Cardiac conduction and Sudden Cardiac Death

what is the formula for stroke volume

HR x stroke vol

automaticity

ability to initiate an impulse spontaneously and continuously

excitability

ability to be electrically stimulated

conductivity

ability to be able to transmit an impulse along a membrane

contractility

ability to respond mechanically to an impulse

what is the normal rate for SA node

60-100

what is the normal for the AV node

40-60

what is the rate of the bundle of his and purkenje fibers

20-40

what is artifact caused by

leads not firmly placed or electrical interference from an outside source

muscle tremors

shivering

convulsions

strong respiratory movements

strong muscle movements

if the tele monitor is displaying a concerning heart ryththym what should be done first

check the patient

check the leads

what are the cardiac causes of dysrythmias

accessory pathways

cardiomyopathy

conduction defects

heart failure

MI

valve disease

non cardiac causes of dysrythmias

acid-base imbalances

alcohol, caffeine, tobacco

connective tissue disorder

drug effects

electric shock

electrolyte imbalances

emotional crises

herbal supplements

hypoxia

shock

metabolic conditions

near drowning

poisoning

diagnostic studies for dysrythmias

electrophysiology test

cardiac stress test

holter monitor

electrophysiology test

done in the cath lab

maps dysrythmias

like an in depth ECG

looks at the electrical mapping

cardiac stress test

done on a treadmill or a bike to see how the heart responds under stress

what 2 things stop the stress test

chest pain

EKG changes

what should be held before a stress test

beta blockers because you want to see what the pt’s heart does in response to stress

if a patient is unable to do the stress test what is given to get their heart racing

adenosine

holter monitor

worn for 30 days with a journal to accompany it

some can be under the skin

normal sinus rythym

60-100 bpm

regular rate and rythm

sinus bradycardia

less than 60bpm

regular rate and rythm

symptomatic vs asymptomatic bradycardia

some people have heart rates that are less than 60 bpm and that is normal for them and it does not need to be treated. If the person is experiencing sx such as

SOB

dizziness/lightheadedness

decreased LOC

that needs to be treated

what is the tx for symptomatic bradycardia

atropine

temporary pacemaker

permanent pacemaker

when can you move your arm on the side of the body that has the pacemaker

sinus tachycardia

HR over 100bpm-180bpm

regular rate and rythm

what are the causes of tachycardia

pain

excersise

fever

anemia

dehydration

anxiety

sepsis

HF

MI

PE
stimulant use

treatment for sinus tachy

treat the underlying cause

antipyretics

analgesics

fluids

blood products

avoiding caffeine or nicotine

relaxation techniques

PSVT

100-300bpm

usually cannot see the p wave

usually regular

what is the tx for PSVT

1 vagal maneuvers

2 adenosine

3 cardioversion

what are vagal maneuvers

coughing

squatting

breath-holding

ice on face

what are some considerations with vagal maneuvers

should not be done for more than 10 seconds

make sure oxygen, suction, a defib, and emergency meds are available

continuous ECG

do not use external ocular pressure

carotid massage is not reccomended

considerations for administering adenosine

want to have both the adenosine and a flush ready because as soon as the adenosine is administered the flush needs to be immediately pushed

adenosine is a bronchodilator so it may cause coughing, dyspnea, and bronchospasms

who should avoid adenosine and why

people with severe asthma because it is a mild bronchodilator

what is cardioversion

lower energy levels than the defib

medical procedure that needs consent

synchronized with the R wave

what does a pt need to prepare for a cardioversion

informed consent

recent ECG

18g IV with fluids

oxygen
sedation

NPO 6-8 hrs before the procedure

atrial fibrillation

irregular rate and rythym

many little bumps between QRS waves

what medication are people on that have a-fib

coumadin or eliquis

to avoid blood clots

bc blood pools in the atria

what to do before a cardioversion

blood thinners and TEE

be careful with an a-fib patient because blood is pooling and they have a high risk for clots

a-fib with RVR

over 100bpm

irregular rate and rythym

what is the first thing you want to do with a-fib with RVR

control the rate with calcium channel blockers and beta blockers

signs and sx of afib and flutter

palpitations

weakness

dizziness

SOB

atrial flutter

sawtooth rythm

what are the tx for afib and aflutter

calcium channel blockers

cardioversion

cardiac ablation

what medications are used for afib and flutter

calcium channel blockers

beta blockers

antiarrythmics

antiplatelet aggregators

anticoagulants

cardiac ablation

destroy signals in the heart to get rid of multiple foci

patient teaching for pacemakers

know what kind of pacemaker you have

let all health care providers know about your pacemaker

wear a medical bracelet or necklace for emergencies

stay away from strong electrical devices

it is okay to be active but avoid contact sports

get the pacemaker checked regularly to make sure it is working properly

what does a pacemaker look like on a pacemaker strip

spikes then the p-wave (atrial)

spikes then the QRS (vetnricular)

failure to capture

pacemaker goes off but the ventricles did not contract and there is no QRS

failure to sense

when the pacemaker goes off at random times

vtach

very fast heart rythm

what is the special thing about vtach

can occur with or without a pulse

if there is no pulse with vtach what do you do

defib

what are the causes of vtach

coronary artery disease

cardiomyopathy

what can vtach lead to

vfib

vfib

asystole

no movement on the strip

PEA

normal activity is on the strip but the pt has no pulse

what are the causes of PEA

6 H’s

hypovolemia

hypoxia

acidosis

hypo/hyperkalemia

hypoglycemia

hypothermia

5 T’s

toxins

tamponade

tension pneumothorax

thrombosis

trauma

what is sudden cardiac death caused by

vfib and vtach

what is TTM

targeted temperature management

preserves neuro function after cardiac death

do not rewarm the pt too fast becuase it can cause seizures

ICD

implantable cardioverter defib

monitors and corrects dangerous heart rythms (vfib and vtach)

how can you tell the difference between vtach and vfib

vtach is regular and vfib is irregular

p wave

atrial contraction

systole

atrial depolarization

PR interval

the time it takes for the electrical impulse to travel from the atrium to the ventricles

QRS

ventricles contracting

systole

ventricular depolarization

ST

time it takes to go from depol to repol

systole to diastole

T wave

total repolarization

diastole

autonomy

having the ability to make decisions for onesself

beneficence

going out of one’s way to do an act of kindness

nonmaleficence

avoiding causing harm to others

justice

fairness and equality

veracity

truthfullness or accuracy

delerium

can be hypoactive or hyperactive

treated with haloperidol and atypical antipsychotics

frequently reorient the patient first

DT

complication of alcohol withdrawal that is treated with lorazepam and diazepam

where does cardioversion. sync and where does it not want to sync

R wave

T wave causes scd

tx for PSVT

vagal

adenosine

cardioversion

RVR

calcium channel blocker

cardiovert

cardiac ablation

vtach causes

CAD

cardiomyopathy

SCD

gravestones

what is special about vtach

can have a pulse or no pulse

vtach with pulse

give drugs

CPR

vfib

never has a pulse

vtach without pulse

defib

CPR
drugs

what do you do i

vfib

defib

compressions

meds

asystole

CPR

drugs

not shockable

PEA

looks normal on the strip and then has no pulse

tx for PEA

find the cause

CPR

meds

not shockable

SCD

vfib and vtach

TTM

after SCD to prevserve neuro function

ICD

personal defibilator for someone that is at high risk for SCD

when adenosne is given what happened

a short period of asystole