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SSM Dysrhythmia Course > Exam Review > Flashcards

Exam Review Flashcards

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1
Q

Inherent rate of SA node

A

60 to 100

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2
Q

Inherent rate of AV node

A

40 to 60
“Junctional tissue”

AV node + bundle of his can combine to become the pacemaker of the heart, if necessary.

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3
Q

Inherent rate of Purkinje fibers

A

20 to 40

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4
Q

Sympathetic Nervous System

A
  1. Innervation affects both atria and ventricles
  2. Causes coronary artery vasodilation, increases HR, increases speed of conduction through the AV node, increases force of contraction
  3. “Speeds up”
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5
Q

Parasympathetic

A
  1. Innervation effect atria
  2. Causes decrease in HR, decrease speed of conduction through the AV node, decreases force of contraction
  3. “Slows down”
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6
Q

Polarization

A

Resting state
Polarized state, no current flow
+ and - are relatively equal

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7
Q

Depolarization

A

Cardiac muscle cell is stimulated
Cell membrane changes and becomes more permeable
Na+ moves into the cell
Depolarization - contraction

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8
Q

Repolarization

A

Takes place after depolarization.
Cells begin to recover and restore electrical charges to normal
Inside of the cell is restored to negatively charged state

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9
Q

Absolute refractory period

A

Portion of ventricular cardiac cycle where no stimulus, no matter how strong, can excite the cardiac tissue. Stimulus will be rejected.

“Absolutely nothing will happen.”

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10
Q

Relative Refractory Period

A

Portion of the ventricular cardiac cycle when all cardiac cells are not fully repolarized. A strong enough stimulus can excite cardiac tissue. This is referred to as the vulnerable period and if hit right can initiate arrhythmias.

“When relatives are there, something bad can happen.”

Relative refractory period is visualized in the last 1/2 of the ‘T’ wave.

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11
Q

ECG Deflections

A

Definition: any wave or complex recorded in the ECG is inscribed as positive or negative deflection.

  • A current flowing toward a (+) electrode gives a (+) deflection.
  • A current flowing away from a (+) electrode gives a (-) deflection.
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12
Q

P wave

A

Usually the 1st wave
Usually originates in the SA node
Reflects atrial depolarization

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13
Q

PR interval

A

Measured from the beginning of the P wave to beginning of QRS complex
Represents interval from time the impulse leaves the SA node, the delay at the AV node, until it arrives at the Purkinje fibers.
Normal PR interval is 0.12 to 0.20

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14
Q

QRS complex

A

Ventricular activity
Represents ventricular depolarization
Represents time required for impulse to travel through the R and L ventricles
Normal range is 0.12 or less.

Bundle branch block has QRS of 0.12 or greater

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15
Q

T wave

A

Represents ventricular Repolarization, last half of T wave is relative refractory period

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16
Q

ST segment

A

Represents time between completion of ventricular depolarization and beginning of Repolarization.

This is the segment between QRS and T wave

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17
Q

QT interval

A

Represents total ventricular activity, depolarization and Repolarization.
QT interval varies with heart rate.

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18
Q

Normal sinus rhythm characteristics

A 
HR 60 to 100
Rhythm is regular
PR interval is 0.12 to 0.20
QRS is less than 0.12
One P wave for each QRS, uniform in appearance
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19
Q

Sinus bradycardia characteristics

A 
HR less than 60
Rhythm is regular
PR interval 0.12 to 0.20
QRS less than 0.12
One P wave for every QRS, uniform appearance
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20
Q

Sinus tachycardia characteristics

A 
HR 100-160
Rhythm regular
PR interval 0.12 to 0.20
QRS less than 0.12
Uniform appearance
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21
Q

Sinus arrhythmia characteristics

A

Rate: slightly increases with inspiration, decreases with expiration
Rhythm: irregular, varies with respiration
PR interval: 0.12 to 0.20
QRS: less than 0.12

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22
Q

Sinus bradycardia Cause/Treatment

A

Cause: athlete, vegal stimulation, decreased metabolism, medications, elevated ICP, sinus node disease

Treatment: assess PT, IV/O2, atropine to increase HR, pacemaker

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23
Q

Sinus tachycardia causes/treatment

A

Cause: sympathetic stimulation (fever, stress, pain, anxiety, exercise), hyperthyroid, medications, caffeine, atropine, hypotension, shock, hypo olefin

Treatment: Treat the underlying cause!! Do not give cardiac med.

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24
Q

Sinus Arrhythmia causes/treatment

A

Cause: usually seen with deep breathing, commonly seen in the young and the elderly

Treatment: usually doesn’t require intervention - if symptomatic, IV/O2, atropine, pacemaker

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25
Premature atrial contractions (PACs) characteristics
Rhythm is regular except for the premature beat P wave early with premature beat, may have different configuration PR interval with PAC may vary QRS with PAC should be similar to regular QRS T wave shape may change when early P wave is buried in proceeding T wave
26
Premature atrial contractions (PACs) causes/treatment
Cause: sympathetic stimulation, altered electrolytes, hypoxia, digoxin toxicity, HF, stress, caffeine, alcohol, may be normal for some people Treatment: Assess patient, treat underlying cause, BB/CCB may help when idiopathic.
27
Atrial tachycardia characteristic
Rate usually 160 to 250, classic rate is 180, may be precipitated by PAC P waves "should be seen", but may be lost in preceding T wave PR interval may be different than normal PR interval, may not be measurable QRS less than 0.12 * *Sinus tachycardia 100-160 (slow onset) * *Atrial tachycardia 160-250 (sudden onset)
28
Atrial tachycardia causes/treatment
Cause: dig toxicity, hypoxia, ischemia, electrolyte imbalance, CAD Treatment: if stable - vagle maneuver, adenosine, CCB, BB, amiodarone If unstable - synchronized cardio version
29
Paroxysmal Atrial Tachycardia (PAT) characteristics
Same as atrial tachycardia, but has a sudden onset/cessation **Causes/treatment same as atrial tachycardia
30
Atrial flutter characteristics
Saw tooth pattern - flutter waves Atrial rate (use exact method) is 250 to 400 PR interval is not measurable Ventricular rate depends on amount of blocking occurring at AV node; may be regular or irregular QRS less than 0.12 QT is usually immeasurable in flutter
31
Atrial flutter causes/treatment
Causes: rheumatic heart disease, valve disease, ischemia, hypoxia, pericarditis, sick sinus syndrome Treatment: Control rate (BB, CCB, dig, amiodarone), convert the rhythm (rate > 48 hrs then anticoagulate first) use amiodarone, synchronized electrical cardioversion, ablation
32
Atrial fibrillation characteristics
Absence of P waves *zero coordinated electrical activity, atrial just quiver. Atrial rate is 400+ (known from research, this cannot actually be measured Rhythm is irregular Ventricular rate depends on amount of blocking by the AV node If ventricular rate is greater than 100 then it is called a fib with RVR QRS is less than 0.12
33
Atrial fibrillation causes/treatment
Cause: rheumatic heart disease, hypertension, MI/ischemia, COPD, frequent PAC's, post cardiac surgery Treatment: control rate, convert rhythm, concerns for clot formation (this is the same as atrial flutter)
34
Supra ventricular tachycardia (SVT) characteristics
Broad term Any tachycardia originating from somewhere above the ventricles Cannot see P waves Skinny QRS
35
Junctional rhythm characteristics
``` Rate is 40 to 60 P wave may be inverted, absent, or after the QRS PR interval less than 0.12 QRS less than 0.12 R-R interval is regular ```
36
Junctional rhythm causes/treatment
Cause: digoxin, hypokalemia, ischemia, SA node disease, electrolyte imbalances, cardiomyopathy Treatment: determine underlying cause, withold medications, potassium replacement, is s/s give atropine to stimulate SA node, may need to pace temporarily.
37
Accelerated junctional rhythm characteristics
Rate is 61 to 100 P wave is inverted, absent, or after QRS QRS less than 0.12
38
Accelerated junctional rhythm causes/treatment
Causes: dig toxicity, MI, HF, valvular disease Treatment: treat the underlying cause
39
Junctional tachycardia characteristics
Rate 101 to 200 P wave absent, inverted, or after QRS QRS 0.12 or less
40
Junctional tachycardia causes/treatment
Causes: #1 cause is dig toxicity Treatment: Treat underlying cause, O2/IV, BB, CCB, amiodarone, cardioversion
41
Premature ventricular contractions (PVCs) characteristics
Rhythm is irregular due to premature beat QRS is wide and ugly; greater than 0.12 ST & T wave slope in opposite direction of the ectopic QRS
42
PVC causes/treament
Causes: sympathetic stimulation, dig toxicity, ischemia, MI, HF, electrolyte imbalance, hypoxia, stimulants Treatment: assess PT, O2/IV, replace electrolytes, amiodarone, lidocaine
43
Ventricular tachycardia characteristics
Rate 100 to 250 - use exact method Rhythm R-R is regular Usually no visible P waves QRS is wide, >0.12
44
V tach causes/treatment
Causes: same as PVCs Treatment: Assess Pt, check pulse, O2/IV, amiodarone, cardioversion, if no pulse, call code, CPR, defibrillation, epi/amiodarone.
45
Torsades de Pointes Torsades V Tach Characteristics
Variation of v tach in which the QRS appears to twist around baseline QRS complex changes shape, size, amplitude, width
46
Torsades V tach cause/treatment
Cause: any drug that may prolong QT interval, inherited prolonged QT interval, low K, low mag, low Ca, acute MI Treatment: Call code, CPR, defibrillation, magnesium, Epi
47
Ventricular Fibrillation Characteristics
``` No measurable rate No identifiable ECG waveform No contraction, no cardiac output Wavy baseline Rhythm is fine or coarse ```
48
V fib cause/treatment
Cause: CAD/CHF, ACS, MI, drug toxicities, electrical shock, post cardioversion, antiarrhythmics Treatment: Call code, CPR, defibrillation, epi, amiodarone
49
Idioventricular rhythm characteristics
Rate 20 to 40 P wave absent, sometimes retrograde QRS wide, greater than 0.12, look alike
50
Idioventricular causes/treatment
Cause: ischemia, MI, dying heart, hypoxia, dig toxicity, SA node/AV junction have failed Treatment: avoid antiarrhythmics, correct underlying cause, atropine, temporary pacing
51
Accelerated idioventricular rhythm (AIVR) characteristics
Rate 41 to 100 | QRS > 0.12
52
AIVR cause/treament
Cause: ischemia, reperfusion, dig toxicity, cocaine, cardiomyopathy Treatment: do not give antiarrhythmics, give atropine if rate is slow
53
Asystole
Complete absence of electrical activity in the heart May resemble fine v fib Confirm in 2 leads ``` Check PT Call code CPR Epi Fix the cause ``` Cause: hypovolemia, hypoxia, acidosis, hypokalemia, hypothermia, toxins, tamponade, tension pneumothorax, thrombosis
54
Agonal rhythm
Dying heart Rate is less than 20 Tx: transcutaneous pacing, call code, CPR, epinephrine, atropine
55
Beta Blockers
Decreases HR, BP, strength of contractions Used with MI and unstable angina Examples: metoprolol, labetalol, atenolol, carvedilol
56
Calcium channel blockers
Decreases myocardial contractility, decreases conduction of SA and AV nodes. Used to control atrial tach Ex: diltiazem, amylodipine
57
Digoxin
Cardiac glycoside Used to control a fib with RVR and a flutter Very narrow therapeutic window
58
Amiodarone
Antiarrhythmics used to control atrial and v tach dysrhythmias.
59
Adenosine
Push fast | Depresses AV and SA node activity
60
Amiodarone
Treat v-tach
61
Lidocaine
Grate ventricular arrhythmias.
62
Epinephrine
Only IVP when doing CPR Vasopressor Increases HR, BP, perfusion pressure to the brain and heart
63
Magnesium
Shortens QT interval | Used to treat or prevent recurrence of torsades de Pointes v tach.
64
1st degree heart block
Rhythm regular, originates in the SA node P wave is present, appears normal PR is greater than 0.20 consistently QRS less than 0.12 Cause: seen in aging, may be normal, may be a forerunner to further AV block Tx: usually no tx, hold medication, continue to monitor
65
2nd degree heart block type I
Atrial rate is greater than ventricular rate P-P is constant, originates in SA node (P-P always regular) Some P waves not conducted, more P waves than QRSs PR interval progressively lengthens until QRS is dropped Ventricular rhythm is irregular (R-R irregular) QRS less than 0.12 Has a consistent pattern Cause: increased parasympathetic tone, medications, MI Tx: usually none required, hold medications, monitor for further block, atropine if bardycardic, may need to externally pace if atropine doesn't work.
66
2nd degree heart block type II
Atrial rate is regular, P to P is constant (exact method) More P waves than QRS's (P waves all on time) Ventricular rate varies, R-R is usually irregular PR interval constant where present, may be greater than 0.12 QRS less than 0.12 Cause: MI, drugs, degeneration of the conduction system Tx: hold meds, atropine if symptomatic, temporary pacemaker
67
3rd degree heart block | Complete heart block
A/V rates unrelated, complete a sense of conduction between atria and ventricle Atrial rate regular, P to P constant, P waves normal (exact method) Ventricular rate regular (R to R constant) PR interval varies and has no pattern QRS may be wise or narrow - depends on where impulse originates Cause: ischemia or injury, CCP, BB, trauma Tx: hold meds, pacing, epi drip, atropine (maybe)
68
Conduction system electrical pathway | Name the components
Sinus node --> Bachmann's bundle Internodal pathways -->AV node --> Bundle of His --> Left bundle branch --> Purkinje fibers Right bundle branch --> Purkinje fibers

SSM Dysrhythmia Course (1 decks)

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