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Cardio I - ECG > Meds/Management/Interventions > Flashcards

Meds/Management/Interventions Flashcards

(46 cards)

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1
Q

A-fib

A

Control ventricular rate via blocking AV node to increase filling time and CO
Convert A-fib or A-flutter to NSR
BBs/CCBAs/digoxin ==> rate control
Amiodarone ==> NSR

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2
Q

Ventricular arrhythmias

A

Treat underlying conditions
Prevent V-fib
PVCs - reduce vs. risk of premature death
BBs/amiodarone/flecanide/quinidine/procainamide

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3
Q

Pacemaker indications

A 
Slow HR
Absent HR:
Sick sinus syndrome (SA node not firing well)
Symptomatic bradycardia
Tachy-brady syndrome
A-fib c slow ventricular response
3rd degree heart block
Chronotropic incompetence 
Paroxysmal A-fib (comes and goes c NSR)
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4
Q

Areas of insertion for PM

A 
Subclavian v.
Axillary v.
Cephalic v.
RA
RV
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5
Q

External PM use

A

Short-term or in emergencies

Temporary use after cardiac surgery - implanted during surgery and usually out s/p day 1

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6
Q

Endocardial PM

A

Can be used in children

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7
Q

How does a PM work?

A

Electrical stimulation of myocardium to depolarize it

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8
Q

Can you tell if someone has a PM by their telemetry strip?

A

Yes - it appears as a vertical line - vertical deflection before the complex it is trying to pace

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9
Q

If the PM is pacing the atria…

A

The black line appears before the P wave

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10
Q

If the PM is pacing a ventricle…

A

The black line appears before the QRS complex

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11
Q

Types of PMs

A

Fixed rate
Demand - sense depolarization and normal electrical activity (can change c activity) - if depolarization is absent or delayed, it fires at a present rate

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12
Q

Single chamber PM…

A

Paces either the ventricles or atria

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13
Q

Dual chamber PM…

A

Paces both the atria and the ventricles

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14
Q

AV synchronous chamber PM…

A

Paces the atria and ventricles simultaneously and restores normal timing

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15
Q

How are PMs classified?

A

According to:
Chambers paced
Chambers sensed
Response to sensed impulse

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16
Q

1st letter PM code…

A

PACED chamber (A; V; D - both)

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17
Q

2nd letter PM code…

A 
SENSED chamber (A; V; D - both)
*senses intrinsic electrical activity*
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18
Q

3rd letter PM code…

A

RESPONSE TO SENSED SIGNAL
I - inhibited by activity (PM withholds or inhibits response - doesn’t give a pace - if electrical activity sensed)
T - triggered by activity
D - dual - inhibited or triggered

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19
Q

4th letter PM code…

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A

PROGRAMMABILITY
P - simple programmability
M - multi-programmable (rate, sensing, output, refractory period)
C - communicating (telemetry)
R - rate response (can respond to physical activity, but doesn’t tell which type of sensory - RR vs. activity sensor)

20
Q

5th letter PM code…

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A

ANTI-TACHYCARDIA FEATURES
O - no anti-tachy arrhythmia function
P - can pace the Pt. Out of tachy episode

21
Q

Which type of PM can be used c A-fib?

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A

VVI
V - paces ventricles
V - senses ventricles
I - inhibited by sensed ventricular depolarization (PM will not pace if ventricle is depolarizing)

22
Q

PM ex: DDI

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A

Paces both A/V
Senses both A/V
Inhibits PM output if normal electrical activity occurring in either/both chambers

23
Q

PM ex: AAT

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A

Paces atria
Senses atria
Each sensed event triggers the pacer to fire within the P wave

24
Q

How does a VVI PM work c A-fib?

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A

It tries to maximize communication between A/Vs
It waits for the ventricle to contract
Telemetry: PM spike, then QRS (wide) bc pacing ventricles and bc impulse from PM, not AV node
there is not great synchrony between A/Vs

25
PM ex: DDD
Optimal, fully automatic, universal, physiologic Both chambers paced and sensed Sensed atrial signal causes PM to INHIBIT atrial output - timer starts that causes a triggered ventricular output after certain interval If QRS occurs naturally, PM inhibits ventricular output Intrinsic P wave and intrinsic QRS can inhibit pacing Intrinsic P wave can trigger a paced QRS
26
Which type of PM is the most common?
DDD
27
Rate modulation - PM 4th code
Physiologically-based (minute ventilation - increases c activity ==> RR x TV) *requires a longer warm-up bc there is a slight delay to activity - need to extend warm-up and cool-down c exercise*
28
If there are no depolarization complexes on ECG c PM...
The PM fires normally but fails to capture
29
PM failure to sense
Fails to sense underlying rhythm and fires in complete disregard for Pt.'s own rhythm - may compete c heart for control
30
PM under- or over-sensing
PM can over-sense by misinterpreting muscle movement as depolarization
31
Sx when PM isn't meeting demands (CO sx if not keeping up c activity)...
``` SOB Syncope Angina CHF sx (if decreased ventricular contraction) Fatigue Vertigo Confusion Dizziness ```
32
If PM used for tachy-dysrhythmia, NOTE CUT-OFF RATE...
10 beats BELOW cut-off rate is MAX HR IN KARVONEN - otherwise PM will fire when not necessary
33
If PM ATRIAL RATE IS FIXED, ventricular rate is affected
BLUNTED HR response to exercise ==> need prolonged warm-up/cool-down
34
PM PT considerations
No lifting x 6 wks. (Fibrosis needs to occur over PM) No overhead exercise until MD clears Avoid contact sports (low-intensity competitive sports allowed if approved by MD)
35
ICD (implantable cardiac defibrillator)
Monitors heart RHYTHM (PM ==> RATE) ==> prevents SCD Delivers electrical shock if dangerous rhythm detected: V-tach V-fib
36
ICD considered for...
Previous cardiac arrest (V-tach or V-fib) I controlled dysrhythmia c meds Cardiomyopathy c dysrhythmia (or at risk) CAD, low LVEF, and episode of V-tach
37
Digoxin toxicity can cause which types of heart problems?
``` Sinus dysrhythmia A-fib Junctional rhythm 2nd degree AV block, Type II (Mobitz II) 3rd degree (complete) heart block V-tach V-fib ```
38
Intervention for symptomatic sinus bradycardia
PM | Atropine (need adequate resting CO)
39
Intervention for A-flutter
BBs | Cardioversion to reset electrical system
40
Controlled A-fib
HR < 100 (V rate) ==> little impact on CO
41
Uncontrolled A-fib
HR > 100 (V rate) ==> impacts CO - MONITOR VITALS
42
Interventions for A-fib
Antiarrhyhmic meds | Cardioversion
43
Interventions for junctional rhythm
Atropine to increase HR | PM
44
Interventions for 3rd degree (complete) heart block
Permanent PM | Atropine
45
Interventions for V-tach
Cardioversion; defibrillation | Meds to normalize rhythm
46
Interventions for V-fib
Defibrillation CPR O2 Cardiac meds

Cardio I - ECG (7 decks)

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