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50 Cards in this Set
- Front
- Back
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PACs
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occurs when an irritable site within the atria fires before the next SA node impulse is due to fire
ID -early (premature) P waves -positive (upright) P waves (in lead II) that differ in shape from sinus P waves -early P waves that may or may not be followed by a QRS complex |
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non-compensatory (incomplete) pause
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found in PAC's & PJC's
The SA node is reset and fires shortly after the PAC is done |
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compensatory pause
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found in PVC's
the SA node is not affected as the ventricles fire independently and do not affect the, |
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Aberantly conducted PAC's
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PAC's associated with a wide QRS (0.10s), conduction through the ventricles is abnormal
the L bundle branch with no problem, which fires the R bundle branch a second later |
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Nonconducted PAC's
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Occur because the AV node is still in its refractory period and is unable to conduct an impulse
P waves morph the preceeding T waves -no QRS |
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PAC patterns
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Pairs - Two PAC's
Runs or Bursts - Three or more PACs in a row (often called PAT/PSVT) Atrial Bigeminy - every other beat is a PAC Atrial Trigeminy - every third beat is a PAC Atrial Quadrigeminy - every fourth beat is a PAC |
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PAC causes
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altered automaticity or re-entry, common occur at any age
-emotional stress -CHF -Acute Coronary Syndrome -Mental and Physical fatigue -Atrial enlargement -Valvular heart disease -Digitalis toxicity -Electrolyte imba -Hyperthyroidism -caffeine, tobacco, cocaine can be treated by betablockers, Ca channel blockers, antianxiety meds |
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Multiformed Atrial Rhythm / Wandering atrial pacemaker
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p waves vary shifting from beat to beat, associated with a normal or slow rate and irregular intervals, normal QRS
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Multifocal Atrial Tach
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WAP at a rate of greater then 100
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WAP/MAR causes
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can be in normal healthy hearts and during sleep, some digitalis toxicity, no S & S unless brady
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Multifocal Atrial Tachycardia
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Wandering atrial pacemaker beat that is greater then 100 BPM
hard to distinguish from A Fib, look for differing P waves |
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MAT causes and treatment
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causes
-COPD -Hypoxia -Acute Coronary Syndrome -Digoxin Toxcitiy -Rheumatic heart disease -electrolyte imba TX vagal manuevers to ID -calcium channel blockers |
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CSM in children?
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not effective
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3 types of SVT
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Atrial Tachycardia - in AT an irritable site in the atria fires automatically at a rapid rate
AVNRT - fast and slow pathways in the AV node form an electrical circuit or loop spinning and depolarizing AVRT - the impulse begins above the ventricles but travels via a pathway other than the AV node and bundle of his |
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Atrial Tach
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irritable focus in the atria fire rapidly, P waves look slightly different from sinus P waves
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Atrial tach causes and symptoms
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cause
-occur in persons with normal hearts or pts with heart disease -stimulant use (caffeine cocaine) -infection -electrolyte imba -acute illness with excessive catecholamine release -MI Effects -asymptomatic -palpitations -cx pressure -fatigue -dizziness/syncope |
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Amiodarone
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directly depresses automaticity of the SA and AV nodes slowing conduction through the AV node and in the accessory pathway of pt's with WPW
inhibits A and B receptors and has vagolytic and calcium channel blocking properties prolongs the PR, QRS, QT, may cause torsades de pointes hypotension, bradycardia, and AV blcok are side effects |
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AVNRT / PSVT
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most common type of SVT, caused by reentry in the area of the AV node, two pathways 1 fast, 1 slow
Fast pathway - slow recovery Slow pathway - fast recovery Rate 150-250 regular P waves lost in the T or at the end of the QRS if retrograde depolarization occurs |
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AVRNT causes/S&S
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-Hypoxia
-Stress -Overexertion -anxiety -caffeine -smoking -sleep deprivation -meds S&S -palpitations, -lightheadnedness -neck vein pulsations -syncope or near syncope -dsypnea -weakness -nasuea -cx pn |
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AVRNT treatment
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-O2, IV, Vagal
-adenosine -cardioversion -calcium channel blocking -amiodarone -catheter ablation |
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AVRT
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2nd most common SVT
rhythm originate from above the ventricles but the impulse travels via a pathway other then the AV node and bundle of his, carries the depolarization to ventricles before the normal AV depolarization signal |
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3 major forms of AVRT
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1. Wolff - Parkinson - White (WGW) syndrome, use the bundle of kent to connect R atria to R ventricle (most common, M, 1.5:1000)
2. Lown-Ganoung-Levine (LGL) syndrome - james bundle, connects the atria directly to the lower portion of the AV node, bypassing it 3. mahaim fibers originate below the aV node and insert into the Ventricular wall |
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WPW ID
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usually 60-100 BPM
regular unless A -FIB Normal positive P waves in II unless A-FIB P waves less the .12 sec (short PRI) QRS greater then .12 secs and delta slurring |
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3 main types of tachyd. in WPW
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AVRT
-Orthodromic (narrow QRS, assessory pathway takes PAC signal from V to A, circuit) -Antidromic (wide QRS, PAC A to V using accessory pathway, normal signal via AV, completes circuit) A FIB A Flutter |
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TX
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Narrow QRS (orthodromic)
-O2, IV, Vagal -Adenosine, calcium channel blocker, Wide QRS (antidromic) -O2, IV, procanaimide or amiodarone |
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A Flutter
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ectopic atrial rhythm in which an irritable site fires reguarly at a very rapid rate
Type 1 - caused by reentry 250-350 BPM Type 2 - atypical rapid flutter 350-450 BPM |
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Conditions associated with A flutter
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-hypoxia
-PE -chronic lung disease -mitral or tricuspid valve stenosis or regurgitation -pneumonia -ichemic heart disease -MI -cardiomyopathy -hyperthryroidism -digitalis -cardiac surgery -pericarditis/myocarditis |
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A flutter treatment
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symptomatic - syncronized cardioversion
no heart failure -calcium cannel blockers -beta blockers heart failure - digoxin, dilatazem, amiodarone anticoagulants - best course of action |
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A Fibrillation
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altered automaticity cause muscles in the atria to quiver and fire at a rate of 400-600 times/min
irregular rhythm, if controlled suspect betablockers, digitalis, calcium channel blockers |
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PJC vs Escape
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If the junctional complex comes early, its a PJC, if it come later then expected its an escape beat
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PJC ID
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may occur before, during or after the QRS [inverted]
narrow QRS |
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what causes it
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-CHF
-Acute Coronary Syndrome -Mental and Physcial fatigue -Valvular heart disease -Digitalis toxicity -Electrolyte imba -Rheumatic heart disese -stimulants caffeine, tobacco |
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Junctional Escape beats
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several sequential escape beats
junctional bradycardia if less then 40 BPM |
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Escape beat causes
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-Acute Coronary Sundromes
-Hypoxia -Rheumatic Heart disease -Valvular disease -SA node disease -increased parasympathetic tone -immediately after cardiac surgery -effects of meds including betablockers, calcium channel blocksers |
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Junctional Escape beat TX
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stop digitalis
-atropine -transcutaneous pacing |
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Accelerated Junctional Rhythm
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Junction speeds up and fires at a rate of 61-100
ID -very regular -P waves inverted before during or after QRS |
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accelerated junctional rhythm causes & TX
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-digitalis
-acute MI -cardiac surgery -rheumatic fever -COPD -hypokalemia TX -stop digitalis |
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Junctional Dysrhythmias at a glance
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Junctional Rhythm - 40-60 BPM
Accelerated Junctional Rhythm - 61-100 BPM Junctional Tach - 101-180 BPM |
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Junctional Tach
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3 or more sequential PJCs at a rate of more then 100 BPM
ID 101-180 BPM regular inverted P before during or after QRS |
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Junctional Tach cause & tx
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Cause
-enhanced automaticity -ACS -CHF -digitalis What do i do about it Symptomatic -O2, IV, vagal, IV adenosine -beta blocker, calcium channel blocker, or amiodarone ordered |
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common cause of reentry
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hyperkalemia
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ventricular rhythm in A-Fib
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Irregular
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cardiac glycoside
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digioxin
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4 reasons why the AV junction may assume responsibility for pacing the heart
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1) SA arrest
2) SA block 3) Enhanced junction 4) AV Block |
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volumetric pump
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electronic IV fluid infusion
check programming, and check IV sites for infiltration |
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PCA
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Patient controlled analgesic device
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Syringe pump
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infusion of small doses of meds that can not be mixed with other substances
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calibrated burette
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measurement device for greater accuracy in small volume IV meds
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saline lock specs
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1-2 mL NS flush every 6-8 hours
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