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102 Cards in this Set
- Front
- Back
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The heart is composed of 3 layers, name them:
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-Epicardium: outer layer
-Myocardium: middle muscle layer -Endocardium: inner layer |
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Describe the pathway blood takes in the right-side of the heart, starting with from where the right atrium receives blood:
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1.) Inferior and Superior Vena Cava, and Coronary Sinus
2.) Right Atrium 3.) Tricuspid Valve 4.) Right Ventricle 5.) Pulmonic Valve 6.) Pulmonic Artery 7.) Lungs |
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Describe the pathway blood takes in the left-side of the heart, starting with from where the left atrium receives blood:
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1.) Pulmonary Veins
2.) Left Atrium 3.) Mitral Valve 4.) Left Ventricle 5.) Aortic Valve 6.) Aorta 7.) Circulatory System |
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The cusps of the mitral and tricuspid valves are attached to thin strands of fibrous tissue termed:
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-Chordae tendineae
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What does the left coronary artery divide into? What does it supply?
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-Left anterior descending artery and left circumflex artery
-Supplies left atrium, left ventricle, the interventricular septum, and portion of the right ventricle |
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What does the right coronary artery supply?
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-Right atrium, right ventricle, and a portion of the posterior wall of the left ventricle
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Most of the blood from the coronary system drains into what?
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-Coronary sinus, which then empties into the right atrium (to become oxygenated)
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Describe the route of conduction in the heart:
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-SA node
-AV node -Bundle of His -Right and left bundle branches -Purkinje Fibers |
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What does the P wave represent on an ECG?
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-Firing of the SA node and depolarization of the fibers of the atria
-Atrial contraction |
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What does the QRS complex represent on an ECG?
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-Depolarization from the AV node throughout the ventricles
-Ventricular contraction |
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What does the PR interval represent on an ECG?
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-The time it takes for an impulse to travel from the SA node to the AV node, bundle of His and Purkinje fibers
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What does the T wave represent on an ECG?
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-Repolarization of the ventricles (already responded to an impulse and now is resetting and getting ready for another)
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What does the ST interval represent on an ECG?
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-Time between ventricular depolarization and very early part of ventricular repolarization
-Segment should be flat or isoelectric |
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What does the QT interval represent on an ECG?
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-Depolarization and repolarization of ventricles (time it takes for impulse to travel from AV node to bundle of His to bundle branches to Purkinje fibers and end)
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The difference between systolic and diastolic BP:
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-Pulse Pressure
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The perfusion pressure felt by organs in the body:
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-Mean Arterial Pressure
(MAP= (SBP + 2DBP) / 3 |
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Ability to initiate an impulse spontaneously and continuously:
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-Automaticity
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Ability to be electrically stimulated
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-Excitability
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Ability to transmit an impulse along a membrane in an orderly manner:
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-Conductivity
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Ability to respond mechanically to an impulse:
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-Contractility
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Four properties of cardiac cells enable to conduction system to initiate an electrical impulse, which is transmitted through the cardiac tissue, stimulating muscle contraction:
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1.) Automaticity
2.) Excitability 3.) Conductivity 4.) Contractility |
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Stimulation of the _____ _____ causes a decreased rate of firing of the SA node, slowed impulse conduction of the AV node, and decreased force of cardiac muscle contractions.
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-Vagus nerve
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Stimulation of the _____ ______ that supply the heart has essentially the opposite effect on the heart.
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-Sympathetic nerves
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When a cell or groups of cells are stimulated, each cell membrane changes its permeability and allows Na to move rapidly into the cell, making the inside of the cell positive compared with the outside or called:
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-Depolarization
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A slower movement of ions across the membrane restores the cell to the polarized state, which is called:
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-Repolarization
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The 12-lead ECG may show changes that are indicative of structural changes or damage such as:
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-Ischemia
-Infarction -Enlarged cardiac chambers -Electrolyte imbalance -Drug toxicity |
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The observation of a patient's HR and rhythm to rapidly diagnose dysrhythmias, ischemia, or infarction:
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-Telemetry monitoring
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Disturbance in conduction within atria usually effects which part of the ECG?
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-P wave
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Disturbance in conduction usually in the AV node, bundle of His, or bundle branches but can be in atria as well, usually effects which part of the ECG?
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-PR interval
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Disturbance in conduction in bundle branches or in ventricles usually effects which part of the ECG?
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-QRS complex
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Disturbances usually caused by electrolyte imbalances, ischemia, or infarction usually effects which part of the ECG?
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-T wave and ST interval
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Disturbances usually affecting repolarization more than depolarization and caused by drugs, electrolyte imbalances, and changes in HR, usually effects which part of the ECG?
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-QT interval
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Refers to a rhythm that originates in the SA node and follows the normal conduction pattern of the cardiac cycle:
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-Normal sinus rhythm
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What does the QRS interval represent on an ECG?
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-Time it takes for depolarization
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The heart's recovery period after stimulation is called:
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-Refractory phase
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This occurs when excitability is zero and heart tissue cannot be stimulated:
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-Absolute refractory period
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This occurs slightly later in the cycle and excitability is more likely:
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-Relative refractory period
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The heart is completely recovered and completely ready for stimulation:
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-Full excitability
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This diagnostic test is performed to identify different mechanisms of tachydysrhythmias, as well as heart blocks, bradydysrhythmias, and causes of syncope
-Can also be used to identify locations of accessory pathways and to determine the effectiveness of antidysrhythmia drugs -Several electrode catheters are introduced through the femoral vein to the right-side of the heart with fluoroscopic guidance -Electrical stimulation to induce dysrhythmias |
-Electrophysiological study (EPS)
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This diagnostic test is a device that records the ECG while the pt is ambulatory
-Can record heart rhythm for 24-48 hours while the pt performs daily activities -Pt maintains a diary in which activities and any symptoms are recorded -Useful for detecting significant dysrhythmias and evaluating the effects of drugs during a pt's normal activities |
-Holter monitor
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The conduction pathway is the same as that in sinus rhythm but the SA node fires at a rate < 60 bpm:
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-Sinus bradycardia
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Clinical associations with this dysrhythmia can be normal in aerobically trained athletes and in others during sleep; also can occur in the following conditions:
-carotid massage -Valsalva maneuver -hypothermia -increased IOP -increased vagal tone -admin of parasympathomimetic drugs -hypothyroidism -increased ICP -obstructive jaundice -inferior wall MI |
-Sinus bradycardia
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Describe s&s for a patient experiencing bradycardia:
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-pale, cool skin
-hypotension -weakness -angina -dizziness or syncope -confusion or disorientation -shortness of breath |
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Describe treatment for a patient experiencing bradycardia:
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-Atropine
-Pacemaker therapy |
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The conduction pathway is the same as that in normal sinus rhythm; discharge rate from the sinus node is increased as a result of vagal inhibition or sympathetic stimulation; >100bpm:
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-Sinus tachycardia
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Clinical associations with this dysrhythmia include:
-exercise -fever -pain -hypotension -hypovolemia -anemia -hypoxia -hypoglycemia -myocardial ischemia -HF -hyperthyroidism -anxiety -fear -effect of drugs such as epinephrine, norepinephrine, atropine, caffeine, theophylline, nifedipine, hydralazine, pseudoephedrine: |
-Sinus tachycardia
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Describe s&s for a patient experiencing sinus tachycardia:
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-dizziness
-dyspnea -hypotension -increased myocardial consumption -angina -acute MI |
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Describe treatment for a patient experiencing sinus tachycardia:
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-Treatment is based on treating the underlying cause (i.e. treating pain, hypovolemia)
-IV adenosine and B-adrenergic blockers (lopressor) |
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A contraction originating from an ectopic focus in the atrium in a location other than the sinus node; ectopic signal originates in the left or right atrium and travels across the atria by an abnormal pathway, creating a distorted P wave:
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-Premature Atrial Contraction
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Describe s&s for a patient experiencing premature atrial contraction (PAC):
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-Healthy hearts: not significant
-Unhealthy: enhanced automaticity of the atria, or a reentry mechanism; initiate more serious dysarhythmias |
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Describe treatment for a patient experiencing PAC:
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-Withdrawl of stimulation such as caffeine or sympathomimetic drugs
-B-Adrenergic blockers |
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A dysarhythmia originating in an ectopic focus anywhere above the bifurcation of the bundle of His; occurs because of the reentrant phenomenon or the reexcitation of the atria when there is a one-way block; usually triggered by a PAC:
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-Paroxysmal Supraventricular Tachycardia (PSVT)
**Paroxysmal refers to an abrupt onset and termination. Termination is sometimes followed by a brief period of asystole |
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Clincial associations with this dysarhythmia include:
-If normal, healthy heart: overexertion, emotional stress, deep inspiration, and stimulants (caffeine and tobacco) -Rheumatic heart dz -Digitalis toxicity -CAD -Cor pulmonale |
-Paroxysmal Supraventricular Tachycardia (PSVT)
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Describe s&s for a patient experiencing PSVT:
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-Depends on symptoms and HR
-Prolonged episode and HR >180 bpm may precipitate a decreased CO, resulting in hypotension, dyspnea, and angina |
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Describe treatment for a patient experiencing PSVT:
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-Vagal stimulation: valsalva and coughing
-Drug therapy: IV adenosine is the 1st drug of choice to convert PSVT to a normal sinus rhythm (short half-life of 10 sec and well tolerated by most); IV beta-blockers, Ca channel blockers, digitalis, and amiodarone -Cardioversion may be used if drug therapy is not tolerated |
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Describe treatment for a patient experiencing atrial flutter:
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-Primary goal in treatment is to slow the ventricular response by increasing AV block
-Ca channel blockers and beta blockers control ventricular rate -Electrical cardioversion in an emergency situation -Antidysrhythmia drugs to convert to normal sinus rhythm: amiodarone -Radiofrequency catheter ablation is curative therapy -Warfarin is used to prevent CVA in pts with flutter >48hrs |
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An atrial tachydysrhythmia identified by recurring, regular, sawtooth-shaped flutter (F) waves that originate from a single ectopic focus in the right atrium:
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-Atrial flutter
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Clincial associations with this dysrhythmia include:
-Rarely occurs in a normal heart -CAD -HTN -Mitral valve disorders -PE -Chronic lung dz -cor pulmonale -Cardiomyopathy -Hyperthyroidism -Use of drugs: digoxin, quinidine, epinephrine |
-Atrial flutter
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Describe s&s for a patient experiencing atrial flutter:
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-Loss of atrial "kick" results in decrease CO and possibly HF
-Increased risk of CVA b/c of the risk of thrombus formation in the atria from the stasis of blood |
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Characterized by a total disorganization of atrial electrical activity due to multiple ectopic foci resulting in loss of effective atrial contraction; may be chronic or intermittent; most common dysrhythmia in the U.S. especially in the geriatric pop:
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-Atrial fibrillation
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Clincial associations with this dysrhythmia include:
-Usually occurs in the pt with underlying heart dz: CAD, rheumatic heart dz, cardiomyopathy, HTN heart dz, HF, and pericarditis -If acute: thyrotoxicosis, alcohol intoxication, caffeine use, electrolyte disturbances stress, and cardiac sx |
-Atrial fibrillation
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Describe s&s for patient experiencing atrial fibrillation:
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-Decrease in CO from loss of atrial "kick"
-Extremely high risk for stoke |
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Describe treatment for a patient experiencing atrial fibrillation:
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-Goals of treatment include a decrease in ventricular response (to <100) and prevention of cerebral embolic events
-Ventricular rate control is priority by use of Ca channel blockers, beta-blockers, digoxin -Antidysrhythmia drugs (amiodarone, propafenone, flecainide, procainamide, ibutilide) -Cardioversion ->48 hrs, anticogaulation therapy with warfarin for 3-4 weeks b4 any attempt at cardioversion and for 4-6 weeks after successful cardioversion (can cause clots to dislodge) -Long term anticoagulation therapy is required if drugs or cardioversion to do not work - Radiofrequency catheter ablation -Maze procedure: a surgical intervention that stops atrial fibrillation by interrupting the ectopic electrical signals that are responsible for this dysrhythmia |
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Refer to dysrhythmias that originate in the area of the AV node, primarily because the SA node has failed to fire or the signal has been blocked
-AV node becomes the pacemaker of the heart -Impulse from the AV node usually moves in a backward fashion that produces an abnormal P wave occuring just before or after the QRS complex or that is hidden in the QRS complex -Impulse usually moves normally through the ventricles |
-Junctional Dysrhythmias
**Includes: junctional premature, junctional excape rhythm, accelerated juctional rhythm, and junctional tachycardia |
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Describe s&s for a patient experiencing juctional dysrhythmias:
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-Serve as a safety mechanism occurring when the SA node has not been effective
-Escape rhythms should not be suppressed -Accelerated juctional rhythm and juctional tachycardia indicate a more serious problem with the SA node -May result in a reduction of CO causing the pt to become hemodynamically unstable |
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Describe treatment for a patient experiencing juctional dysrhythmias:
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-treatment varies according to the type
-Escape: atropine -Accelerated and tachycardia caused by digoxin toxicit: withheld -In absence of toxicity: beta-blockers and Ca channel blockers and amiodarone can be used -Cardioversion should NOT be used |
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A type of AV block in which every impulse is conducted to the ventricles but the duration of AV conduction is prolonged
-After impulse moves throught the AV node, it is usually conducted normally through the ventricles" |
-1st-degree AV block
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Describe s&s for a pt experiencing 1st-degree AV block:
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-Asymptomatic
-Usually not serious |
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Describe treatment for a pt experiencing 1st-degree AV block:
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-No treatment
-Possibly changing med causatives |
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A type of AV block that includes a gradual lengthening of the PR interval
-Occurs b/c of a prolonged AV conduction time until an atrial impulse is nonconducted and a QRS complex is blocked (missing) -Most commonly occurs in the AV nodes, but can also occur in the His-Purkinje system |
-Type 1, 2nd-degree AV block
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Describe s&s for a pt experiencing type 1, 2nd-degree AV block:
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-Usually a result of myocardial ischemia or MI so is almost always transient and well tolerated
-However, in some pts, it may be a warning signal of a more serious AV conduction disturbance |
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Describe treatment for a pt experiencing a type I, 2nd-degree AV block:
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-Symptomatic: atropine to increase HR, or a temporary pacemaker
-Asymptomatic: closely observe -Bradycardia is most likely to become symptomatic if one or more of the following are present: 1.) hypotension, 2.) HR, or 3.) shock |
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A type of AV block that a P wave is nonconducted wo/ progressive antecedent Pr lengthening
-Occurs when a block is one of the bundle branches is present -Certain number of impulses from the SA node are not conducted to the ventricles (occurs in ratios of 2:1, 3:1, etc in that 2 P waves to 1 QRS complex) -Almost always occurs in the His-Purkinje system |
-Type II, 2nd-degree AV block
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Describe s&s for a pt experiencing type II, 2nd-degree AV block:
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-Often progresses to 3rd-degree AV block and is associated with a poor prognosis
-Reduced HR often results in decreased CO with subsequent hypotension and myocardial ischemia |
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Describe treatment for a pt experiencing type II, 2nd-degree AV block:
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-Permanent pacemaker
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A type of AV block that constitutes once form of AV dissociation in which no impulses from the atria are conducted to the ventricles
-Atria are stimulated and contract independently of the ventricles -Ventricular rhythm is an escape rhythm, and the ectopic pacemaker may be above or below the bifurcation of the bundle of His |
-3rd-degree AV block or Complete heart block
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Describe s&s of a pt experiencing 3rd-degree AV block:
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-Almost always results in reduced CO with subsequent ischemia, HF, and shock
-Syncope may result from severe bradycardia or even periods of asystole |
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Describe treatment for a pt experiencing 3rd-degree AV block:
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-Pacemaker ASAP
-Atropine, epinephrine, isoproterenol, and dopamine is a temporary measure to increase HR and support BP |
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A contraction originating in an ectopic focus in the ventricles
-Premature occurrence of a QRS complex, which is wide and distorted in shape compared with a QRS complex initiated from the normal conduction pathway: |
-Premature Ventricular Contractions (PVC)
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PVCs that are initiated from different foci appear different in shape from each other and are called:
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-Multifocal PVCs
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PVCs that appear to have the same shape are called:
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-Unifocal PVCs
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When EO beat is a PVC, it is called:
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-Ventricular bigeminy
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When every third beat is a PVC, it is called:
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-Ventricular trigeminy
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Two consecutive PVCs are called:
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-couplets
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This phenomenon occurs when a PVC falls on the T wave of a preceding beat:
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-R-on-T phenomenon
**Considered especially dangerous as the PVC is firing during the relative refractoryphase of ventricular repolarization and the risk of the PVC to initiate ventricular tachycardia or ventricular fibrillation is great |
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Describe s&s for a pt experiencing PVC:
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-Usually a benign finding in the pt with a normal heart
-May reduce CO and precipitate angine and HF -Pt's physiological response to PVCs must be monitored -Assess the pt's apical-radial pulse rate as PVCs often do not generate a sufficient ventricular contraction to result in a peripheral pulse and may lead to a pulse deficit |
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Describe treatment for a pt experiencing PVCs:
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-Often based on the cause of PVCs (O2 therapy for hypoxia, etc)
-Drugs therapy: beta-blockers, amiodarone, procainamide, lidocaine |
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When a run of 3 or more PVCs occurs
-Ectopic focus or foci fire repetitively and the ventricle takes control as the pacemaker -Considered to be a life-threatening dysrhythmia |
-Ventricular tachycardia (VT)
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This form of VT has a QRS complexes that are the same in shape, size, and direction:
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-Monomorphic VT
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This form of VT has QRS complexes that gradually change back and forth from one shape, size, and direction to another over a series of beats:
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-Polymorphic VT
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When VT lasts for >30 seconds it is called:
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-Sustained VT
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When VT lasts for <30 seconds it is called:
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-Nonsustained VT
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Describe s&s for a pt experiencing VT:
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-Can be stable (pulse) or unstable (pulseless)
-Sustained VT will cause a severe decrease in CO as a result of decreased ventricular diastolic filling times and loss of atrial contraction resulting in hypotension, pulmonary edema, decreased cerebral blood flow, and cardiopulmonary arrest |
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Describe treatment for a pt experiencing monomorphic VT:
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-If stable (pulse) and preserved left ventricular function: IV procainamide, sotalol, amiodarone, or lidocaine is used
-If unstable (pulseless) or has poor left ventricular function: IV amiodarone or lidocaine is given followed by cadrioversion |
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Describe treatment for a pt experiencing polymorphic VT:
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-With normal baseline QT interval: beta-blockers, lidocaine, amiodarone, procainamide, or sotalol; cardioversion is used if drugs are ineffective
-With prolonged QT interval: IV Mg, isoproterenol, Dilantin, lidocaine, or antitachycardia pacing; cardioversion may be needed |
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Describe treatment for a pt experiencing both VT and V-fib without a pulse:
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-CPR
-Defibrillation -Followed by epinephrine if needed |
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A severe derangement of the heart rhythm characterized on ECG by irregular undulations of varying shapes and amplitude
-Represents the firing of multiple ectopic foci in the ventricle -Ventricle is simply "quivering" and no effective contraction, and consequently no CO, occurs |
-Vetricular Fibrillation
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Represents the total absence of ventricular activity
-Depolarization does not occur -Pt is unresponsive, pulseless, and apneic -Requires immediate treatment -Prognosis is poor |
-Asystole
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Describes a situation in which electrical activity can be observed on the ECG, but there is no mechanical activity of the ventricles and pt has no pulse
-Prognosis is poor unless underlying cause is identified and quickly corrected -Hypovolemia, hypoxia, metabolic acidosis, hyperkalemia, or hypokalemia, hypothermia, drug overdose, cardiac tamponade,MI, tension pneumothorax, PE -CPR followed by intubation and IV therapy with epinephrine and/or atropine |
-Pulseless Electrical Activity
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Refers to death from a cardiac cause:
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-Sudden cardiac death
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Antidysrhythmic drugs may cause life-threatening dysrhythmias similar to those for which they are administered and is termed:
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-Prodysrhythmia
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