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Adult Health 1 Review > T1 Blueprint - Cardiac Rhythm (Josh) > Flashcards

T1 Blueprint - Cardiac Rhythm (Josh) Flashcards

(107 cards)

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1
Q

What is the HR of Sinus Bradycardia?

A

less than 60 bpm

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2
Q

What are some causes of Sinus Bradycardia?

A

Increased Parasympathetic Tone (athletes)

SA Nodal disease (Sick Sinus Syndrome)

Meds

VAGAL STIMULATION

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3
Q

What is the hemodynamic effect of Sinus Bradycardia?

A

Decreased CO

Hypotension (orthostatic, syncope)

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4
Q

When do you treat Sinus Bradycardia and how do you treat?

A

ONLY if symptomatic

Use:

  • Atropine (DOC)
  • Pacemaker
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5
Q

What are the dysrhythmias we talked about?

A 
Sinus Brady
Sinus Tachy
Afib (most common)
Atrial Flutter
PACs
Junctionals (Accelerated Junctional, Junctional Tachy, PJCs)
SVTs
Ventricular Tachy
Vfib
PVCs
Heart Blocks
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6
Q

What HR is Sinus Tachy?

A

101 - 150 bpm

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7
Q

What are some causes of Sinus Tachy?

A

Increased O2 demand (fever, exercise)

Compensatory response to low CO (CHF, Dehydration, Hypovolemia)

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8
Q

What are the hemodynamic effects of Sinus Tachy?

A

increases the heart rate and improves CO

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9
Q

What do you do to treat Sinus Tachy?

A

correct the underlying cause

***ie: if fever, treat the fever

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10
Q

What is the most common dysrhytmia?

A

Afib

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11
Q

What is the rate associated with Afib?

A

greater than 350 bpm

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12
Q

What are some causes of Afib?

A

Heart Disease

Ischemia

Rheumatic Fever

Mitral or Tricuspid Valve disorders

Overstretched Atrium (HF)

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13
Q

What is the hemodynamic effects of Afib?

A

Lose Atrial Kick

Decreased SV

Decreased Diastolic filling time

CO can decrease by 20-30%

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14
Q

What are the three treatment goals of Afib?

A

Get them out of the Rhythm

Control the Rate (if you can’t get them out of the rhythm)

Prevent complications from Stasis of Blood

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15
Q

What is the number one fear associated with Afib?

A

stasis of blood in the Atrium

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16
Q

Afib:

What meds can be used to get them out of the rhythm?

A

Amiodarone

Ibutilide

Disopyramide

Flecainide

Dofetilide

Sotalol

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17
Q

Afib:

If meds don’t work, what else can we do to get them out of the rhythm?

A

Cardioversion

Surgical ablation (MAZE procedure)

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18
Q

Afib:

If you can’t get them out of the rhythm, what meds can we give to control the rate?

A

Ca Channel Blockers

Beta Blockers

Digoxin

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19
Q

What is the rate associated with Atrial Flutter?

A

250-350 bpm

***sawtooth appearance

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20
Q

With Atrial Flutter, will the client always know they have it?

A

No, because they may have a normal ventricular rate

***still lose their Atrial Kick

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21
Q

What are the Junctional Rhythms we talked about?

A

Junctional

Accelerated Junctional

Junctional Tachy

Premature Junctional Contraction (PJC)

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22
Q

What is a Junctional Rhythm?

A

AV Node takes over as pacemaker when a higher node fails to initiate or conduct to AV node

***rate is that of AV node (40-60 bpm)

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23
Q

What is the rate of a Junctional Rhythm?

A

40-60 bpm

***the normal rate of AV node

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24
Q

What do you use to treat a Junctional Rhythm?

A

Atropine

***If symptomatic

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25
What is an Accelerated Junctional Rhythm?
Rate increases form normal junctional rhythm (40-60) to faster rate (61-100)
26
How concerned should we be about an Accelerated Junctional Rhythm?
not very concerned no treatment necessary
27
What is Junctional Tachy?
rate faster than accelerated junctional rate of 101-180 bpm
28
What is the Hemodynamic effect of Junctional Tachy?
Decrease CO due to abnormal atrial kick and rapid rate)
29
What is the medication mgmt for Junctional Tachy?
Ca Channel Blocker Beta Blocker Amiodarone
30
If meds don't work, what can we do for Junctional Tachy?
AV Node ablation with pacemaker for severe, symptomatic patients
31
What happens with PJC?
Premature Junctional Contraction - single beat originating with AV junction that causes the atria to depolarize by retrograde conduction
32
What do we do about PJC?
just observe it **It has no hemodynamic effect
33
What are some causes of PJC?
Irritable focuse within AV junction Dig toxicity
34
When we think of Dig toxicity, what rate should we think of?
PJC
35
What is an SVT?
Supraventricular Tachy - any rapid rate originating above ventricle - Sinus tachy - Atrial tachy - Atrial flutter - Afib - Junctional tachy
36
What is the rate associated with SVT?
100-280 (with a mean of 170 in adults)
37
When do you treat SVT?
if it is paroxysmal (sudden onset)
38
What meds can be used for SVT?
Adenosine (Rapid Infusion) Amiodarone Cardizem
39
If meds don't work, what else can be used for SVT?
Vagal Stimulation Cardioversion Ablation
40
What rate is Ventricular Tachy?
140-180 bpm
41
What do you do FIRST when you have Ventricular Tachy?
check pulse * **pulseless - defibrillator * **pulse - cardioversion
42
Treatment for PULSELESS Ventricular Tachy?
Defibrillator CPR Epi Vasopressin
43
Treatment for Ventricular Tachy with a PULSE?
Amiodarone Sotalol Lidocaine Cardioversion
44
What is the concern with Vfib and Vtach?
can lead to Torsades
45
What is the hemodynamic effect of Vtach?
No contraction No forward blood flow No CO
46
What are the shockable rhytms?
Pulseless Vtach Vfib
47
How many jules for biphasic fibrillation? Monophasic?
150-200j (requires less) 360j
48
Management of Pulseless Vtach and Vfib?
Check for Pulse (if no pulse) SHOCK CPR for 5 cycles (about 2 mins) Check for Pulse
49
What does QRS look like with PVC?
wide and bizarre can occur in bigeminey or trigeminy
50
What is treatment for PVC?
Look for cause and treat it - Drugs - Hypoxia - Cardiac Disease - Irritation of ventricle by catheter Antidisrhythmia meds
51
Which Heart Block is hemodynamically stable?
1st Degree
52
What do you do to treat 1st Degree Heart Block?
nothing, other than treating any possible cause ex: if hyperkalemia, then get rid of some K+
53
What are the different types of 2nd Degree Blocks?
Type I: Wenchenbach or Mobitz I Type II: Mobitz II
54
Which 2nd Degree Block is more severe?
Type II: Mobitz II
55
What is hemodynamic effects of 2nd Degree Blocks?
stable but can progress to unsable
56
If treating the underlying cause doesn't correct 2nd Degree block, what else could be used?
possible transcutaneous pacing or transvenous pacing
57
What is happening with the nodes during a Third Degree Block ?
each is firing at its own intrinsic rate (out of cycle)
58
Which Heart Block is hemodynamically UNSTABLE?
3rd Degree
59
Which Heart Block always requires pacemaker?
3rd Degree
60
Which electrolyte determines conduction velocity and helps to confine pacing activity to the SA Node?
Potassium (3.5-5.0)
61
What does Hyperkalemia do to electical system of heart?
Decreases rate of ventricular depolarization Shortens Repolarization Depresses AV conduction
62
Potassium: Acidosis is a sign of --- Alkalosis is a sign of ---
Hyperkalemia Hypokalemia
63
What is treatment for Hyperkalemia?
D50W and IV Insulin (temporary) Ca Chloride (temporary) Cation exchange resin products into GI Tract such as Kayexalate (Permanent) Hemodialysis or Peritoneal Dialysis (permanent)
64
What doe Hypokalemia do to the electrical system of the heart?
impairs myocardial conduction prolongs ventricular repolarization ***Hypokalemia reduces the excitability of cells so they are less responsive to stimuli
65
What are some causes of Hyperkalemia?
Excess K+ administration K+ sparing diuretics ACE Inihibitors ARBs Renal Failure Acidosis Extensive Muscle Destruction (Rhabo)
66
What are some causes of Hypokalemia?
GI Losses Renal dysfunction Alkalosis Diuretic Therapy with insufficienty replacement Chronic Steroid Therapy
67
Treatment for Hyperkalemia?
K+ replacement (10 mEq per hr) Replace magnesium if Hypomagnesium exists BEFORE replacing K+
68
When replacing K+, how do we give?
Slowly (10 mEq per hr) * **High alert med * **Never IV Push * **Monitor for Phlebitis
69
What is normal Magnesium level in ECF?
1.8-2.4 mg/dL
70
Which is rare, Hypermagnesemia or Hypomagnesemia
Hypermagnesemia
71
What are causes of Hypermagnesemia?
Renal dysfunction Tumor Lysis Syndrome Overtreatment w/ Mag
72
Magnesium: ECG for Hypermagnesemia looks similar to --- ECG for Hypomagnesemia looks similar to ---
Hyperkalemia Hypokalemia
73
Hypomagnesemia and Hypokalemia both do what to the electrical function of heart?
Impair myocardial conduction Prolong ventricular repolarization
74
What are some causes of Hypomagnesemia?
Insufficient Mag intake ETOH abuse Diuresis / Diarrhea Rapid administration of citrated blood products
75
Magnesium ---- can lead to: - Sudden cardiac death - Coronary Artery spasm - HTN - Torsades
Hypomagnesemia
76
Treatment for Hypomagnesemia?
Mag IV replacement * **evaluate renal status first * **Check for pulse Pulseless = 1-2g in 10 mL D5W over 5-20 mins Pulse = 1-2 g over 5-60 mins
77
Which electrolyte is an important mediator for cardiac functions like vascular tone, myocardial contractility, and cardiac excitability?
Calcium Total serum = 8.5-10.5 mg/dL Ionized = 4-5 mg/dL
78
What is difference between serum calcium and ionized calcium?
ionized is what you can actually use and represents that amount unbound to albumin
79
Why would the following changes be associated with Hypercalcemia: - Shortened QTc Interval - Bradycardia - Heart Block - BBB
too much calcium: - Strengthens contractility - Shortens ventricular depolarization
80
What are some causes of Hypercalcemia?
Bone Tumors Hypomagnesemia Endocrine Disorders Excessive intake of Vit. D
81
Treatment for Hypercalcemia?
Loop diuretics (Lasix) Calcitonin (SQ or IM) Bisphosphonates Hemodialysis
82
Why would the following be associated with Hypocalcemia: - Variable ECG - Bradycardia - Vtach - Asystole - Prolonged QT
too little calcium causes: - Decreased myocardial contractility - Reduced CO - Hypotension - Decreased responsiveness to Digoxin
83
What are some causes of Hypocalcemia?
Post surgical blood loss (blood transfusions) Alkalosis Shock Mag imbalances
84
Treatment for Hypocalcemia?
Seizure precautions Oral and IV replacement - Ca chloride - Ca gluconate
85
12 Lead ECG: What is Normal Axis?
Lead 1 = + Lead aVf = +
86
12 Lead ECG: What is Right Axis?
Lead 1 = - Lead aVf = +
87
12 Lead ECG: What is Left Axis?
Lead 1 = + Lead aVf = -
88
12 Lead ECG: What is NW Axis?
Lead 1 = - Lead aVf = -
89
12 Lead ECG: What causes Left Axis (+, -) Deviation?
Q waves of inferior MI Emphysema Hyperkalemia Injection of contrast into Left Coronary Artery Left Ventricular Hypertrophy
90
12 Lead ECG: What causes Right Axis (-, +) Deviation?
Normal finding in children and tall thin adults Right Ventricular Hypertrophy Chronic lung disease eve without pulmonary HTN Anterolateral MI PE
91
12 Lead ECG: What causes NW (-, -) Deviation?
Emphysema Hyperkalema Lead Transposition Artificial Cardiac Pacing Vtach
92
12 Lead ECG: What are the Limb Leads? What are the Precordial Leads?
Limb = I, II, II, aVr, Avl, aVf Precordial = V1, V2, V3, V4, V5, V6
93
Which viewpoint of the heart do the Limb Leads provide?
frontal plane of heart
94
Which viewpoint of the heard do the Precordial leads provide?
horizontal plane of the heart
95
Where should V1 be placed?
4th ICS right sternal border
96
What should we see in the R waves on the Precordial leads?
R Wave progression from V1 to V6
97
When do you use Defibrillation?
NO PULSE * *Pulseless Vtach * *Vfib
98
When do you use Cardioversion?
PULSE * *Afib * *SVT * *Vtach with a pulse
99
Order with Defibrillation?
1) Check for Pulse 2) (if pulseless) Shock with 150-200 (if biphasic) or 360j (if monophasic) 3) Then 5 cycles of CPR (about 2 mins) 4) Check for pulse
100
Cardioversion vs. Defibrillation: Which is syncronized?
Cardioversion is synchronized because it needs to coincide with the PULSE ***Defibrillation is not synchronized because there is NO PULSE
101
Pacemakers: In the 3 code system, what do the following position means: Position I Position II Position III
Position I = Chambers paced Position II = Chambers sensed Position III = Response to sensing
102
Pacemakers: What are the possible settings for Position I and Position II?
``` 0 = None A = Atrial V= Ventricle D = Dual ```
103
Pacemakres: What are the possible settings for Position III?
``` 0 = None T = Triggered I = Inhibited D = Dual (T and I) ```
104
Pacemakers: When we are pacing, what are we pacing?
A = Right Atria before P wave V = Right Ventricle before QRS D = both
105
What are some indications for a Temporary Pacemaker?
Asystole Pulseless idioventricular rhythm Symptomatic brady that won't respond to Atropine or Isuprel Drug toxicity Implanted pacer fail
106
What are some containidcations for Temporary Pacemakers?
Prolonged cardiac arrest Cardiac trauma Extensive MI
107
What are some complications from Pacemakers?
Catheter dislodgement Lead failure Pacemaker system failure Erosion of pulse generator Pacer induced tachy Infection Cardiac perforation with tamponade Thrombosis or SVC Dysrhythmias

Adult Health 1 Review (26 decks)

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