229 Ch 22 management of pts with arrhythmias and conduction problems

What are arrhythmias?

Disorders of formation or conduction of electrical impulses within the heart.

What do arrhythmias receive their name from?

The site of origin.

What are some risk factors for arrhythmias?

Sleep apnea, smoking, and a recent myocardial infarction (MI).

What is the normal electrical conduction pathway in the heart?

SA Node, AV Node, Bundle of His, Right and Left Bundle Branches, Purkinje Fibers.

What does depolarization lead to in the heart?

The contraction or systole.

What does repolarization lead to in the heart?

The relaxation or diastole.

What is a standard method of monitoring the heart's electrical activity?

Electrocardiogram (ECG).

What are the types of ECG's mentioned?

Bedside ECG, standard 12 lead ECG, hardwire monitoring, Holter monitor, and loop recorder.

What are Holter monitors used for?

They are worn for a specified amount of time to document activity.

What is Sinus Bradycardia?

A heart rate of 60 bpm, occurs when the SA node creates an impulse at a slower than normal rate.

What are some symptoms of Sinus Bradycardia?

Exercise intolerance, fatigue, dizziness, headache, nausea, palpitations, and chest pain.

How is Sinus Bradycardia treated?

With an artificial pacemaker, medications like Atropine or Warfarin.

What is Sinus Tachycardia?

A heart rate of 100 bpm, occurs when the sinus node creates an impulse faster than normal.

What can trigger Sinus Tachycardia?

Fear, anxiety, exercise, blood loss, shock, or pain.

How are Orthostatic Hypotension and POTS Syndrome related?

POTS is a condition where the body does not compensate fast enough, causing dizziness, sweating, fatigue, and other symptoms.

What are PACs?

Premature Atrial Complexes, which occur when an electrical impulse starts in the atrium before the next normal impulse from the sinus node.

What is Atrial Fibrillation?

A condition characterized by heart palpitations, fatigue, shortness of breath, and irregular rapid pulses from different foci.

What medication should be given if Afib does not resolve in 48 hours?

Warfarin.

What is the primary risk factor for stroke in patients with Afib?

Risk for thromboembolism.

What is Premature Ventricular Complex (PVC)?

An impulse that starts in a ventricle and is conducted through the ventricle before the next normal sinus impulse.

What are the two types of Ventricular Tachycardia?

Monomorphic and polymorphic.

What is the treatment for Ventricular Fibrillation?

Immediate defibrillation and CPR.

What is the definition of Ventricular Asystole?

A flatline; no heartbeat, no palpable pulse, and absent QRS.

What does a first-degree AV block indicate?

All atrial impulses are conducted through the AV node at a slower than normal rate.

What is the treatment for symptomatic AV blocks?

IV bolus of atropine, temporary transcutaneous pacing, or a permanent pacemaker if it persists.

What is the purpose of electrical cardioversion?

To revert arrhythmias back into rhythm.

What should patients avoid following placement of a pacemaker?

Avoid lifting the arm on the side where the pacemaker is implanted.

What is LAAO?

Left Atrial Appendage Occlusion, a procedure to block or close the opening of the LAA.

What is an Implantable Cardioverter-Defibrillator (ICD)?

An electronic device that detects and terminates life-threatening episodes of tachycardia or fibrillation.

What should patients with atrial flutter expect to see on their ECG?

A sawtooth pattern indicating rapid, regular atrial impulses.

What can cause Atrial Flutter?

Excessive alcohol consumption, thyroid problems, age, or cardiovascular disease.

What is the significance of abnormal ECG findings?

It may indicate the presence of arrhythmias that require further evaluation.

What is the role of anticoagulants in treating Afib?

To prevent thromboembolism.

What is cath lab used for in cardiac care?

For evaluating and treating arrhythmias.

What should be monitored post-procedure for cardiac patients?

Rhythm, pulse, incision site and symptoms of complications.

What medications may be given for arrhythmias?

Amiodarone, lidocaine, and magnesium.

What is the primary symptom of Ventricular Tachycardia (VT)?

Three or more PVCs in a row at a rate of 100 bpm.

What is a common cause of Ventricular Fibrillation?

Untreated or unsuccessfully treated VT.

What should be done if a patient goes into Ventricular Asystole?

Initiate high-quality CPR and establish IV access.

What is the purpose of transesophageal echocardiogram in cardiac evaluation?

To evaluate for thrombi.

What defines a temporary pacemaker?

A device used to regulate heart rate temporarily.

What is a common complication of pacemaker implantation?

Dislodgement of pacing electrode.

What is atrial flutter characterized by?

Atrial flutter is characterized by a rapid, regular atrial rate and may produce a 'sawtooth' pattern on an ECG.

What is the heart rate in atrial fibrillation?

In atrial fibrillation, the heart rate can vary widely, often exceeding 100 bpm.

How does myocardial infarction relate to arrhythmias?

Myocardial infarction can damage heart tissue, leading to disturbances in electrical conduction and increasing the risk of arrhythmias.

What is the role of a Holter monitor in cardiac assessment?

A Holter monitor records the heart's electrical activity over 24-48 hours to capture arrhythmias that may not occur during a standard ECG.

Which arrhythmia is often referred to as 'skipping beats'?

Premature Atrial Complexes (PACs) are often described as 'skipping beats' from early atrial impulses.

What can the presence of a first-degree AV block indicate?

First-degree AV block suggests that there is a delay in conduction through the AV node, which may not require treatment unless symptomatic.

What medication is typically used for rate control in atrial fibrillation?

Beta-blockers or calcium channel blockers are commonly used for rate control in atrial fibrillation.

What is the potential complication of untreated atrial fibrillation?

The primary complication of untreated atrial fibrillation is an increased risk of stroke due to thromboembolism.

In the context of arrhythmias, what does the term 'synchronized cardioversion' refer to?

Synchronized cardioversion is a procedure used to convert an arrhythmia to normal sinus rhythm using an electrical shock, timed with the heart's rhythm.

What is the significance of a patient experiencing symptoms like syncope or near-syncope in relation to arrhythmias?

Symptoms like syncope or near-syncope may indicate significant arrhythmias that require urgent evaluation and intervention.