Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
165 Cards in this Set
- Front
- Back
|
A normal cardiac impulse begins in the ___ node in the upper ____ _____ (chamber). It spreads over the atrial myocardium via ___-____ pathways (Bachmann's bundle) and ______ pathways, causing ____ contraction. The impulse then travels to the ___ node, through the ______ of _____, and down the left and right ____ ____. It ends in the ____ _____ , which transmit the impulse to the ________.
|
A normal cardiac impulse begins in the SA node in the upper right atrium. It spreads over the atrial myocardium via inter-atrial pathways (Bachmann's bundle) and internodal pathways, causing atrialcontraction. The impulse then travels to the AV node, through the Bundle of His and down the left and right Bundle Branches. It ends in the Purkinje Fibers , which transmit the impulse to the ventricles.
|
|
|
ut the following areas in correct order to sequence the path of the action potential along the conduction system of the heart.
AV node Purkinje fibers Internodal pathways Bundle of His Ventricular cells SA node Right and left atrial cells Right and left bundle branches |
SA node
Internodal pathways Right & Left atrial cells AV node Bundle of His Right & Left Bundle Branches Purkinje Fibers Ventricular Cells |
|
|
The P wave represents....
|
atrial depolarization
|
|
|
QRS complex represents....
|
ventricular depolarization
|
|
|
The upright T wave represents....
|
ventricular repolarization
|
|
|
Where is the atrial repolarization?
|
buried in QRS can't see it
|
|
|
The first phase of the cardiac cycle marks the onset of.....
It is heard as S1/S2, the ___ of the lub-dub. This signifies closure of the ____ and ___ valves (which is what we hear). THe heart sounds are made by pressure gradients of blood which forces the valves shut. Blood volume and pressure are what force the ________ valves shut and pushes the ______ and ____ valves open. |
The first phase of the cardiac cycle marks the onset of ventricular systole.
It is heard as S1, the lub of the lub-dub. This signifies closure of the mitral and tricuspid valves (which is what we hear). The heart sounds are made by pressure gradients of blood which forces the valves shut. Blood volume and pressure are what force the atrioventricular (AV) valves shut and pushes the pulmonic and aortic valves open. |
|
|
The second phase of the cardiac cycle marks the onset of....
It is heard as... It signifies closure of the ____ and ____ valves. The heart sounds are made by pressure gradients of blood which force valves shut (AV valves are pushed open from pressure coming through from atrium on the way to fill the ventricles) |
The second phase of the cardiac cycle marks the onset of ventricular diastole
It is heard as the S2, the dub of the lub dub. It signifies closure of the aortic and pulmonic valves. The heart sounds are made by pressure gradients of blood which force valves shut (AV valves are pushed open from pressure coming through from atrium on the way to fill the ventricles) |
|
|
Extra heart sounds, either S3 or S4 can signify a few things, what are they?
(Know what these might represent) |
S3: Ventricular gallop (↓ compliance LV; seen in CHF; valvular regurgitation; heard after S2)
S4: Atrial gallop (caused by abnormal atrial contraction; heard before S1 of NEXT cycle) |
|
|
The autonomic nervous system plays an important role in the rate of impulse formation, the speed of conduction, and the strength of contraction. What are the components of the autonomic nervous system that affect the heart?
|
vagus nerve fibers of the parasympathetic nervous system and the nerve fibers of the sympathetic nervou system.
|
|
|
Stimulation of the vagus nerve causes a ______ rate of ____ of the ___ node and slowed impulse ____ of the ____ node. Stimulation of the sympathetic nerves increases ___ node firing, ___ node impulse conduction, and cardiac ________.
|
Stimulation of the vagus nerve causes a decreased rate of firing of the SA node and slowed impulse conduction of the AV node. Stimulation of the sympathetic nerves increases SA node firing, AV node impulse conduction, and cardiac contractility.
|
|
|
The membrane of a cardiac cell is semipermeable, allowing it to maintain a high concentration of ____ and a low concentration of _____ inside the cell. The opposite is true outside the cell. The inside of the cell, when at rest, or in the _______ state, is positive/negative compared with the outside. When a cardiac cells are stimulated, each cell membrane changes its pereability and allows _____ to move rapidly into the cell, making the inside of the cell negative/positive compared to the outside; this is known as _______. A faster/slower movement of ions across the membrane restores the cell to the polarized stated, called ______. This describes the cardiac action potential.
|
The membrane of a cardiac cell is semipermeable, allowing it to maintain a high concentration of potassium and a low concentration of sodium inside the cell. The opposite is true outside the cell. The inside of the cell, when at rest, or in the polarized state, is negative compared with the outside. When a cardiac cells are stimulated, each cell membrane changes its permeability and allows sodium to move rapidly into the cell, making the inside of the cell positive compared to the outside; this is known as depolarization. A slower movement of ions across the membrane restores the cell to the polarized stated, called repolarization.
|
|
|
What is the proper location for lead placement of chest electrodes?
|
V1 4th intercostal space at right sternal border
V2 4th intercostal space at left sternal border V3 halfway between V2 and V4 V4 5th intercostal space at left midclavicular line V5 5th intercostal space at left anterior axillary line V6 5th intercostal space at left midaxillary line (Do we need to know this stuff?? also limb leads 1 2 & 3, aVr, aVl, and aVF lewis p. 819....) |
|
|
Antidysrhythmia medications have a direct effect on the various phases of the _____ ______.
|
Antidysrhythmia medications have a direct effect on the various phases of the action potential.
|
|
|
True or False: One or more ECG leads can be used to continuously monitor a patient's ECG. The most common leads selected are leads II, V1, and MCL1.
|
true
|
|
|
ECG paper consists of large (heavy lines) and small (light lines) squares. Each large square incorporates ___ smaller squares, ___ horizontally, and ___ vertically. Each small square represents ____ second(s) and ____ millivolt(s) (mV) vertically. This means that the large square equals ____ second(s) and that ___ large squares equals 1 minute(s). Vertically, one large square is equal to ____ mV.
|
ECG paper consists of large (heavy lines) and small (light lines) squares. Each large square incorporates 25 smaller squares, 5 horizontally, and 5 vertically. Each small square represents 0.4 second and 0.1 millivolt(s) (mV) vertically. This means that the large square equals 0.20 second(s) and that 300 large squares equals 1 minute(s). Vertically, one large square is equal to 0.5 mV.
|
|
|
A(n) ______ is a distortion of the baseline and waveforms seen on the ECG. You will see this on the monitor when leads and electrodes are not secure, or if tere is muscle activity (i.e. shivering), or electrical interference from an outside source. It is difficult to accurately interpret the cardiac rhythm when this is present. What should you do?
|
An artifact is a distortion of the baseline and waveforms seen on the ECG. You will see this on the monitor when leads and electrodes are not secure, or if tere is muscle activity (i.e. shivering), or electrical interference from an outside source. It is difficult to accurately interpret the cardiac rhythm when this is present. You should check for secure connections in the equipment. You may need to replace the electrodes if the conductive gel has dried out.
|
|
|
The ___ wave represents time for the passage of the electrical impulse through the atrium causing atrial depolarization (contraction). It should be ______. The normal duration is ____ to ___ sec. A source of possible variation would be a disturbance in.......
|
The P wave represents time for the passage of the electrical impulse through the atrium causing atrial depolarization (contraction). It should be upright. The normal duration is 0.06 - 0.12 sec. A source of possible variation would be a disturbance in conduction within the atria.
|
|
|
The ___ interval is measured from the beginning of the ___ wave to the beginning of the QRS complex. It represents the time taken for impulse to spread through the atria, AV node and bundle of His, the bundle branches, and the Purkinje fibers, to a point immediately preceding ______ _______. The normal duration is ______ to _____ sec. A source of possible variation include disturbances in conduction usually in the ___ node, bundle of His, or bundle branches, but can be in atria as well.
|
The PR interval is measured from the beginning of the P wave to the beginning of the QRS complex. It represents the time taken for impulse to spread through the atria, AV node and bundle of His, the bundle branches, and the Purkinje fibers, to a point immediately preceding ventricular contraction. The normal duration is 0.12 to 0.20 sec. A source of possible variation include disturbances in conduction usually in the AV node, bundle of His, or bundle branches, but can be in atria as well.
|
|
|
The QRS interval is measured from beginning to end of QRS complex. It represents the time taken for ______ of _____ _____ (systole). What is the normal duration? A source of possible variation would be a disturbance in conduction in....
|
The QRS interval is measured from beginning to end of QRS complex. It represents the time taken for depolarization of both ventricles (systole). Normal duration is <0.12 sec. A source of possible variation would be a disturbance in conduction in the bundle branches or in ventricles.
|
|
|
The ____ segment is measured from the S wave of the QRS complex to the beginning of the T wave and represents the time between ventricular _____ and ______. It should be _____. What is the normal duration? Disturbances usually are caused by _____, ______, or ______.
|
The ST segment is measured from the S wave of the QRS complex to the beginning of the T wave and represents the time between ventricular depolarization and repolarization (diastole). It should be isoelectric (flat). The normal duration is 0.12 sec. Disturbances usually are caused by ischemia, injury, or infarction.
|
|
|
The ___ wave represents time for ventricular repolarization and should be ___. The normal duration is ____ sec. Disturbances are usually caused by _____ imbalances, ischemia, or infarction.
|
The T wave represents time for ventricular repolarization and should be upright. The normal duration is 0.16 sec. Disturbances are usually caused by electrolyte imbalances, ischemia, or infarction.
|
|
|
The QT interval is measured from the beginning/end of the QRS complex to the beginning/end of the T wave. It represents time taken for entire electrical _____ and _____ of the _____. Normal duration is ____ to ____ seconds. Disturbances usually affect repolarization more than depolarization and are caused by drugs, electrolyte imbalances, and changes in heart rate.
|
The QT interval is measured from the beginning of the QRS complex to the end of the T wave. It represents time taken for entire electrical depolarization and repolarization of the ventricles. Normal duration is 0.34 to 0.43 seconds. Disturbances usually affect repolarization more than depolarization and are caused by drugs, electrolyte imbalances, and changes in heart rate.
|
|
|
The QT interval increases/decreases in duration as the heart rate increases/decreases.
|
The QT interval decreases in duration as the heart rate increases.
|
|
|
Intrinsic rates of the conduction system:
SA node AV node Bundle of His, Purkinje fibers |
SA node- 60 - 100 times/min
AV node- 40- 60 times/min Bundle of His, Purkinje fibers- 20-40 times/min |
|
|
Dysrhythmias result from disorders of ____ formation, _____ of impulses, or both.
|
Dysrhythmias result from disorders of impulse formation, conduction of impulses, or both.
|
|
|
An _____ focus or accessory pathway is an area outside the normal conduction pathway and results in a dysrhythmia, which places the normal sinus rhythm.
|
ectopic
|
|
|
In _____ _________, the conduction pathway is the same as that in sinus rhythm but the SA node fires at a rate less than 60 beats per minute. _________ _______ refers to a HR that is less than 60 beats per minute and is inadequate for the patient's condition, causing the patient to experience symptoms such as chest pain and syncope.
|
In sinus bradycardia, the conduction pathway is the same as that in sinus rhythm but the SA node fires at a rate less than 60 beats per minute. Symptomatic bradycardia refers to a HR that is less than 60 beats per minute and is inadequate for the patient's condition, causing the patient to experience symptoms such as chest pain and syncope.
|
|
|
What are some clinical associations for sinus bradycardia?
|
may be normal sinus rhythm in conditioned athletes
may occur for some during sleep Occurs in response to: PNS stimulation (Vagus nerve- cranial nerve 10) corotid sinus massage, Valsalva maneuver, hypothermia, adm. of certain drugs such as beta blockers and CCB's Disease states: hypothyroidism, increased ICP, hypoglycemia, and inferior wall MI |
|
|
The clinical significance of sinus bradycardia depends on how the patient tolerates it hemodynamically. What are some s/s of sinus bradycardia?
|
pale, cool skin
hypotension weakness angina dizziness/syncope confusion/disorientation SOB |
|
|
What is the tx of sinus bradycardia?
|
If patient has symptoms, adm. of atropine (an anticholinergic drug)
Pacemaker therapy may be required. If due to drugs, dose may need to be held, discontinued, or reduced. |
|
|
The conduction pathway is the same in sinus tachycardia as that in normal sinus rhythm. The discharge from the sinus node increases because of _____ inhibition or _____ stimulation. The sinus rate is ____ to _____ beats per minute. It can be caused by sympathomimetics, caffeine, and bronchodilators.
|
The conduction pathway is the same in sinus tachycardia as that in normal sinus rhythm. The discharge from the sinus node increases because of vagal inhibition or sympathetic stimulation. The sinus rate is 101 to 200 beats per minute.
|
|
|
Sinus tachycardia is associated with physiologic and psychologic stressors such as exercise, f_____, pain, hypo______, hypo______, hypo_____, hypo____, a____, myocardial infarction, heart failure, hyper________, anxiety, and fear. It can also be an affect of drugs such as epinephrine, norepinephrine, atropine, caffeine, theophylline, nifedipine (Procardia), or hydralazine. Over the counter cold remedies such as ____ can also cause tachycardia. In compromised patients, sinus tach can lead to myocardial ______ because of decreased ____ filling time.
|
Sinus tachycardia is associated with physiologic and psychologic stressors such as exercise, fever, pain, hypotension, hypovolemia- (blood loss, impending shock), hypoglycemia, hypoxia, anemia, myocardial infarction, heart failure, hyperthyroidism (grave's disease), anxiety, and fear. It can also be an affect of drugs such as epinephrine, norepinephrine, atropine, caffeine, theophylline, nifedipine (Procardia), or hydralazine. Over the counter cold remedies such as pseudoephedrine (Sudafed) can also cause tachycardia. In compromised patients, sinus tach can lead to myocardial ischemia because of decreased diastolic filling time.
|
|
|
The clinical significance of sinus tachycardia depends on how the patient tolerates the increased HR. What are some associated symptoms?
Increased myocardial _____ consumption is associated with an increased HR. Angina or an increase in infarction size may accompany sinus tachycardia in patients with CAD or an acute MI. |
dizziness (due 2 dec. CO)
dyspnea (due 2 dec. CO) hypotension (due 2 dec. CO) Increased myocardial oxygen consumption is associated with an increased HR. Angina or an increase in infarction size may accompany sinus tachycardia in patients with CAD or an acute MI. |
|
|
How is sinus tachycardia treated? (4)
|
The underlying cause of tachycardia guides the treatment.
If due to pain, manage pain. Treating hypovolemia should resolve any associated tachy. In patients who are clinically stable, vagal maneuvers can be attempted. IV beta blockers such as metoprolol can be given to reduce HR and decrease myocardial oxygen consumption. |
|
|
Premature Atrial Contractions are contractions originating from an ____ focus in the ____. The ____ signal originates in the left or right ___ and travels across the atria by an abnormal pathway, creating a ______ ___ wave. At the AV node, it may be ______ (nonconducted PAC), ____ (lengthened ___ interval), or conducted normally. If the signal moves through the ___ node, in most cases it is conducted normally through the ventricles.
|
Premature Atrial Contractions are contractions originating from an ectopic focus in the atrium. The ectopic signal originates in the left or right atrium and travels across the atria by an abnormal pathway, creating a distorted P wave. At the AV node, it may be stopped (nonconducted PAC), delayed (lengthened PR interval), or conducted normally. If the signal moves through the AV node, in most cases it is conducted normally through the ventricles.
|
|
|
In a normal heart, a PAC can result from....
It can also result from h_____, e_______ i_______, and disease states such as hyper________, ______, and heart disease such as _____ and valvular disease. |
In a normal heart, a PAC can result from emotional stress, physical fatigue, or use of caffeine, tobacco, or alchol.
It can also result from hypoxia, electrolyte imbalances, and disease states such as hyperthyroidism, COPD, and heart disease such as CAD and valvular disease. |
|
|
True or False: In patient's with healthy hearts, isolated PACs are not significant. They may report palpiations or a sense that their hearts "skipped a beat."
|
true
|
|
|
In persons with heart disease, PACs may indicate enhanced _______ of the atria, or a ____ mechanism. Such PACS may warn of or initiate more serious _______ such as _______ tachycardia.
|
In persons with heart disease, PACs may indicate enhanced automaticity of the atria, or a reentry mechanism. Such PACS may warn of or initiate more serious dysrhythmias such as supraventricular tachycardia.
|
|
|
Treatment of PACs depends on the patient's symptoms. What might be included?
|
Withdrawal of sources of stimulation such as caffeine or sympathomimetic drugs may be warranted. Beta blockers may be used to decrease PACs
|
|
|
Paroxysmal Supraventricular Tachycardia (PSVT) is a dysrhythmia originating in an ectopic focus anywhere above/below the bifurcation of the _____ ____ _____. Identification of the ectopic focus is often difficult even with a 12-lead ECG as it requires recording the dysrhythmia as it is initiated.
|
Paroxysmal Supraventricular Tachycardia (PSVT) is a dysrhythmia originating in an ectopic focus anywhere above the bifurcation of the bundle of His. Identification of the ectopic focus is often difficult even with a 12-lead ECG as it requires recording the dysrhythmia as it is initiated.
|
|
|
True or False: PSVT occurs because of a reexit phenomenon.
|
FALSE!
PSVT occurs because of a reentrant phenomenon (reexcitation of the atria when there is a one-way block). |
|
|
PSVT occurs because of a reentrant phenomenon (reexcitation of the atria when there is a one-way block). Usually a ___ triggers a run of repeated premature beats. Paroxysmal refers to an ____ onset and termination. Termination is sometimes followed by a brief period of ____ (absence of all cardiac electrical activity). Some degree of AV ____ may be present. PSVT can occur in the presence of _____ syndrome, or "______." In this syndrome, there are extra conduction or accessory pathways.
|
PSVT occurs because of a reentrant phenomenon (reexcitation of the atria when there is a one-way block). Usually a PAC triggers a run of repeated premature beats. Paroxysmal refers to an abrupt onset and termination (back to normal sinus rhythm). Termination is sometimes followed by a brief period of asystole (absence of all cardiac electrical activity). Some degree of AV block may be present. PSVT can occur in the presence of Wolff-Parkinson-White (WPW) syndrome, or "preexcitation." In this syndrome, there are extra conduction or accessory pathways.
|
|
|
What are some clinical associations of PSVT?
4 triggers for a normal heart 4 disease states |
In normal heart- overexertion, emotion stress, deep inspiration, stimulants- tobacco, caffeine
Also associated with rheumatic heart disease, digitalis toxicity, CAD, and cor pulmonale |
|
|
The clinical significance of PSVT depends on the associated symptoms. A prolonged episode and HR greater than ____ beats per minute may precipitate a decreased CO due to reduced stroke volume. Symptoms may include: (3)
|
The clinical significance of PSVT depends on the associated symptoms. A prolonged episode and HR greater than 180 beats per minute may precipitate a decreased CO due to reduced stroke volume. Symptoms may include: angina, hypotension, dyspnea
|
|
|
How is PSVT treated?
What is the 1st drug of choice? If the first two options fail, what do you try? |
vagal stimulation and drug therapy. (Common vagal maneuvers include Valsalva and coughing)
IV adenosine (Adenocard) is the first drug of choice to convert PSVT to a normal rhythm. This drug has a short half life (10 seconds) and is usually well tolerated but patient needs to be closely monitored. IV beta blockers (sotalol (Betapace)) , CCB's (Cardizem) which decrease heart rate, and amiodarone (Cararone) can also be used. If vagal stimulation and drug therapy are ineffective and patient becomes hemodynamically unstable, direct current (DC) cardioversion is used. Radiofrequency catheter ablation therapy can also be used. |
|
|
adenosine (Adenocard) is administered at what rate and followed by what?
Monitor what? A ____ period of asystole is common/uncommon. Observe patient for f____ing, ____ness, ___ pain, or p_______. |
adenosine (Adenocard) is administered rapidly- over 1 to 2 seconds. It is followed by a rapid NS flush.
Monitor ECG continuously. A brief period of asystole is common. Observe patient for flushing, dizziness, chest pain, or palpitations. |
|
|
_____ _____ is an atrial tachydysrhythmia identified by recurring, regular, sawtooth-shaped waves that originate from a ______ ectopic focus in the _____ atrium or less commonly, in the ____ atrium.
|
Atrial flutter is an atrial tachydysrhythmia identified by recurring, regular, sawtooth-shaped waves that originate from a single ectopic focus in the right atrium or less commonly, in the left atrium.
|
|
|
True or False: Atrial flutter often occurs in a healthy heart.
True or False: Atrial flutter is usually regular, in contrast to A fib |
False. Atrial flutter rarely occurs in a healthy heart.
True. (Pt may go back and forth between a. flutter, a. fib, normal sinus, etc. ) |
|
|
Atrial flutter is associated with disease states such as....
and can be caused by what 3 drugs (examples)? |
CAD
HTN mitral valve d/o's PE chronic lung disease cor pulmonale cardiomyopathy hyperthyroidism digoxin quinidine epinephrine |
|
|
Patients with atrial flutter can experience serious consequences. The high/low ventricular/atrial rate and loss of the atrial "_____" that are associated with atrial flutter decrease the c_____ o_____ and can cause ____ _____ especially in the patient with underlying heart disease. These patients are at increased risk of ____ because of the thrombus formation in the atria from the stasis of blood. _____ is given to prevent this.
|
Patients with atrial flutter can experience serious consequences. The high ventricular rate and loss of the atrial "kick" that are associated with atrial flutter decrease the cardiac output and can cause heart failure especially in the patient with underlying heart disease. These patients are at increased risk of stroke because of the thrombus formation in the atria from the stasis of blood. Coumadin (warfarin) is given to prevent this.
|
|
|
The primary goal in treatment of atrial flutter is to ___ the ventricular response by _____ing AV block. Drugs that can control ventricular rate include what two classifications? _____ _____ may be performed to convert atrial flutter to sinus rhythm in an emergency if patient is hemodynamically unstable and electively. Antidysrhythmia drugs used to convert atrial flutter into sinus rhythm or to maintain sinus rhythm include amiodarone, propafenone (Rhythmol), ibutilide (Corvert) and flecainide (Tambocor). Dronedarone (Multaq) is used in atrial flutter for patients whose hearts have returned to normal rhythm or for those who will undergo drug or electric shock treatment to restore a normal heartbeat.
|
The primary goal in treatment of atrial flutter is to slow the ventricular response by increasing AV block. Drugs that can control ventricular rate include Beta Blockers and CCBs. Electrical cardioversion may be performed to convert atrial flutter to sinus rhythm in an emergency if patient is hemodynamically unstable and electively. Antidysrhythmia drugs used to convert atrial flutter into sinus rhythm or to maintain sinus rhythm include amiodarone, propafenone (Rhythmol), ibutilide (Corvert) and flecainide (Tambocor). Dronedarone (Multaq) is used in atrial flutter for patients whose hearts have returned to normal rhythm or for those who will undergo drug or electric shock treatment to restore a normal heartbeat.
|
|
|
What is the tx of choice for atrial flutter?
|
Radiofrequency catheter ablation, a procedure done in the electrophysiology lab and involves positioning a catheter in the right atrium between the inferior vena cava and tricuspid valve. Using a low-voltage, high-frequency form of electrical energy, the tissue is ablated (or destroyed), the dysrhythmia is terminated, and normal sinus rhythm is restored.
|
|
|
___ _______is characterized by a total disorientation of atrial electrical activity due to _____ ectopic foci resulting in loss of effective atrial contraction. Atrial fib is regularly/ irregularly irregular.
|
Atrial fibrillation is characterized by a total disorientation of atrial electrical activity due to multiple ectopic foci resulting in loss of effective atrial contraction. Atrial fib is irregularly irregular.
|
|
|
Atrial fibrillation may be _____ (begins and end spontaneously) or persistent (lasting > __ days) It is the least/most common, clinically significant dysrhythmia with respect to morbidity rate, mortality rate, and economic impact. It occurs in approximately 3% of people over age 65 and prevalence increases with age.
|
Atrial fibrillation may be paroxysmal (begins and end spontaneously) or persistent (lasting > 7 days) It is the most common, clinically significant dysrhythmia with respect to morbidity rate, mortality rate, and economic impact. It occurs in approximately 3% of people over age 65 and prevalence increases with age.
|
|
|
Atrial fibrillation usually occurs in the patient with underlying heart disease, such as CAD, rheumatic heart disease, cardiomyopathy, hypertensive heart disease, HF, and pericarditis. It often develops acutely with thyrotoxicosis, ______ intoxication, use of ______, ________ disturbance, st___, and cardiac _____ such as CABG.
|
Atrial fibrillation usually occurs in the patient with underlying heart disease, such as CAD, rheumatic heart disease, cardiomyopathy, hypertensive heart disease, HF, and pericarditis. It often develops acutely with thyrotoxicosis, alcohol intoxication, use of caffeine, electrolyte disturbance, stress, and cardiac surgery such as CABG.
|
|
|
Atrial fibrillation results in a decrease in ___ ____ because of ineffective _____ contractions, loss of ____ ___, and/or a rapid ____ _____. _____ form in the atria because of blood stasis. An embolized clot may develop and pass to the ____, causing a stroke. Atrial fibrillation accounts for as many as 20% if all strokes.
|
Atrial fibrillation results in a decrease in cardiac output because of ineffective atrial contractions, loss of atrial kick, and/or a rapid ventricular response. Thrombi (clots) form in the atria because of blood stasis. An embolized clot may develop and pass to the brain, causing a stroke. Atrial fibrillation accounts for as many as 20% if all strokes. (No atrial depolarization, atrial systole contributes 30% of cardiac output, loss of "atrial kick" loses this contribution to cardiac output)
|
|
|
What is the goal of treatment of Afib? (3 main goals)
Doctor may order what test for a patient with new onset A fib? |
decrease in ventricular response to less than 100 beats/min, prevention of cerebral embolic events, and conversion to sinus rhythm if possible.
Thyroid studies: T3, T4, TSH etc. because thyroid disorders and a fib go hand and hand. |
|
|
Ventricular rate control is a priority for patients with A fib. Drugs used for rate control include.... what main 4?
|
CCB's -- diltiazem
Beta Blockers- metoprolol digoxin dronedarone (Multaq) |
|
|
For some patients, pharmacologic or electrical ____of atrial fibrillation to normal sinus rhythm may be a consideration (e.g. reduced exercise tolerance with rate control drugs or contraindications to warfarin). The most common antidysrhythmia drugs used for conversion to and maintenance of sinus rhythm include ____ and ____.
|
For some patients, pharmacologic or electrical cardioversion of atrial fibrillation to normal sinus rhythm may be a consideration (e.g. reduced exercise tolerance with rate control drugs or contraindications to warfarin). The most common antidysrhythmia drugs used for conversion to and maintenance of sinus rhythm include amiodarone and ibutilide.
|
|
|
Electrical cardioversion may convert atrial fib. to a normal sinus rhythm. If a fib persists longer than __ hours, ____ therapy with ___ is needed for ____ weeks before the cardioversion and for ____ weeks after the successful cardioversion. This is necessary because the cardioversion procedure can cause the clots to dislodge, thus placing the patient at risk for stroke.
|
Electrical cardioversion may convert atrial fib. to a normal sinus rhythm. If a fib persists longer than 48 hours, anticoagulant therapy with Coumadin is needed for 3 weeks before the cardioversion and for 4 weeks after the successful cardioversion. This is necessary because the cardioversion procedure can cause the clots to dislodge, thus placing the patient at risk for stroke. A TEE may be performed in order to rule out the presence of clots in the atria. If there are no clots present, anticoagluation therapy is not required before the cardioversion procedure.
|
|
|
If drugs or cardioversion do not convert A fib to normal sinus rhythm, long-term ______ therapy is required. What is the drug of choice for this? What lab monitors this? _____ is used in patients who are considered at low risk for embolic strokes.
|
If drugs or cardioversion do not convert A fib to normal sinus rhythm, long-term anticoagulation therapy is required.
The drug of choice is warfarin (Coumadin) and patients are monitored for therapeutic levels with INR. Aspirin is used in patients who are considered at low risk for embolic strokes. |
|
|
For patients with drug-refractory atril fib. or who don't respond to electrical conversion, radiofrequency catheter ______ (similar to procedure for atrial flutter) and the ____ procedure are further options. The ____ procedure is a surgical intervention that stops a fib by interrupting the ectopic electrical signals that are responsible for this dysrhythmia. Incisions are made in both atria and cryoblation (____ therapy) is used to stop the formation and conduction of these signals and restores normal sinus rhythm.
|
For patients with drug-refractory atril fib. or who don't respond to electrical conversion, radiofrequency catheter ablation (similar to procedure for atrial flutter) and the Maze procedure are further options. The Maze procedure is a surgical intervention that stops a fib by interrupting the ectopic electrical signals that are responsible for this dysrhythmia. Incisions are made in both atria and cryablation (cold therapy) is used to stop the formation and conduction of these signals and restores normal sinus rhythm.
|
|
|
What are some moderate risk factors for stroke for people with atrial fibrillation ?
|
Heart failure
EF of LV 35% or less HTN Age of 75 or older DM (HE HAD moderate risk factors) |
|
|
What are some high risk factors for stroke for people with atrial fibrillation ?
|
Previous stroke, TIA, or embolism
Mitral stenosis Prosthetic heart valve |
|
|
If someone has a fib and has no risk factors, what drug at what dose is given to prevent thrombi and stroke?
|
aspirin 81-325 mg daily
|
|
|
If someone has a fib and has one moderate- risk factor, what drug at what dose is given to prevent thrombi and stroke?
|
aspirin 81-325 mg daily
or warfarin (INR 2.0 - 3.0) |
|
|
If someone has a fib and has more than one moderate- risk factor or any high-risk factor, what drug at what dose is given to prevent thrombi and stroke?
|
warfarin (INR 2.0 - 3.0)
|
|
|
For prosthetic valves, target INR is..
|
2.5- 3.5
|
|
|
If not taking anticoagulants (anybody else), what is the normal value? What is the normal INR, for someone on anticoagulant therapy?
If they had a heart valve replacement, which tends to clot more, what is the normal value? |
1.3 - 2.0
2.0 - 3.0 2.5 - 3.5 |
|
|
A first-degree AV block is a type of AV block in which every impulse is conducted to the _______ but the duration of AV conduction is ______. After the impulse moves through the __ node, the ventricles usually respond abnormally/normally.
|
A first-degree AV block is a type of AV block in which every impulse is conducted to the ventricles but the duration of AV conduction is prolonged. After the impulse moves through the AV node, the ventricles usually respond normally.
|
|
|
First Degree AV block is associated with ___, ____, _____fever, hyper______, ____ stimulation, and drugs such as d____, ____ blockers, ___ ____ blockers, and flecainide
|
First Degree AV block is associated with MI, CAD, rheumatic fever, hyperthyroid, , vagal stimulation, and drugs such as digoxin, beta blockers, CCB's, and flecainide..
|
|
|
True or False: First degree AV block is a very serious condition.
What are the clinical manifestation of first degree AV block? What drugs can cause it? |
False, usually not serious but can be a precursor of higher degrees of AV block.
None, asymptomatic. Regular rate & rhythm digoxin delays conduction thru av node... treats tachy dysrhythmias and can cause heart block. Beta blockers and calcium channel blockers can also be culprit. |
|
|
What is the tx for first degree AV block?
|
There is no tx for first-degree AV block. Modifications to potentially causative medications may be considered. You should monitor patients for any new changes in heart rhythm, such as a more serious AV block.
|
|
|
A premature ventricular contraction (PVC) is a contraction originating from where? It is the premature occurrence of a ___ ____, which is wide and distorted in shape compared with one initiated from the normal conduction pathway. PVCs that arise from different foci appear different in shape from each other and are called _______ PVCs. PVCs that have the same shape are called _____ PVCs. When every other beat is a PVC, the rhythm is called venticular _______. When every third beat is a PVC, it is called ventricular ______. Two consecutive PVCs are called a ____.
|
A premature ventricular contraction (PVC) is a contraction originating from an ectopic focus in the ventricles. It is the premature occurrence of a QRS complex, which is wide and distorted in shape compared with one initiated from the normal conduction pathway. PVCs that arise from different foci appear different in shape from each other and are called multifocal PVCs. PVCs that have the same shape are called unifocal PVCs. When every other beat is a PVC, the rhythm is called ventricular. When every third beat is a PVC, it is called ventricular trigeminy. Two consecutive PVCs are called a couplet.
|
|
|
______ _______ occurs when there are THREE or more PVCS.
|
Ventricular tachycardia occurs when there are THREE or more PVCS.
|
|
|
What is R on T phenomenon? Why is it significant?
|
R on T occurs when a PVC falls on the T wave of a preceding beat. This is especially dangerous because the PVC is firing during the relative refractory phase of ventricular repolarization. Excitability of the cardiac cells increases during this time, and the risk for the PVC to initiate Ventricular tachycardia or ventricular fibrillation is great.
|
|
|
PVCs are associated with medications such as aminophylline, epinephrine, isoproterenol, and digoxin. What are some other clinical associations for PVCs?
Disease states? |
PVCs are associated with stimulants such as caffeine, alcohol, nicotine, They are also associated with electrolyte imbalances such as hypokalemia, hypoxia, fever, exercise, and emotional stress.
Disease states associated with PVCs include MI, mitral valve prolapse, HF, and CAD. |
|
|
PVCs are usually a benign finding in a patient with a ____ _____.
|
normal heart
|
|
|
PVCs may reduce ____ ____ and precipitate ____ and ___ ___ depending on frequency. Because PVCs in CAD or acute MI indicate atrial/ventricular irritability, the patient's physiological re_____ to PVCs must be closely monitored. What is another important thing to monitor in a patient with PVCs?
|
PVCs may reduce cardiac output and precipitate angina and heart failure depending on the frequency. Because PVCs in CAD or acute MI indicate ventricular irritability, the patient's physiological response to PVCs must be closely monitored.
It is important to assess the patient's apical-radial pulse rate as PVCs often do not generate a sufficient ventricular contraction to result in a peripheral pulse. This may lead to a pulse deficit. |
|
|
Treatment for PVCs relates to the ___ of the PVCs such as treating ______ with oxygen or replacing ______. Assessment of the patient's hemodynamic status is important to determine if treatment with drug therapy is needed. Drug therapy includes what 4 drugs? (one class, 3 specifics)
|
Treatment for PVCs relates to the cause of the PVCs such as treating hypoxia with oxygen or replacing electrolytes. Assessment of the patient's hemodynamic status is important to determine if treatment with drug therapy is needed. Drug therapy includes beta blockers, procainamide, amiodarone, or lidocaine (Xylocaine)
|
|
|
A run of three or more PVCs defines ventricular tachycardia (VT). It occurs when an ectopic focus or foci fire repetitively and the ______ takes control as the ______. Different forms of VT exist, depending on QRS configuration. ________ VT has QRS complexes that are the same in shape, size, and direction. ______ VT occurs when the QRS complexes gradually change back and forth from one shape, size, and direction to another over a series of beats. Torsades de pointes (French for "twisting of the points") is polymorphic VT associated with a prolonged QT interval of the underlying rhythm.
|
A run of three or more PVCs defines ventricular tachycardia (VT). It occurs when an ectopic focus or foci fire repetitively and the ventricle takes control as the pacemaker. Different forms of VT exist, depending on QRS configuration. Monomorphic VT has QRS complexes that are the same in shape, size, and direction. Polymorphic VT occurs when the QRS complexes gradually change back and forth from one shape, size, and direction to another over a series of beats. Torsades de pointes (French for "twisting of the points") is polymorphic VT associated with a prolonged QT interval of the underlying rhythm.
|
|
|
Ventricular Tachycardia (VT) may be sustained (longer than ____ seconds) or nonsustained (less than ____ seconds).
|
Ventricular Tachycardia (VT) may be sustained (longer than 30 seconds) or nonsustained (less than 30 seconds).
|
|
|
True or False: The development of VT is an ominous sign. It is a life-threatening dysrhythmia because of decreased CO and the possibility of development of ventricular fibrillation, which is a lethal dysrhythmia.
|
true
|
|
|
VT is associated with M_, C__, significant _______ imbalances especially _______, cardio______, mitral valve ______, long ____ syndrome, drug toxicity such as ______, and ______ _____ system disorders. Can it be seen in patients who don't have heart disease?
|
VT is associated with MI,CAD, significant electrolyte imbalances (especially potassium), cardiomyopathy, mitral valve prolapse, long QT syndrome, drug toxicity such as digoxin, and central nervous system disorders. VT can be seen in patients who have no evidence of cardiac disease.
|
|
|
Patient can be stable, where patient has a _____ or unstable, where patient has no ______. Sustained VT causes a severe decrease in ____ ____ because of decreased ventricular diastolic filling times and loss of ____ contraction. This results in hypo______, pulmonary ______, decreased _______ blood flow, and cardiopulmonary ______. The dysrhythmia must be treated quickly, even if it occurs only briefly and stops abruptly. Episodes may recur if prophylactic tx is not started. V Fib can also develop.
|
Patient can be stable, where patient has a pulse or unstable, where patient has no pulse (pulseless). Sustained VT causes a severe decrease in cardiac output because of decreased ventricular diastolic filling times and loss of atrial contraction. This results in hypotension, pulmonary edema, decreased cerebral blood flow, and cardiopulmonary arrest. The dysrhythmia must be treated quickly, even if it occurs only briefly and stops abruptly.
|
|
|
In treating Ventricular Tachycardia (VT), precipitating causes must be identified and treated, such as electrolyte imbalances and ischemia. If the VT is monomorphic and the patient is hemodynamically stable (has a pulse) and has preserved left ventricular function, IV _____, ____, ____, or ____ is used.
|
In treating Ventricular Tachycardia (VT), precipitating causes must be identified and treated, such as electrolyte imbalances and ischemia. If the VT is monomorphic and the patient is hemodynamically stable (has a pulse) and has preserved left ventricular function, IV procainamide, sotalol, amiodarone, or lidocaine is used.
|
|
|
If the patient in VT becomes hemodynamically unstable or has poor left ventricular function, IV ____ or _____ is given followed by _____.
|
If the patient in VT becomes hemodynamically unstable or has poor left ventricular function, IV amiodarone or lidocaine is given followed by cardioversion.
|
|
|
If the VT is polymorphic with a normal baseline QT interval, any one of the following medications is used: Beta blockers, lidocaine, amiodarone, procainamide, or sotalol. ______ is used if drug therapy is ineffective. If the VT is polymorphic with a baseline QT interval that is prolonged, therapies include IV magnesium, isoproterenol, phenytoin (Dilantin) lidocaine, or antitachycardia pacing. Drugs that prolong the ___ interval such as dofetilide (Tikosyn) should be discontinued. If the rhythm is not converted, cardioversion may be needed.
|
If the VT is polymorphic with a normal baseline QT interval, any one of the following medications is used: Beta blockers, lidocaine, amiodarone, procainamide, or sotalol. cardioversion is used if drug therapy is ineffective. If the VT is polymorphic with a baseline QT interval that is prolonged, therapies include IV magnesium, isoproterenol, phenytoin (Dilantin) lidocaine, or antitachycardia pacing. Drugs that prolong the QT interval such as dofetilide (Tikosyn) should be discontinued. If the rhythm is not converted, cardioversion may be needed. (YEAH whatever!)
|
|
|
VT without a ___ is a life-threatening situation and is treated in the same manner as ventricular fibrillation. ____ and rapid ______ are the first lines of treatment, followed by administration of vasopressors such as ________ and antidysrhythmics such as _____ if defibrillation is unsuccessful.
|
VT without a pulse is a life-threatening situation and is treated in the same manner as ventricular defibrillation. CPR and rapid defibrillation are the first lines of treatment, followed by administration of vasopressors such as epinephrine and antidysrhythmics such as amiodarone if defibrillation is unsuccessful.
|
|
|
An accelerated idoventricular rhythm (AIVR) can develop when the intrinsic pacemaker rate (SA node or AV node) becomes less than that of a ventricular ectopic pacemaker. The rate is between ____ and ____ beats per minute. It is most commonly associated with an acute MI and reperfusion of the myocardium after _______ therapy or angioplasty of the coronary arteries. It can also be seen with ____ toxicity. In the setting of an acute MI, AIVR is usually self-limiting and well tolerated, and requires no treatment. If the patient becomes symptomatic (angina, hypotension), ______ can be considered. Temporary ____ing may be required. Drugs that suppress ventricular rhythms such as ______ should/shouldn't be used as these can terminate the ventricular rhythm and further reduce the HR.
|
An accelerated idoventricular rhythm (AIVR) can develop when the intrinsic pacemaker rate (SA node or AV node) becomes less than that of a ventricular ectopic pacemaker. The rate is between 40 and 100 beats per minute. It is most commonly associated with an acute MI and reperfusion of the myocardium after fibrinolytic therapy or angioplasty of the coronary arteries. It can also be seen with digitalis or digoxin toxicity. In the setting of an acute MI, AIVR is usually self-limiting and well tolerated, and requires no treatment. If the patient becomes symptomatic (angina, hypotension), atropine can be considered. Temporary pacing may be required. Drugs that suppress ventricular rhythms such as amiodarone shouldn't be used as these can terminate the ventricular rhythm and further reduce the HR.
|
|
|
Ventricular Fibrillation (VF) is a severe derangement of the heart rhythm characterized by irregular waveforms of varying shapes and amplitudes. This represents the firing of a single/multiple ectopic foci in the ____. Mechanically, the ventricle is simply "quivering" with no effective ________, and consequently no ___ ___ occurs. VF is a lethal dysrhythmia.
|
Ventricular Fibrillation (VF) is a severe derangement of the heart rhythm characterized by irregular waveforms of varying shapes and amplitudes. This represents the firing of multiple ectopic foci in the ventricle. Mechanically, the ventricle is simply "quivering" with no effective contraction,, and consequently no cardiac output (CO) occurs. VF is a lethal dysrhythmia.
|
|
|
VF can occur in an acute MI and myocardial ischemia and in chronic diseases such as HF and cardiomyopathy. It may occur during cardiac pacing or cardiac catheterization procedures because of catheter ______ of the ventricle. It may also occur with coronary re_______ after fibrinolytic therapy. Other clinical associations are accidental ____ _____, hyper______, hypo_____, acidosis/alkalosis, and drug ____.
|
VF can occur in an acute MI and myocardial ischemia and in chronic diseases such as HF and cardiomyopathy. It may occur during cardiac pacing or cardiac catheterization procedures because of catheter stimulaion of the ventricle. It may also occur with coronary reperfusion after fibrinolytic therapy. Other clinical associations are accidental electric shock, hyperkalemia, hypoxemia, acidosis, and drug toxicity.
|
|
|
Ventricular Fibrillation results in an un________, pulse____, and a____ state. If not rapidly treated, the patient will die.
|
Ventricular Fibrillation results in an unresponsive, pulseless, and apneic state. If not rapidly treated, the patient will die.
|
|
|
Treatment of V Fib consists of immediate initiation of CPR and BLS/ACLS measures with the use of _____ and definitive drug therapy. If a defibrillator is immediately available, there should be absolutely no ____ in using it.
|
Treatment of V Fib consists of immediate initiation of CPR and ACLS measures with the use of defibrillation and definitive drug therapy. If a defibrillator is immediately available, there should be absolutely no delay in using it.
|
|
|
HR is less than 60 beats per minute and rhythm is regular. The P wave precedes each QRS complex and has a normal shape and duration. The PR interval is normal, and the QRS complex has a normal shape and duration. What is the name of this rhythm?
|
sinus bradycardia
|
|
|
Atrial rate is 200 to 350 beats per minute. Atrial rhythm is regular, and ventricular rhythm is usually regular. The PR interval is variable and not measurable. The QRS complex is usually normal. It is identified by recurring, regular, sawtooth-shaped waves. What is the name of this rhythm?
|
Atrial Flutter, an atrial tachydysrhtyhmia identified by recurring, regular, sawtooth-shaped flutter waves that originate from a single ectopic focus, usually in the right atrium. Because the AV node can delay signals from the atria, there is usually some AV block in a fixed ratio of flutter waves to QRS complexes (e.g. 2:1, 3:1)
|
|
|
Contraction originating from an ectopic focus in atrium. Rhythm is irregular. P wave has a different shape from that of the P wave originating from the SA node. It may be notched or have downward (or negative) deflection, or it may be hidden in the preceding T wave. The PR interval may be shorter or longer than the PR interval originating from the SA node, but it is within normal limits. If the QRS interval is greater than or equal to 0.12 seconds, abnormal conduction through the ventricles is present. What is the name of this rhythm?
|
PAC- Premature atrial contraction
|
|
|
HR is 150 to 220 beats per minute. The rhythm is regular or slightly irregular. The P wave is often hidden in the preceding T wave, but if seen, it may have an abnormal shape. The PR interval may be shortened or normal and the QRS complex is usually normal. It usually is triggered by a run of PACs. What is the name of this rhythm?
|
PSVT- Paroxysmal Supraventricular Tachycardia
|
|
|
HR is 101 to 200 and rhythm is regular. The P wave is normal, precedes each QRS complex, and has a normal shape and duration. The PR interval is normal, and the QRS complex has a normal shape and duration. What is the name of this rhythm?
|
Sinus tachycardia
|
|
|
Atrial rate can be as high as 350 to 500 beats per minute. P waves are replaced by chaotic, fibrillatory waves. Ventricular rate varies and the rhythm is usually irregular. The PR interval is not measurable, and the QRS complex usually has a normal shape and duration. What is the name of this rhythm?
|
atrial fibrillation
|
|
|
True or False: At times, atrial flutter and atrial fibrillation may coexist.
|
true
|
|
|
If atrial fibrillation is accompanied by a ventricular rate between 60 and 100, it is atrial fib with a _______ ventricular response. If atrial fibrillation is accompanied by a ventricular rate greater than 100 beats per minute, it is atrial fib with a _______ ventricular response. If atrial fibrillation is accompanied by a ventricular rate less than 60 beats per minute, it is atrial fib with a _______ ventricular response.
|
If atrial fibrillation is accompanied by a ventricular rate between 60 and 100, it is atrial fib with a controlled ventricular response. If atrial fibrillation is accompanied by a ventricular rate greater than 100 beats per minute, it is atrial fib with a rapid ventricular response. If atrial fibrillation is accompanied by a ventricular rate less than 60 beats per minute, it is atrial fib with a slow ventricular response.
|
|
|
HR is normal and and rhythm is regular. The P wave is normal, the PR interval is prolonged (greater than 0.20 second), and the QRS complex usually has a normal shape and duration. What is this rhythm?
|
First-degree AV block
|
|
|
Ventricular rate is 150 to 250 beats per minute. Rhythm may be regular or irregular. AV disassociation may be present, with P waves occurring independently of the QRS complex (P waves not usually seen). The atria may be depolarized by the ventricles in a retrograde fashion. The P wave is usually buried in the QRS complex. What is this rhythm?
|
ventricular tachycardia
|
|
|
Irregular rhythm. P wave is rarely visible and is usually lost on QRS complex. PR interval is not measurable. QRS complex is wide and distorted in shape, lasting more than 0.12 second. The T wave is generally large and opposite in direction to the major direction of the QRS complex. What is this rhythm?
|
PVC- the premature occurrence of a QRS complex, which is wide and distorted in shape compared with one initiated from normal conduction pathway.
|
|
|
HR is not measurable. Rhythm irregular and chaotic. P wave not visible, PR interval and QRS interval are not measurable. What is this rhythm?
|
ventricular fibrillation
|
|
|
Does the ECG tell you anything about the heart's mechanical function?
|
no
|
|
|
On an ECG, the horizontal lines represent _____. Vertical lines represent ______. Each little box is _____seconds, x ___ boxes = ____seconds per large box
vertical boxes represent amplitude in millavolts (mV) |
On an ECG, the horizontal lines represent time. Vertical lines represent millivolts (mV). Each little box is 0.04 seconds, x 5 boxes = 0.20 seconds per large box
vertical boxes represent amplitude in millavolts (mV) |
|
|
How do you calculate the rate of an EKG strip if you don't already know it? What is an important implication that determines whether this can be done?
|
Quick method: (not as accurate)
Markers appear q 3 seconds on ECG paper. Count the number of R-R intervals in 6 seconds. Multiply by 10. More accurate method: Count the # of SMALL squares between one R-R interval. Divide this number into 1500 to get heart rate. or Count the number of large squares between one R-R interval. Divide this number into 300. It has to be regular! |
|
|
The term Sudden Cardiac Death (SCD) refers to death from a cardiac cause. The majority of SCDs result from _______ dysrhythmias, specifically ____ ____ and ____ ___.
|
The term Sudden Cardiac Death (SCD) refers to death from a cardiac cause. The majority of SCDs result from ventricular dysrhythmias, specifically ventricular tachycardia and ventricular fibrillation.
|
|
|
People who survive an episode of SCD generally require a diagnostic workup to determine whether they have had an MI. Thus serial analysis of cardiac markers and ECGs are done. Because most people with SCD have ____, cardiac ______ is indicated to determine the possible location and extent of coronary artery occlusion. PCI or ___ surgery may be indicated. Most SCD patients have a lethal ventricular dysrhythmia that is associated with a low/high incidence of recurrence. Thus, it is useful to know when those persons are most likely to have a recurrence and what drug therapy is the most effective treatment. What kinds of tests are done?
|
People who survive an episode of SCD generally require a diagnostic workup to determine whether they have had an MI. Thus serial analysis of cardiac markers and ECGs are done. Because most people with SCD have CAD, cardiac catherization is indicated to determine the possible location and extent of coronary artery occlusion. PCI or CABG surgery may be indicated. Most SCD patients have a lethal ventricular dysrhythmia that is associated with a high incidence of recurrence. Thus, it is useful to know when those persons are most likely to have a recurrence and what drug therapy is the most effective treatment.
*24 h Holter monitoring or other type of event recorder *exercise stress testing *signal averaged ECG *EPS- electrophysiology study |
|
|
EPS- electrophysiology study is done under _____. Pacing _____ are placed in selected intracardiac areas and _____ are selectively used to attempt to produce ______. The patient's response to various anti_______ medications is determined and monitored in a controlled environment.
|
EPS- electrophysiology study is done under fluoroscopy. Pacing electrodes are placed in selected intracardiac areas and stimuli are selectively used to attempt to produce dysrhythmias. The patient's response to various antidysrhythmic medications is determined and monitored in a controlled environment.
|
|
|
What is the most common approach to preventing a recurrence of SCD?
What may be used in addition> |
an implantable cardioverter-defibrillator (ICD)
Research has shown that an ICD improves survival compared with drug therapy alone. Drug therapy with amiodarone (Cordarone) may be used in conjunction with an ICD to decrease episodes of ventricular dysrhythmias. |
|
|
True or False: Patients who have experienced SCD have many psychosocial needs because they may develop a walking "time bomb" mentality becoming anxious, angry, and depressed. The caregivers are likely to experience the same feelings. Fear often impairs resumption of regular activities such as sexual or recreational activities. The grief response varies among patients or caregivers.
|
TRUE!
|
|
|
Pulseless Electrical Activity (PEA) describes a situation in which electrical activity is observed on the ECG, but there is no ______ activity of the ventricles and the patient has no _____. Prognosis is poor unless the underlying cause is identified and quickly corrected. The most common causes of PEA include hypo_____, hypo___, hypo____, hypo____ hyper_____, metabolic acidosis/alkalosis, drug ______, cardiac _______, MI, tension ________, trauma, and pulmonary _____. Treatment begins with ____ followed by definitive drug therapy such as _____ and intubation. _____ is used if the ventricular rate is slow. Treatment is aimed at correcting the underlying cause.
|
Pulseless Electrical Activity (PEA) describes a situation in which electrical activity is observed on the ECG, but there is no mechanical activity of the ventricles and the patient has no pulse. Prognosis is poor unless the underlying cause is identified and quickly corrected. The most common causes of PEA include hypovolemia, hypoxia, hypothermia, hypokalemia hyperkalemia, metabolic acidosis, drug overdose, cardiac temponade, MI, tension pneumothorax, trauma, and pulmonary embolism. Treatment begins with CPR followed by definitive drug therapy such as epinephrine and intubation. Atropine is used if the ventricular rate is slow. Treatment is aimed at correcting the underlying cause.
|
|
|
Antidysrhythmia drugs can cause life-threatening dysrhythmias similar to those for which they are given. This concept is termed ______. The patient who has severe ____ _____ _____ is the most susceptible. D____ and class 1A, 1C, and III antidysrhythmia drugs can cause this response. The first several days of drug therapy are the _____ period for developing these. For this reason, many oral antidysrthythmia drug regimens are started in a monitored hospital setting.
|
Antidysrhythmia drugs can cause life-threatening dysrhythmias similar to those for which they are given. This concept is termed prodysrhythmia. The patient who has severe left ventricular dysfunction is the most susceptible. Digoxin and class 1A, 1C, and III antidysrhythmia drugs can cause this response. The first several days of drug therapy are the vulnerable period for developing these. For this reason, many oral antidysrthythmia drug regimens are started in a monitored hospital setting.
|
|
|
Antidysrhythmic Drugs...
Class I: Sodium Channel Blockers decrease _____ velocity In the ____, ____, and ___-___ system. |
Class I: Sodium Channel Blockers decrease conduction velocity In the atria, ventricles, and His-Purkinje system
|
|
|
Antidysrhythmic Drugs...
Class IA (sodium channel blockers) includes disopyramide (Norpace), procainamide (Pronestyl), and quinidine (Quinora) They delay ________. ECG will show widened QRS and prolonged QT interval |
Class IA (sodium channel blockers) includes disopyramide (Norpace), procainamide (Pronestyl), and quinidine (Quinora)
They delay repolarization. ECG- will show widened QRS and prolonged QT interval |
|
|
Antidysrhythmic Drugs...
Class IB (sodium channel blockers) include lidocaine (Xylocaine), mexiletine (Mexitil), phenytoin (Dilantin). They accelerate ________. How is the ECG effected? |
Antidysrhythmic Drugs...
Class IB (sodium channel blockers) include lidocaine (Xylocaine), mexiletine (Mexitil), phenytoin (Dilantin). They accelerate repolarization. Little to no effect on ECG |
|
|
Antidysrhythmic Drugs...
Class IC (sodium channel blockers) include flecainide (Tambocor) and propafenone (Rhythmol). They decrease _______ ________. ECG shows pronounced prodysrhythmic actions, widened QRS, prolonged QT interval. |
Antidysrhythmic Drugs...
Class IC (sodium channel blockers) include flecainide (Tambocor) and propafenone (Rhythmol). They decrease impulse conduction. ECG shows pronounced prodysrhythmic actions, widened QRS, prolonged QT interval. |
|
|
Antidysrhythmic Drugs...
Class II: include ___blockers such as atenolol, carvedilol, asmolol, metoproplol, and sotalol. Effects on ECG: ____cardia, prolonged PR interval, AV ____ |
Class II: include beta blockers such as atenolol, carvedilol, asmolol, metoproplol, and sotalol.
Action: decrease automaticity of SA node, decrease conduction velocity in AV node, reduce atrial and ventricular contractility Effects on ECG: Bradycardia, prolonged PR interval, AV block |
|
|
Antidysrhythmic Drugs...
Class III: include ___ _____ blockers which include amiodarone, bretylium (Bretylol), dofetilide (Tikosyn), ibutilide (Corvert), and sotalol (Betapace). ECG changes: Prolonged PR and QT intervals, widened QRS, ____cardia. |
Class III: include Potassium Channel blockers which include amiodarone, bretylium (Bretylol), dofetilide (Tikosyn), ibutilide (Corvert), and sotalol (Betapace).
Action - delays repolarization resulting in prolonged duration of action potential and refractory period. ECG- Prolonged PR and QT intervals, widened QRS, bradycardia |
|
|
Antidysrhythmic Drugs...
Class IV include ___ ____ blockers such as ______ and _____. They decrease automaticity of ___ node, delay ____ node conduction, and reduce _____ _____. ECG may show ___cardia, prolonged PR interval, AV block. |
Antidysrhythmic Drugs...
Class IV: include calcium channel blockers such as diltiazem (Cardizem) and verapamil (Calan). They decrease automaticity of SA node, delay AV node conduction, and reduce myocardial contractility. ECG may show bradycardia, prolonged PR interval, AV block. |
|
|
Other antidysrhythmia medications include adenosine (Adenocard), digoxin, and magnesium. They decrease conduction through the ____ node and reduce automaticity of the ___ node. The ECG may show prolonged PR interval and AV block.
|
Other antidysrhythmia medications include adenosine (Adenocard), digoxin, and magnesium. They decrease conduction through the AV node and reduce automaticity of the SA node. The ECG may show prolonged PR interval and AV block.
|
|
|
Defibrillation is the treatment of choice to terminate V Fib and ______ V Tach. It is most effective when the myocardial cells are/aren't anoxic or acidotic. Rapid defibrillation (within ___ minutes) is critical to a successful patient outcome. Defibrillation is accomplished by the passage of a DC electric shock through the heart that is sufficient to _____ the cells of the myocardium. The intent is that subsequent repolarization of myocardial cells will allow the ___ node to resume the role of pacemaker.
|
Defibrillation is the treatment of choice to terminate V Fib and pulseless V Tach. It is most effective when the myocardial cells ARE NOT anoxic or acidotic. Rapid defibrillation (within 2 minutes) is critical to a successful patient outcome. Defibrillation is accomplished by the passage of a DC electric shock through the heart that is sufficient to depolarize the cells of the myocardium. The intent is that subsequent repolarization of myocardial cells will allow the SA node to resume the role of pacemaker.
|
|
|
Defibrillators deliver energy using a monophasic (one direction) or biphasic (two directions). _____ defibrillators deliver successful shocks at lower energies and with fewer postshock ECG abnormalities than the other type.
|
Defibrillators deliver energy using a monophasic (one direction) or biphasic (two directions). Biphasic defibrillators deliver successful shocks at lower energies and with fewer postshock ECG abnormalities than the other type.
|
|
|
The recommended energy for initial shocks in defibrillation depends on the type of defibrillator. Biphasic defibrillators deliver the first and any successful shocks using ____ to ____ joules. Recommendations for monophasic defibrillators include an initial shock at ____ joules. After the initial shock, start ____ immediately beginning with ___ ______.
|
The recommended energy for initial shocks in defibrillation depends on the type of defibrillator. Biphasic defibrillators deliver the first and any successful shocks using 120 to 200 joules. Recommendations for monophasic defibrillators include an initial shock at 360 joules. After the initial shock, start CPR immediately beginning with chest compressions.
|
|
|
General steps for defibrillation
|
1. CPR should be in progress until defibrillator is available
2. Turn the defibrillator on, and select the proper energy level. 3. Check to see that the synchronizer switch is turned off. 4.Apply conductive materials to chest (e.g. defibrillator gel pads), one to right of sternum just below clavicle, and other to the left of the apex. 5. Charge the defibrillator using the button. 6. Position the paddles firmly on chest wall over conductive material. 7. Make sure everyone is "all clear" (no one touching patient or bed) 8. Deliver charge by pressing buttons on both paddles simultaneously. |
|
|
Synchronized cardioversion is the therapy of choice for the patient with hemodynamically unstable ventricular dysrhythmias such as _____ or supraventricular dysrhythmias such as _____. A synchronized circuit in the defibrillator delivers a countershock that is programmed to occur on the __ waves of the QRS complex of the ECG. The synchronizer sqitch must be turned ___ when cardioversion is planned. The procedure for synchronized cardioversion is the same as for defibrillation with the following exceptions... If done on a nonemergency basis (patient awake and stable) the patient is _____ed before the procedure. Strict attention to the maintenance of a _____ ____ is important in this situation. If a patient with SVT or VT with a pulse becomes hemodynamically ____ , synchronized cardioversion should be performed as quickly as possible. Energy joules are started at ___ to ____ joules and increased if needed. IF the patient becomes _______ or the rhythm deteriorates to __ ____ turn the synchronizer switch ___ and initiate ______.
|
Synchronized cardioversion is the therapy of choice for the patient with hemodynamically unstable ventricular dysrhythmias (e.g. VT with a pulse) or supraventricular dysrhythmias such as atrial fibrillation with RVR. A synchronized circuit in the defibrillator delivers a countershock that is programmed to occur on the R waves of the QRS complex of the ECG. The synchronizer sqitch must be turned on when cardioversion is planned. The procedure for synchronized cardioversion is the same as for defibrillation with the following exceptions... If done on a nonemergency basis (patient awake and stable) the patient is sedated before the procedure. Strict attention to the maintenance of a patent airway is important in this situation. If a patient with SVT or VT with a pulse becomes hemodynamically unstable , synchronized cardioversion should be performed as quickly as possible. Energy joules are started at 50 to 100 joules and increased as needed. If the patient becomes pulseless or the rhythm deteriorates to V Fib turn the synchronizer switch off and initiate defibrillation.
|
|
|
Review: With Defibrillation & Cardioversion...
Check that the synchonizer switch is on/off when defibrillation is planned. Turn the synchronizer switch on/off when cardioversion is planned. Be sure that personnel are "all clear" before device is discharged. |
Review: With Defibrillation & Cardioversion...
Check that the synchonizer switch is OFF when defibrillation is planned. Turn the synchronizer switch ON when cardioversion is planned. Be sure that personnel are "all clear" before device is discharged. |
|
|
Patient Teaching for an ICD (Implantable Cardioverter-Defibrillator
|
Follow up with HCP for routine interrogation of ICD
Report any s/s of infection at incision site or fever immediately Keep incision dry for 4 days after insertion or as instructed Avoid lifting arm on ICD side above shoulder until ok'd by HCP Discuss resuming resuming sexual activity with HCP. Sexual activity can usually be resumed after inc. is healed Avoid driving until ok'd by HCP Avoid direct blows to ICD site Avoid lg magnets/strong electromagnetic fields (interferes) Don't get an MRI Air travel is NOT restricted. Inform airport security of ICD as it may set off metal detector. If hand-held screening wand is used, it should not be placed directly on ICD. Avoid standing near antitheft devices in doorways of stores & public buildings. Walk through them at a normal pace. If your ICD fires, call your HCP immediately. If your ICD fires and you don't feel well, call 911. If your ICD fires more than once, call 911. Always wear a medic-alert bracelet. Always carry ICD ID card and a current list of meds Caregivers should learn CPR |
|
|
Indications for permanent pacemaker (9)
|
-Acquired AV block
-Second-Degree AV block -Third-Degree AV block -Atrial fibrillation with a slow ventricular response -Bundle branch block -Cardiomyopathy (dilated, hypertrophic) -Heart Failure -SA node dysfunction -Tachydysrhythmias (e.g. V tach) |
|
|
Indications for temporary pacemakers include: -Maintenance of adequate ___ and ___ during special circumstances such as ____ and postoperative recovery, during cardiac _________ or coronary ________, during drug therapy that may cause ______, and before implantation of a ______ pacemaker.
- As prophylaxis after ___ ___ surgery -Acute ____ MI with second-degree or third-degree ___ block or ____ _____ block -Acute _____ MI with symptomatic _____ and ___ block. -Electrophysiologic studies to evaluate patient with ________ and ________. |
Indications for temporary pacemakers include: -Maintenance of adequate HR and rhythm during special circumstances such as surgery and postoperative recovery, during cardiac catheterization or coronary angioplasty, during drug therapy that may cause bradycardia, and before implantation of a permanent pacemaker.
- As prophylaxis after open heart surgery -Acute anterior MI with second-degree or third-degree AV block or bundle branch block -Acute inferior MI with symptomatic bradycardia and AV block. -Electrophysiologic studies to evaluate patient with bradydysrhythmias and tachydysrhythmias. |
|
|
The implantable cardioverter-defibrllator (ICD) is an important technology for patients who:
have survived _____; have spontaneous sustained _____ _____ (a dysrhythmia) have _____ with inducible v tach or v fib during EPS; are at high risk for future life-threatening dysrhythmias (such as the condition _______). Use of the SCD has significantly decreased cardiac mortality rates in these patients and has added a new dimension to the management of life-threatening dysrhythmias and the prevention of SCD. |
The implantable cardioverter-defibrllator (ICD) is an important technology for patients who:
have survived SCD; have spontaneous sustained ventricular tachycardia (a dysrhythmia) have syncope with inducible v tach or v fib during EPS; are at high risk for future life-threatening dysrhythmias (such as the condition cardiomyopathy) |
|
|
The ICD consists of a ____ system placed via a _______ vein to the endocardium. A battery-powered pulse generator (similar to size of pacemaker) is implanted subcutaneously, usually over the pectoral muscle on the patient's dominant/nondominant side.
Most systems are single-lead systems. The ICD sensing system monitors the ____ ____ and _____ and identifies ___ ____ and ___ ___. Approximately 25 seconds after the system detects a lethal dysrhythmia, the defibrillating mechanism delivers a 25-joule or less shock to the patient's heart. If the first shock is unsuccessful, the generator recycles and can continue to deliver shock. |
The ICD consists of a lead system placed via a subclavian vein to the endocardium. A battery-powered pulse generator (similar to size of pacemaker) is implanted subcutaneously, usually over the pectoral muscle on the patient's nondominant side.
Most systems are single-lead systems. The ICD sensing system monitors the heart rate rhythm and identifies V FIB and V TACH. Approximately 25 seconds after the system detects a lethal dysrhythmia, the defibrillating mechanism delivers a 25-joule or less shock to the patient's heart. If the first shock is unsuccessful, the generator recycles and can continue to deliver shock. |
|
|
In addition to the defibrillation capabilities, ICDs are equipped with antitachycardia and antibradycardia pacemakers. These sophisticated devices use dysrhythmia algorithms that detect dyrsrhythmias and determine the appropriate programmed response. They can initiate "overdrive pacing" of supraventricular and vent. tachycardias, sparing the patient painful shocks. It can also provide backup pacing for bradydysrhythmias that may occur after defibrillation discharges. Nursing care is similar to that of patient undergoing permanent pacemaker implantation. What are some nursing diagnosis for a patient with an iCD?
|
fear of body image change
fear of recurrent dysrhythmias fear of pain with discharge of ICD Anxiety r/t going home with new device and being out of hospital |
|
|
An artificial cardiac pacemaker is an electronic device used to pace the heart when the normal conduction pathway is damaged. The basic pacing circuit consists of a power source (battery powered pulse generator), one or more conduction leads (pacing leads) , and the m_______. The electrical signal (stimulus) travels from the pacemaker, throught the leads, to the wall of the myocardium, where the myocardium is "captured" and stimulated to ____. They pace the atrium and one or more of the ventricles. The pacemakers can do anti______, anti_____ pacing, and _____ pacing, which involves pacing the atrium at rates of 200-500 impulses per minute in an attempt to terminate atrial tachycardias.
|
An artificial cardiac pacemaker is an electronic device used to pace the heart when the normal conduction pathway is damaged. The basic pacing circuit consists of a power source (battery powered pulse generator), one or more conduction leads (pacing leads) , and the myocardium. The electrical signal (stimulus) travels from the pacemaker, throught the leads, to the wall of the myocardium, where the myocardium is "captured" and stimulated to contract. They pace the atrium and one or more of the ventricles. The pacemakers can do antitachycardia, antibradycardia pacing, and overdrive pacing, which involves pacing the atrium at rates of 200-500 impulses per minute in an attempt to terminate atrial tachycardias (i.e. atrial flutter with RVR)
|
|
|
A permanent pacemaker is implanted totally within the body. The power source is placed subcutaneously, usually over the ____ muscle on patient's dominant/ nondominant side. The pacing leads are threaded transvenously to the right atrium and one or both ventricles and attached to the power source.
|
A permanent pacemaker is implanted totally within the body. The power source is placed subcutaneously, usually over the pectoral muscle on patient's nondominant side. The pacing leads are threaded transvenously to the right atrium and one or both ventricles and attached to the power source.
|
|
|
Cardiac resynchronization therapy (CRT) is a pacing technique that resyncronizes the cardiac cycle by pacing both ventricles, thus promoting improvement in ventricular function. Most patients with ____ ____ (condition) have intraventricular conduction delays causing abnormal ventricular activation and contraction which results in reduced systolic function, pump efficiency, and worsening symptoms of HF. CRT is combined with a ____ for maximum therapy.
|
Cardiac resynchronization therapy (CRT) is a pacing technique that resyncronizes the cardiac cycle by pacing both ventricles, thus promoting improvement in ventricular function. Most patients with heart failure (condition) have intraventricular conduction delays causing abnormal ventricular activation and contraction which results in reduced systolic function, pump efficiency, and worsening symptoms of HF. CRT is combined with a ICD or maximum therapy
|
|
|
Temporary pacemakers have the power source ____ the body. There are 3 types: transvenous, epicardial, and transcutaneous. Before initiating TCP therapy, it is important to tell the patient what to expect. Explain that the muscle contractions created by the pacemaker when the current passes through the chest wall are ______. Reassure the patient that the TCP- (transcutaneous) is temporary and that it will be replaced with a transvenous pacemaker as soon as possible. When possible, provide provide _____ and/or sedation while TCP is in use.
|
Temporary pacemakers have the power source outside the body. There are 3 types: transvenous, epicardial, and transcutaneous. Before initiating TCP therapy, it is important to tell the patient what to expect. Explain that the muscle contractions created by the pacemaker when the current passes through the chest wall are uncomfortable. Reassure the patient that the TCP- (transcutaneous) is temporary and that it will be replaced with a transvenous pacemaker as soon as possible. When possible, provide provide analgesia and/or sedation while TCP is in use.
|
|
|
Patients with temporary or permanent pacemakers will be monitored with ____ to evaluate the status of the pacemaker. Pacemaker malfunction primarily involves a failure to sense or a failure to capture. Failure to sense occurs when the pacemaker fails to recognize spontaneous atrial or ventricular activity, and it fires in______, resulting in firing during excitable period of cardiac cycle, resulting in ___ ____. Failure to sense is cause by pacer ____ damage, ____ failure, sensing set too high/low, or dislodgement of electrode. Failure to capture occurs when the electrical charge to the myocardium is insufficient to produce atrial or ventricular contraction. This can result in serious ______ or ____. Failure to capture is caused by pacer lead damage, battery failure, dislodgement of the electrode, electrical charge set too high/low, or fibrosis at the electrode tip.
|
Patients with temporary or permanent pacemakers will be monitored with ECG to evaluate the status of the pacemaker. Pacemaker malfunction primarily involves a failure to sense or a failure to capture. Failure to sense occurs when the pacemaker fails to recognize spontaneous atrial or ventricular activity, and it fires inappropriately, resulting in firing during excitable period of cardiac cycle, resulting in V Tach. Failure to sense is cause by pacer lead damage, battery failure, sensing set too high, or dislodgement of electrode. Failure to capture occurs when the electrical charge to the myocardium is insufficient to produce atrial or ventricular contraction. This can result in serious bradycardia or asystole. Failure to capture is caused by pacer lead damage, battery failure, dislodgement of the electrode, electrical charge set too low, or fibrosis at the electrode tip.
|
|
|
What are some complicationf os invasive temporary (transvenous) or permanent pacemaker insertion?
|
infection & hematoma formation at site of insertion
pneumothorax failure to sense or capture perforation of atrial or ventricular septum by ppacing lead appearance of "end of life" battery parameters on testing the pacemaker...?? |
|
|
What are some measures that can prevent or assess for complications of pacemakers?
|
prophylactic antibiotic therapy before and after insertion
post insertion chest x ray to check lead placement and r/o pneumothorax monitor insertion site continuous ECG monitoring |
|
|
After the pacemaker has been inserted, the patient can be out of bed once ____. When are they usually discharged?
After discharge, patient will need to check pacemaker function on a regular basis. This can include outpatient visits to a pacemaker interrogator or programmer, or home monitoring using telephone transmitter devises. Another method is noninvasive program stimulation, which is done on an outpatient basis in the electrophysiology lab. |
After the pacemaker has been inserted, the patient can be out of bed once stable. Pt. is usually discharged the following day after insertion.
After discharge, patient will need to check pacemaker function on a regular basis. This can include outpatient visits to a pacemaker interrogator or programmer, or home monitoring using telephone transmitter devises. Another method is noninvasive program stimulation, which is done on an outpatient basis in the electrophysiology lab. |
|
|
True or False: Microwave ovens are unsafe for people with pacemakers to use because they interfere with pacemaker function.
|
false, they're ok!
|
|
|
Patient with a pacemaker should monitor ____ and inform HCP if it drops below a predetermined rate.
|
pulse
(patient teaching pretty much identical to that of ICD) |
|
|
______ _____ _____is considered the nonpharmacologic treatment of choice for atrial dysrhythmias resulting in rapid ventricular rates and AV nodal reentrant tachycardia refractory to drug therapy. It uses electrical energy to burn or ablate areas of conduction system as definitive treatment of tachydysrhtyhmias. It is done after ___ has identified the source of the dysrhtyhmia. It is a successful therapy with a low complication rate.
|
Radiofrequency catheter ablation is considered the nonpharmacologic treatment of choice for atrial dysrhythmias resulting in rapid ventricular rates and AV nodal reentrant tachycardia refractory to drug therapy. It uses electrical energy to burn or ablate areas of conduction system as definitive treatment of tachydysrhtyhmias. It is done after EPS has identified the source of the dysrhtyhmia. It is a successful therapy with a low complication rate.
|
|
|
ST segment elevation is significant if it is greater than or equal to ___ above the _____ line.
|
ST segment elevation is significant if it is greater than or equal to 1 mm above the isoelectric line.
|
|
|
Syncope, a brief lapse in consciousness accompanied by a loss in postural tone (fainting), is a common diagnosis of patients in the ER. Causes can be cardiac or not. The 2 most common cardiac causes of syncope are cardioneurogenic syncope or "_____syncope" (e.g. corotid sinus sensitivity)
Primary cardiac dysrhythmias causing syncope can include _____ or _______. Other cardiac causes can relate to prosthetic valve _______, pulmonary _____, aortic dissection, a____, and h____ f____. Noncardiac causes include hypo_____, hysteria, s____, s_____, and transient ______ attack. |
cardioneurogenic syncope or "vasovagal syncope (e.g. corotid sinus sensitivity)
primary cardiac dysrhythmias causing syncope can include tachycardias and bradycardias. Other cardiac causes can relate to prosthetic valve malfunction, pulmonary embolism, aortic dissection, anemia, and heart failure. Noncardiac causes include hypoglycemia, hysteria, seizure, stroke, and transient ischemic attack. |
|
|
A diagnostic workup for a patient with syncope begins with ruling out structural or ischemic heart disease. Echos, Stress tests, and EPS are often done. Treatments include antidysrhythmia drugs, pacemakers, ICDs, and catheter ablation therapy. In patients without structural heart disease or in whom EPS testing is not diagnostic, the ___up ___ test may be performed. Normally, an upright position results in gravity displacing 300 to 800 ml of blood to the lower extremities. Mechanoreceptors respond to the increased blood volume by initiating a reflex increase in ____ stimulation and decrease in parasympathetic output. The end results are a slight increase in ____ ____ and systolic/diastolic BP, a slight decrease in systolic/diastolic BP. In the head-up tilt-test, the patient is placed on a table supported by a belt across the torso and feet. Baseline ECG, BP, and HR are obtained in horizontal position. Then the table to tilted to 60 to 80 degrees and patient is kept upright for 20 to 60 minutes. The ECG and HR are recorded continuously and BP is measured every 3 minutes. If the patient's BP and HR responses are abnormal and clinical symptoms are reproduced (faintness) the test is negative/positive. If after 30 min there is no response, the table is returned to the horizontal position and an IV infusion of low-dose i_____ may be started to provoke a response.
|
A diagnostic workup for a patient with syncope begins with ruling out structural or ischemic heart disease. Echos, Stress tests, and EPS are often done. Treatments include antidysrhythmia drugs, pacemakers, ICDs, and catheter ablation therapy. In patients without structural heart disease or in whom EPS testing is not diagnostic, the head up tilt test may be performed. Normally, an upright position results in gravity displacing 300 to 800 ml of blood to the lower extremities. Mechanoreceptors respond to the increased blood volume by initiating a reflex increase in sympathetic stimulation and decrease in parasympathetic output. The end results are a slight increase in heart rate and diastolic BP, a slight decrease in systolic BP. In the head-up tilt-test, the patient is placed on a table supported by a belt across the torso and feet. Baseline ECG, BP, and HR are obtained in horizontal position. Then the table to tilted to 60 to 80 degrees and patient is kept upright for 20 to 60 minutes. The ECG and HR are recorded continuously and BP is measured every 3 minutes.
If the patient's BP and HR responses are abnormal and clinical symptoms are reproduced (faintness) the test is positive. If after 30 min there is no response, the table is returned to the horizontal position and an IV infusion of low-dose isoproterenol may be started to provoke a response. |
|
|
In cardioneurogenic syncope, the increase in venous pooling that occurs in the upright position reduces venous return to heart. This results in a sudden, compensatory increase in _______ contraction. This is misinterpreted by the brain as a ______ state and consequently sympathetic stimulation is withdrawn. This produces a paradoxic vasodilation and ______ (vasovagal response). The end results are ____, hypo_____, cerebral hypo_____, and syncope.
|
In cardioneurogenic syncope, the increase in venous pooling that occurs in the upright position reduces venous return to heart. This results in a sudden, compensatory increase in ventricular contraction. This is misinterpreted by the brain as a hypertensive state and consequently sympathetic stimulation is withdrawn. This produces a paradoxic vasodilation and bradycardia (vasovagal response). The end results are bradycardia, hypotension, cerebral hypoperfusion, and syncope.
|
|
|
Other diagnostic tests for syncope include various recording devices such as a Holter monitor. About thirty percent of those who have one episode of syncope will experience a _____.
|
Other diagnostic tests for syncope include various recording devices such as a Holter monitor. About thirty percent of those who have one episode of syncope will experience a recurrence.
|
|
|
Maintenance of adequate HR and rhythm during special circumstances such as surgery or during drug therapy that may cause bradycardia is an indication for a temporary or a permanent pacemaker?
|
temporary
|
|
|
Prophylactic pacemakers after open heart surgery is an indication for a temporary or a permanent pacemaker?
|
temporary
|
|
|
Acquired AV block, 2nd degree AV block, Third degree AV block are indications for a temporary or a permanent pacemaker?
|
permanent
|
|
|
Heart Failure can be an indication for a temporary or a permanent pacemaker?
|
permanent
|
|
|
Acute anterior MI with 2nd or 3rd degree AV block or bundle branch block is an indication for a temporary or a permanent pacemaker?
|
temporary
|
|
|
______ or _______ cardiomyopathy are indications for permanent pacemakers.
|
Dilated or hypertrophic cardiomyopathy are indications for permanent pacemakers.
|
|
|
A Fib with a slow vent response is an indication for a temporary or a permanent pacemaker?
|
permanent
|
|
|
Bundle branch block is an indication for a temporary or a permanent pacemaker?
|
permanent
|
|
|
Acute inferior MI with symptomatic bradycardia and AV block is an indication for a temporary or a permanent pacemaker?
|
temporary
|
|
|
Electrophysiologic studies to evaluate patient with bradydysrhythmias or tachydysrhythmias is an indication for a temporary or a permanent pacemaker?
|
temporary
|
|
|
SA node dysfunction is an indication for a temporary or a permanent pacemaker?
|
permanent
|
|
|
Tachydysrhythmias such as ventricular tachycardia is an indication for a temporary or a permanent pacemaker?
|
permanent
|
