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33 Cards in this Set
- Front
- Back
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Intrinsic Rate of Conduction |
SA Node - 60-100 bpm
AV Node - 40-60 bpm Bundle of HIS/Purkinje - 20-40 bpm |
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Waveforms
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P Wave - atrial contraction
PR Interval - AV node & Bundle of HIS *(0.12-0.20s) QRS Interval - Ventricular depol & contraction *(<0.12s) ST Segment - Time btwn Ventricular depol & repol T Wave - Ventricular repol |
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Electrocardiogram
(ECG) |
-tracing on graph of heart's electrical activity
-detects electrical activity through leads on skin -DOES NOT detect mechanical activity |
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Sinus Rhythm
(definition) |
-having PQRS&T waves
-regular & 60-100 bpm |
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Sinus Bradycardia
(Patho) |
Pulse regular, > 60 bpm
S/S -syncope, hypotension, weakness or confusion Etiology -athletes(normal HR), sleep, hypothyroid, hypothermia, MI -Valsalva Maneuver (PNS), meds (beta & Ca chnl blockers) |
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Sinus Bradycardia
(Mgmt) |
-Atropine IV 0.5 mg (1st line pharm therapy)
-Pacemaker (transQ or permanent) -TREAT THE CAUSE (meds, BS, Temp) |
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Sinus Tachycardia
(Patho) |
Pulse regular, < 100 bpm (low SV = low CO)
S/S -angina (heart pain), hypotension Etiology -physiological, psychological, compensatory, meds |
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Sinus Tachycardia
(Mgmt) |
TREAT THE CAUSE
-pain -fever -hypolemia -administer Beta Blockers |
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Ectopic Dysrhythmias
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-conduction that starts outside SA node
Etiology -past MI, CHF (A-Fib), Hypoxia -K+ & Mg++ imbalance -Meds (Digoxin), caffeine, drug OD -post cardiac surgery surgery & cardiac cath pts |
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Paroxysmal Supraventricular Tachycardia (PSVT)
(Patho) |
-ectopic, conduction circulates in atria before entering ventricles
-HR 150-220 bpm -overexertion, stress, caffeine & tobacco |
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Paroxysmal Supraventricular Tachycardia (PSVT)
(Mgmt) |
-Vagal (Valsalva) Maneuver (bear down/hold breath)
Meds -Adenosine (slows rhythm briefly, ~2 second asystole) -Beta blockers & Calcium channel blockers -Cardioversion (reset conduction) -Radiofrequency Catheter Ablation (destroys ectopic conduction source) |
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Radiofrequency Catheter Ablation
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-check iodine sensitivity
-NPO -post surg monitoring (peripheral pulse, bleeding, etc) |
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Atrial Flutter
(Patho) |
-regular, recurring and "saw tooth"
-Atrial rate 150-200 bpm -single ectopic focus secondary to loss of ATRIAL KICK |
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Atrial Fibrillation
(Patho) |
-irregularly irregular, atrial activity completely disorganized, NO P WAVE
-high risk for thrombosis (20% of all strokes) Risk Factors -Heart Failure, electrolyte imbalance, thyroid storm Can be accompanied by Rapid Ventricular Response (RVR) or classify as "A-Fib w/ a rate of 50 bpm." |
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Atrial Flutter/Atrial Fibrillation
(Mgmt) |
Convert to sinus rhythm w/:
-Meds -Cardioversion Eliminate ectopic focus (A Flutter) Decrease RVR < 100 bpm (A Fib) -Prevent thrombus formation & embolic event |
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Synchronized Cardioversion
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-depols myocardium to reset SA node as pacemaker
-syncs to deliver 50-100 Joules during R wave (peak) FOR A-FIB ONLY -establish time A-Fib began < 48 hrs - NO anti-coag > 48 hrs - anti-coag 3-4 wks prior Anitcoagulation drug used - Warfarin (Coumadin) -avoid diet high in Vit K (clotting factors) -monitor for hemorrhage/bleeding |
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Premature Ventricular Contraction
(Patho) |
-premature depol of ventricle from an ectopic focus originating in the ventricle
-can be caused by meds (caffiene, ETOH, nicotine, epi, dig) -electrolyte imbalance, hypoxia, fever, stress, exercise -MI, HF or CAD Seen as: -Couplets (back to back) -Multifocal (opposite ends of isoelectric line) -Trigeminy (every 3 beats) |
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R on T Phenomenon
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-PVC where R (V depol) Wave attempts to occur during T Wave (V repol)
-High risk to develop V Tach or V Fib -decreases CO |
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Ventricular Tachycardia
(Patho) |
Stable (+ Pulse) or Unstable (Pulseless)
ECG Characteristics -No P Wave, QRS wide and bizarre -Run of 3 or more PVC’s; V rate 150-300 BPM -Repetitive firing from ectopic focus Causes: -electrolyte imbalance, cardiomyopathy (deterioration), drug toxicity |
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Ventricular Tachycardia
(Mgmt) |
Stable (+ Pulse)
-Consider cardioversion -Meds Unstable (Pulseless) -Defibrillate -CPR -Meds |
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Ventricular Fibrillation
(Patho) |
ECG Characteristics
-Wavy, chaotic and irregular -Ventricular quivering 300-500/min -No CO |
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Ventricular Fibrillation
(Mgmt) |
ACLS protocol
Defibrillate -CPR -Meds |
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Defibrillation
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-most effective w/ lethal dysrhythmias: Pulseless V-Tach & V-Fib
-depolarizes myocardium -intent is that SA node reassumes pacemaker role -CPR until defrib is available -Monitor airway |
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Cardiopulmonary Resuscitation (CPR)
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-practice team dynamics (communication)
-use backboard -1.5-2" compressions, 100/min -MINIMIZE INTERRUPTIONS *Resume CPR for 2min (5 cycles) after defib -know when to stop CPR |
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Asystole
(Patho) |
ECG Characteristics
-No rate, no rhythm, no P wave, no QRS -No cardiac output -No pulse |
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Pulseless Electrical Activity (PEA)
(Patho) |
ECG Characteristics
-Organized rhythm on monitor -No pulse, no blood pressure, no cardiac output -Electrical but NOT mechanical |
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Nonshockable Rhythms
(Mgmt) |
-assess pt & equipment
-check asystole in 2 leads *CPR -Check H's & T's |
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Nonshockable Rhythms
(Risks) |
H's
-Hypovolemia, Hypoxia, Hydrogen Ion (acidosis), Hyper/Hypo K+, Hypoglycemia, Hypotermia T's Toxins, Tamponade (fluid build up btwn myocardium and pericardium), Tension Pneumothorax, Thrombosis, Trauma |
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Complete Heart Block
(Patho) |
-Alteration occurs at AV node
Risk Factors -Heart Failure, MI, systemic diseases, Meds altering AV Node ECG Characteristics -P wave & QRS complex are regular BUT unrelated -A & V contract independently of each other -impaired CO & shock -20-40 bpm |
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Pacemaker - PT Education
(Mgmt) |
-monitor s/s infection, ABCs, vitals
-avoid lifting w/ affected side *Check w/ PCP before MRI* -microwaves & security scanners DO NOT interfere -pt should wear Medic Alert Band |
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Pacemaker Function
(Mgmt) |
Single-Chambered Pacemaker
-V-Pacing should see pacer spike then QRS Dual-Chambered Pacemaker -paces A & V -should see 2 pacer spikes |
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Pacemaker Malfunction
(Mgmt) |
Failure to Sense
-fails to recognize A or V activity and fires inappropriately Failure to Capture -charge is insufficient to produce A or V contraction -no P wave or QRS follows pacer spike Causes -Pacer lead damage, battery failure or dislodgement of electrode, low voltage, edema or scar tissue |
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Implantable Cardioverter-Defibrillator (ICD)
(Mgmt) |
If your ICD fires…
-Stop activity & rest -Call PCP -AND you feel ill. Call EMS -More than once. Call EMS |
