Week 3: MI, Ischemia, Devices, Dysrhythmias

St segment depression

depressed below baseline, can be horizontal, downsloping, upsloping

st segment depression interpretation

myocardial ischemia, reciprocal changes or secondary to other ocnditions

st segment depression implications

presence of ST depression with symptoms or during stress test indicates myocardial ischemia or non st elevation MI (NSTEMI)

st segment depression clinical action

evaluate for symptoms (SOB, chest pain), check troponins, initiate ACS protocol if warranted, address reversible causes

st segment elevation

elevated above baseline, may appear convex/concave/straight

st segment elevation interpretation

acte transmural myocardial injury/necrosis, STEMI (st elevation)

st segment elevation implications

time sensitive cardiac emergency, rapid identification and reperfusion can save the myocardium and lives

st segment elevation clinical action

immediate assessment and activation of STEMI protocol, risk of arrhythmias or cardiogenic shock

permanent pacemaker

implanted device to deliver impulses to stimulate the heart when body cant

permanent pacemaker purpose

prevent bradycardia, maintain normal rate and rhythm, prevent syncope or sudden death

atrial pacemaker

used in sinus node dysfunction with intact AV conduction (before p wave)

ventricular pacemaker

used with av conduction blocks (right before qrs)

dual chamber pacemaker

connects both chamers on right side of heart (RA to RV)

PPM indications

sinus node dysfunction, heart blocks, cardiac denervation, severe cardiac rhythm disturbances, angina, congestive HF

sick sinus syndrome

spectrum of arrhthmias

implantable cardioverter defibrillator (ICD)

1 or 2 lead wires connect mm to pulse generator, monitors and shocks heart for abnormaliteis

ICD indications

treat Vtach and fib, prevent cardiac death, treat a flutter and a fib, bradycardia, sick sinus syndrome

role of PT for pts with PPM or ICD

know the reason, know icd discharge HR, know if they have anxiety around PPM or ICD, know functional and exercise abiltiy, commonuvate those with dr and EPS team

patient education after PPM or ICD implantation

UE in sling for 24 hrs, no shoulder exercise for 4-6 wks, limited fled/abd to 90 for 4-6 weeks, minimal wb (10-15) into UE, no lifting more than 5lbs for 4-6 weeks, no driving until follow up

dysrhthmias associated with normal or near nromal hemodynamics

sinus rhtymn with premature atrial contractions, premature junctional contractions, ventricular contractions, second degree av block type I, artificial pacemaker with 1:1, afib/flutter with ventricular response between 60-100, sinus bradycardia 50-60, av junctional rhythmn 50-60bpm

dysrhthmias associated with normal or near normal hemodynamics but are potentially dangerous

episodes of ventricular tachy, short episode of SVT, second degree AV block type 2, afib/flutter with rapid ventricular response, sinus arrest, accelerated junctional rhthms, pacemaker with premature ventricular contractions, sinus bradycardia with rates below 50

dysrhythmias with significantly altered hemodynamics

ventricular tachy, sinus rhythm or afib with complete heart block, very slow sinus junctional rhythms, malfunctioning pacemaker

dysrhythmias associated with absent hemodynamics, lethal conditions

ventricular fibrillation, asystole, pulseless ventricular tachy or flutter, agonal rhythm, electromagnetic dissociation, third degree av block with ventricular stand still