comple concepts in cardiac function day 2

arryhthmias definition

• alsocalled dysrhythmias

• disorders of the electrical impulse within the heart that cause disturbances of HR, heart rhythm, or both

arryhthmias impact

• without a normal rate and regular rhythm, the heart does not perform efficiently as a pump to circulate oygenated blood

arryhthmias symptoms

• may initially produce symptoms related to the hemodynamic effect they cause, such as a decr. in cardiac output

ECG/EKG , what is it?

• the electrical impulse that tracels through the heart can be viewed by means of an ECG/EKG. Each phase of the cardiac cycle is reflected by specific wavefoms

• helps to identity cardiac issues and other health concerns

• the 12 lead EKG uses multipls leads placed on the body to view different areas of the heart

cardiac waveforms

• P wave: atrial depolarization, represents the electrical impulse starting in sinus node and spreading through the atrea

• PR Interval: time fr sinus node stimulation and AV node conduction. Normal range 0.12 to 0.20 secs

• QRS - ventricular depolarization, represents ventricular depolarization. normal duration: < 0.10 second

• QT: Represents the total time for ventricular depolarization and repolarization. Measured from beginning of QRS commple to end of T wave

• T wave ventricular repolarization

cardiac monitoring: centralized monitoring system

• provides contnuous oversight of cardiac activity across clinical units

cardiac monitoring: advanced alarm system

• automatically alerts medical staff upon detecting dysrhthmias, ischemia, or MI

cardiac monitoring: ambulatory recording

• includes devices like Holter monitors which are portable and recording in nature for long term patient monitoring

what are you looking for in EKGs?

• P wave: atrium is contracting, SA nodes have fired, you want P-waves to look like twins

• PR interval - slow it down a second, you want a really good ventricular polarization

• QRS: polarization desensitzing

• QT: ventrical depolarization and repolarization

• ST: looks like tombstones, it tells you that heart isnt resting if it is not what its looking like

• T wave: were gonna do it again

sinus bradycardia (symptomatic)

• rate <60 BPM

• morphology remains consistent with normal sinus rhythm

sinus tachycardia

• rate > 100 BPM

• consistent P, QRS, and T wave morphology

what does sinus bradycardia look like

• dizziness

• lightheadedness

• SOB

• confusion

• fatigue

• hypotension

• regular rhythm

• normal P-wave and PR interval

• Rate < 60 BPM
  
  

how to treat sinus bradycardia

• treat underlying cause

• atropine 1 mg IVP

  • can only give it 3 times, on 3rd mg, no other drugs you can give

• Transcutaneous pacing

• pace pads cannot be on them forever

  • needs a pacemaker or go inside heart and put a transvenous pacer in heart

  • after atropine and transcutaneous, THEN transvenous

what does sinus tachy look like

• chest pain

• SOB

• palpitation

• dizziness

• aniety

• Rate > 100 bpm

• regular rhythm

• Normal P-wave and PR interval

• because someone in dehydrated or in pain

what is the treatment of sinus tachy

• treatment is usally determined by the severity of symptoms and directed at identifying and treating its cayse

• there is always a cause

what does supraventricula tachycardia look like

• aniety

• panic

• SOB

• dizziness

• palpitations

• chest pain

• usually a female pt with either emotional/physical stress

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treatment of supraventricular tachycardia

• vagal maneuvers

  • bear down

  • blow through straw

• adenosine 6mg, 12 mg IVP

  • 2 times, half life of 10 secs, will flatline for a bit

• electrical cardioversion

  • you should be able to with pacer pads

• 
  

what does A-FIB look like

• dizzy

• lightheadedness

• SOB

• chest pain

• palpitations

• hypotension

• may be transient, statying and stopping suddently, and occuring for a very short time or can be persistent, requiriing treatment to terminate the rhythm or to control the ventricular rate

• riskk of stroke, PE, HF because of blood clots due to quivering

a-fib treatment

• rate control: beta blockers, calcium channel blockers, to control the HR

  • Metoprolol 5 mg is routine dose

  • Cardizem

  • Heparin Drip

  • amniodarone for rhythm

• Rhythm control: flecanide and propafenone

• Anticoag therapy

• Later: ablation, pacemaker

  • If treatment doesnt work, ablation ( go in heart and burn codunction pathway so SA node takes a different route)

  • if that doesnt work, pacemaker

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V- tach definition and s/s

• 3 or more consecutive ventricular beats at a rate > 100 bpm

• dizziness, lightheadedness, palpitations,

• SOB

• chest pain

• near syncope

• ocnfusion

• hypotension

• tachycardia

• 
  

treatment of v-tach

• antiarryhtmic meds like amiodarone or lidocaine

• electrical cardioversion

  • last resort

  • high potential of moving clots and setting them off so it is scary

• worry about QRS if anything bc continued widening = flat lining

Stable v-tach comes fro same area

unstable/polymorphic you want to trat like v-fib, comes from diff areas

treatment of v-fib

• Same as pulselessness VT: follow ACLS protocol

  • CPR until defibrillator arrives

    • do code until return of spontaneous circulation (ROSC)

  • rapid defibrillation

  • identify and treat the underlying cause

  • epinephrine 1 mg IVP every 3-5 mins

    • short acting, epi drip

  • amiodarone (antiarrhythmic)

  • 
    

definition of tosades de pointes

• turning of points

• rare, life threatening form of polymorphic v-tach characterized by twisting ppearance of QRS complees on ECG

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etiology and factors of torsades

• prolonged QT interval due to drug toicity

• electrolyte imbalances (low mag)

• congenital factors

treatment of torsades

magnesium

what can you do for asystole and pulseless electrical activity

• can only do high wuality CPR

  • cannot shock because theres nothing to shock

  • will give epi sometimes to see what will happen

know 1st av block

• prolonged PR interval, consistent

cardioversion - what is it

• syncronized shock: defibrillator is set to synchronize with the EKG on a cardiac monitor so that the elecctrical implse dischargers during ventricular depolarization (QRS comple)

• indications: SVT, A-fib, A-flutter, or unstable VT with a pulse

what is defibrillation

• asynchronos shock: high energy delivered immediately without regard to the cardiac cycle

• indications: v-fib and pulseless v-tach

what is ICd (implantable cardioverter defibrilator

• detects and terminates life threatening tachycardia or fibrillation

• indications: sudden cardiac death survivors (VF) or symptomatic (VT)

• criteria: predetermined rate limit and isolectric line segement changes

• monitoring: interrogated remotely or in-person for programming

• types: single and dual chamber

• pt who has an ICD has to have family learn CPR bc ICD may not work

pacemaker what is it

• electronic device delivering electrical stimulation to regulate HR

• indications: slower than normal HR, conduction disturbance, or advanced HF

• sensitivity: programmed to detect intrinsic electrical activity and cause response

• control: used fo some tachyarrhtyhmias unresponsice to medication

indications and function of a pacemaker

• used when pt develops symptomatic bradycardia, may require emergency packing

• ECG tracingL displays a pacemaker spike (vertical linr) with each impulse

• capture: occurs when the spike is accurately positioned to trigger a response

safety and complications of pacemaker technology

• keep cell phones 6-12 inches away (use opposite ear)

• avoid proimity to learge magnets

• MRIs can be a problem for older pacemakers

• bradycardia symptomatic is pacemaker doesnt work

• failure to capture:

  • pacemaker spikes but no comple is happening afterwards

• failure to sense:

  • doesnt know what is going on with heart, just starts pacing whenevr it wants to