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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, O
, 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
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


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): O
, 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


Dec. CO
Tissue Perfusion

Pacemaker Spikes

Pharma­col­ogical Interv­entions

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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