutter

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Onset of adenosine

Rapid → works right away to break the problem

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What does the ECG strip look like in SVT? Hint: 5

1) Rate: > 100 bpm
2) Rhythm: Regular
3) P wave: if visible, inverted p waves sometimes seen after QRS
4) PR interval: not measurable
5) QRS duration: normal (< 0.10 sec)

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What is this ECG strip showing?

Abnormal ventricular conduction (Bundle branch block; BBB)

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List 2 potential causes of abnormal ventricular conduction (BBB)

1) Congenital defects
2) Heart attack

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What does abnormal ventricular conduction (BBB) occur from? Hint: 2

1) Delay in conduction of ventricles (impulse is slowing/ having a hard time getting thru)
2) Rt or Lt bundle branch block

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What do we see on ECG strip of abnormal ventricular conduction (BBB) Hint: 2

1) Prolonged or wide QRS → > 0.12 sec
2) May also see rabbit ears at peak of R wave

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What do the rabbit ears at the peak of the R waves in BBB tell us?

Its taking some time for the blood to flow; hence why the QRS complex is wide

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Tx of abnormal ventricular conduction (BBB)

1) Tx underlying cause
→ CAD or cardiomyopathy

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What is the biggest cause of PVC?

Hypokalemia → might be caused by loop diuretics (furosemide); 1st thing to do is check K+ if we see PVC

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List 5 clinical manifestations of PVC

1) Asymptomatic or "heart skipped a beat" 2) Bigeminy (PVC every 2 beats) 3) Trigeminy (PVC every 3 beats) 4) Quadrigeminy (PVC every 4 beats) 5) **3 or more successive PVC = VTAC**

What kind of PVC is this ECG showing?

Two PVCs that look the same are known as a "couplet"

What kind of PVC is this ECG showing?

VTAC

What kind of PVC is this ECG showing?

Two PVCs that do not look alike → polymorphic & quadrigeminy (PVC occurs every 4th beat)

List 5 causes of VTAC

1) ACS 2) MI 3) Electrolyte imbalances 4) Cardiomyopathies 5) Structural heart disease

What can untreated VTAC lead to?

Ventricular fibrillation & sudden cardiac death

List 4 clinical manifestations of VTAC

1) Decreased cardiac output 2) Hypotension 3) Pulselessness 4) Unresponsiveness

How can we differentiate sinus tachy vs. ventricular tachy?

Sinus tachy → narrow QRS complexes VTAC → Wide QRS complexes

List the 2 ways VTAC can appear on ECG strip

1) Monomorphic 2) Polymorphic

List 3 management options for VTAC

1) Epinephrine 2) Amiodarone 3) Cardioversion/ defibrillation

How does VTAC occur after an MI?

Can come from reentry, scar tissue after event

Explain what type of ECG strip this is

Monomorphic VTAC → single focus & single portal of exit

Explain what type of ECG strip this is

Polymorphic VTAC → multiple focus & multiple exits

Which type of VTAC is more dangerous?

Poly → because it means multiple foci are causing the problem

What is seen on ECG strip in VTAC? **Hint: 5**

1) Rate: 100-250 bpm 2) Rhythm: Reg 3) P wave: Usually not visible 4) PR interval: none 5) QRS duration: > 0.12 sec

What is the first nursing priority when VTAC is seen on ECG?

Assess the patient!!

When assessing a patient in VTAC what are we looking for? **Hint: 3**

1) Pulse 2) Breathing 3) LOC → Are they awake?

If patient in VTAC has a pulse on assessment what is management?

Cardioversion

If patient in VTAC has no pulse on assessment what is priority management? **Hint: 2**

**Start CPR** FIRST Defibrillation immediately

Why is it extremely important to start CPR right away when there is no pulse?

We only get 4 minutes before the brain becomes anoxic

Identify this rhythm on ECG strip

Example of patient brushing their teeth or having a lead off → A lot of artifact

What are the two types of defibrillation?

1) Monophasic 2) Biphasic → needs less energy (lower joules)

What is this ECG strip showing?

Ventricular fibrillation

List 2 characteristics of V-fib

1) Rapid, disorganized 2) No atrial activity

List 6 causes of V-fib

1) ACS 2) Electrolyte imbalances 3) cardiomyopathies 4) Structural heart disease 5) MI 6) Untreated VTAC / unsuccessful Tx of VTAC

List 3 clinical manifestations of V-fib

1) Absence of audible heartbeat 2) Absence of palpable pulse 3) Absence of respirations

What does ECG strip look like in V-fib **Hint: 5**

1) Rate: often cannot be determined, > 220 bpm 2) Rhythm: Irregular 3) P wave: not visible 4) PR interval: not visible 5) QRS duration: not visible

List 4 Tx options for V-fib

1) Immediate defibrillation 2) CPR 3) Vasoactive medications (vasodilators or constrictors) 4) Antiarrhythmias

List 2 types of V-fib we may see on ECG

1) Coarse VF → easily visible 2) Fine VF → more minimal hard to see on strip

What does ECG look like in Ventricular asystole **Hint: 5**

1) Rate: not measurable 2) Rhythm: not measurable 3) P wave: not visible 4) PR interval: not measurable 5) QRS duration: absent on 2 diff leads

List 2 characteristics of Ventricular asystole

1) Flatline 2) Absence of cardiac electrical activity

Ventricular asystole: No ______, _______, or _______

P wave; QRS complex; T wave

List 3 management options for ventricular asystole

1) CPR 2) Rapid assessment to identify possible cause 3) Fix the cause

What is the ECG strip showing?

Pulseless electrical activity (PEA)

List 4 ways to classify pulseless electrical activity

1) Organized electrical rhythm visible on monitor 2) No pulse → no contraction 3) Unresponsive (not awake) 4) Not breathing

List 2 management options for PEA

1) CPR 2) Life support

List 7 causes of PEA

1) Anything that obstructs filling & contracting of RV 2) Tension pneumothorax 3) Cardiac tamponade 4) Thrombosis → PE or clot in coronary artery 5) Hypovolemia 6) Acidosis/ potassium → metabolic acidosis/ hyperkalemia 7) Trauma

What is the Tx for PEA caused by hypovolemia?

Tx with volume or blood

Why do we see PEA when the RV is taken down or obstructed?

Nothing is making it over to the left side of the heart which causes us to not get adequate blood out to the rest of the body

How does tension pneumothorax cause PEA?

Pressure/ air in pleural space is too great that it pushes lung down onto the RV obstructing the flow of blood into RV

What is Tx option for tension pneumothorax?

Insert needle with catheter to pull air out of pleural space allowing lung to move back over and off RV

What is cardiac tamponade?

Pericardial effusion → collection of fluid in the pericardium; when it gets too big it pushes down on RV & doesn't allow it to fill

Tx for cardiac tamponade

Procedure where we pull the blood out of the pericardium until the pressure is taken off the RV allowing the blood to flow to the left side of the heart & pump out to the rest of the body

ECG Arrhythmias pt. 2 Flashcards

(67 cards)