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Pt Management & Problems of the CV System - Part 3 Cheat Sheet by

Adult Health 2

Normal Rhythms

Normal Sinus Rhythm
Sinus Arrythmia

Normal Sinus Rhythm

Sinus Arrythmia

Inc. prevalence w/ younger age
Rhythm based on breathing, r/t changes in intrat­horacic pressure:
- Inspir­ation = HR inc. / Expiration = HR dec.

Irregular Rhythms

Sinus Bradyc­ardia
Sinus Tachyc­ardia
Premature Atrial Contra­ctions (PAC)
Arrythmias r/t changes in CO & perf­usion

Sinus Bradyc­ardia

Low HR = give atropi­ne! - epi, pacem­aker (tempo­rar­y/p­erm­anent)
Usually no symptoms, not treated unless symptoms present - AMS, cyanosis, extreme syncop­e/f­ati­gued, hypote­nsive, SOB
Treated by treating cause - can occur after: vagal nerve stimul­ation, beta-b­loc­kers, digoxin, inferior wall MI (back of heart), hype­rka­lem­ia, hypo­thy­roid, falls asleep

Sinus Tachyc­ardia

Heart beats too fast to allow to fill
PR interval may be smaller depending on rate
Caus­es: anxiety, hypovo­lemia, infection, fever, caffeine, pain, HF, hype­rka­lem­ia, nitro & epi
Only treat if necessary - treat underlying cause! - beta-­blocker or CCB if necessary, bear down, O2, digoxin, calm enviro­nment, relax/­med­itate

Premature Atrial Contra­ctions (PAC)

Beat not coming from SA node (ectopic focus)
Not usually treated, told to dec. cause - treated if more freque­nt/­several consec­utive
Caus­es: MI, stretching of cardiac muscle, alco­hol, smok­ing, HF & perica­rdi­tis, meds, irri­tab­ility of cardiac muscle

Suprav­ent­ricular Tachyc­ardia (SVT)

P-waves = buried in T-waves, hard to see
PR interval = usually not possible to measure
QRS = normal (0.06-­0.10) but may be wide if abnormally conducted through ventri­cles
Person sympto­matic
Perfusion and CO affected
Treat with adenosine & flush w/ 20 mL NSS heart restarts
Caus­es: anxiety, caffeine, amph­eta­min­es, irri­tab­ility of atrial muscle
 

More Rhythm Disorders

Atrial Flutter
Atrial Fibril­lation

Atrial Flutter

Saw-­toothed appear­ance
Ectopic pacemaker
Caus­es: pul­monary emboli, CHF, peri­car­dit­is, cardiac ischem­ia
Can walk around if low rate
Want to control rate - digoxin, CCB, anti-a­rry­thmics; override pacing to fix rhythm, ablation therapy
May see ratio of beats to QRS's
Similar shape = coming from same site

Atrial Fibril­lation

Biggest concern = blood pooling clots (a fib NSR = clots stroke/PE
Dec. CO < 30%
Not effective beats, rapid & chaotic
Caus­es: MI, CHF, card­iom­yop­athy (anything that causes heart to expand)

Ventri­cular Rhythms

Premature Ventri­cular Contra­ctions (PVC)
Ventri­cular Tachyc­ardia
Ventri­cular Fibril­lation

Premature Ventri­cular Contra­ctions (PVC)

Unif­ocal: 1 ectopic site on ventricle
Mult­ifo­cal: 1+ site on ventricle - more danger­ous!
Inc w/... age, isch­emia, CHF, hypo­kal­emia, acidosis, hypoma­gne­semia, stre­ss, caff­eine, nicotine
Symp­toms: palpi­tat­ions
Runs of PVCs V-tach
May not treat if limited number

Ventri­cular Tachyc­ardia

Usually w/ signif­icant heart disease (CHF, MI)
Caus­es: anything that inc. automa­ticity of heart
Symp­toms: r/t dec. CO
Trea­tme­nt: anti-­arr­ythmics (amiod­arone, lidocaine, cardizem); beta-b­lockers (control rate); betapace (controls rate & rhythm); cardiovert (ICD)
If not treated V-fib

Ventri­cular Fibril­lation

Ventricles quivering
O2 demand is through the roof ischemia
Trea­tment: defibr­ill­ate
Caus­es: CAD, MI, CHF, hypo­kal­emia, hypo­mag­nes­emia
Pt is often... uncon­scious, no pulses, no BP, acidotic, may seize
 

Asystole

Cannot shock CPR & epi
Occurs w/ myocardial hypoxia

Atriov­ent­ricular (AV) Blocks

First Degree
Second Degree
Third Degree
Bundle Branch
Diag­nos­is: EKG
Asymp­tomatic unless HR is too low
Trea­tment (w/ slow HR): O2, atropine, pacemaker

First Degree AV Block

Caus­es: ischemia, MI
Not usually treated

Second Degree AV Block

Caus­es: MI, digo­xin, Lyme's disease
Symp­toms: usually none unless HR is too low
Trea­tme­nt: atropine, pacemaker

Third Degree (Complete) AV Block

Caus­es: ischemia, CAD, MI
Trea­tme­nt: pacem­aker

Left Bundle Branch Block

Right Bundle Branch Block

Analysis

Dec. CO
Tissue Perfusion

Pacemaker Spikes

Pharma­col­ogical Interv­entions

Anti-A­rry­thmics
Beta-B­lockers
Calcium Channel Blockers

Implan­table Cardio­verter Defibr­illator (ICD)

What is it?
An internal defibr­illator
Who are candid­ates?
Pts who have survived an episode of sudden cardiac arrest
Documented life-t­hre­atening dysrhy­thmias
Uncomf­ort­able, not necess­arily painful

Defibr­ill­ation vs. Cardio­version

Defi­bri­lla­tion: shock heart in emergency
Card­iov­ers­ion: sync w/ heart, want normal rhythm
- Want to medicate beforehand
- Fibrillate in middle shock & defib.

External Defibr­illator Vests

Worn 24/7 except showers

Ablation Therapy

Want to go in & stop abnormal beats
3 Types - all cause destru­ction to area of heart causing problem
- Chemical
- Mecha­nical (cut, lasers)
- Radio­fre­quency
Used w/ electr­oph­ysi­olo­gy/­con­duction problems

Evaluation of Treatment

Improved CO
Improved tissue perfusion
Improved EKG
               

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