Patho Exam 2 Part 3

What is dysrhythmia/arrhythmia?

cardiac rhythm abnormality affecting impulse generation or conduction​

What are the factors/etiology leading to dysrhythmia?

\-Hypoxia, electrolyte imbalance, trauma, inflammation, drugs​

\-Infarction causes trauma and inflammation 

_____ indicate an underlying pathophysiologic disorder.

dysrhythmias

Dysrhythmia can impair normal _____.

CO and BP (not a regular or perfused heartbeat so loss of CO​)

WHat is the normal excitation of the heart?

\-SA node​

\-Atrial internodal pathways​

\-AV node​

\-Bundle of His​

\-Ventricular bundle branches​

\-Purkinje fibers​

What is an ECG?

\-Graphic recording of electrical activity of the heart. ​

\-Generates a picture of the electrical current generated by the heart. 

What are the types of ECG?

3 lead tracing and 12 lead tracing

_____ has 6 limb leads and 6 chest leads.

12 lead tracing

What is 12 lead tracing?

diagnostic and provides an electrical “picture” through multiple views of the heart

On an ECG, a tiny box is…

0\.04 sec

On an ECG, a larger box is…

0\.20 sec

On an ECG, 5 larger boxes are…

1 sec

On an ECG, 1500 small boxes are…

1 min

What should every beat include?

P, QRS, and T​

What is a normal PR?

0\.12-0.20

What is a normal QRS?

0\.04-0.10

What is a normal QT?

0\.40 (varies with rate)

_____ is rate over 100.

tachycardia

_____ is rate under 60.

bradycardia

What is a normal sinus rythm (NSR)?

\-Rate 60-100, begins in sinus node and follows normal conduction pathway​

\-Regular rhythm​

\-P wave for every QRS​

\-No “funny looking” beats​

What is the mechanisms of arrythmias?

results in abnormal rates, abnormal impulse generation, and/or abnormal conduction through the heart​

What are the types of arrhythmia?

\-abnormal impulse generation

\-abmormalities of impulse conduction

What is abnormal impulse generation?

\-Loss of automaticity—failure to repolarize​ (Most often caused by ischemia/hypoxia, electrolyte imbalances or ischemia that results in ATP deficiency in cells)​

\-Triggered activity—impulse generated just after repolarization or during repolarization​ (Most often Calcium disturbances or other electrolyte disturbances​)

\-Ectopic pacemaker: impulse starts at the wrong site ​

What is abmormalities of impulse conduction?

\-Reentry phenomena: Conduction gets caught in a “loop”​

\-Slowed conduction or blocks​​

What are the types of sinus node arrythmias?

Sinus Bradycardia, Sinus Tachycardia, Sinus Arrythmia, and Sinus Arrest

What is arrythmias of atrial origin?

impulse originates in atrial cells​

What are the types of arrythmias of atrial origin?

PAC’s, Atrial Flutter, and Atrial Fibrillation

What is junctional arrythmias?

AV node acting as a pacemaker​

What is ventricular arrythmias?

impulse arises in the ventricle​

What are the types of ventricular arrythmias?

PVC’s, Vtach, and Vfib

What is disorders of atrioventricular conduction?

conduction defect in the AV node​

What are the types of atrioventricular conduction?

1st, 2nd, 3rd degree heart blocks, BBB

What is sinus tachycardia?

\->100 beats/min​

\-Causes: ↑ sympathetic activity, ↓parasympathetic activity, fever, hyperthyroidism, pain, ↑metabolism, hypoxia, ↓BP​

\-Compensatory response to ↑ demand for CO

What is sinus bradycardia?

\-

What is sinus arrhythmia?

\-Degree of variability in HR​

\-Normal finding​ (fluctuations in respiratory dynamics​)

\-More often in children​

\-Different from sick sinus​ (alternating sinus tachy and sinus brady)

What is sinus arrest?

\-Absence of impulse initiation​

\-True Flat line​

\-No cardiac output at all​

\-Need a pacemaker​

\-An escape rhythm from a slower pacemaker site with generally begin to fire

What is atrial flutter?

\-Rapid atrial rate, sawtooth pattern​

\-QRS is normal​

\-Ventricular rate is slower and irregular

What is atrial fibrillation?

\-Completely disorganized and irregular rhythm​

\-Irregular ventricular rhythm also​

\-Loss of atrial kick​

\-Chronic a fib requires anticoagulant therapy​

\-Cardioversion, antiarrhythmic drugs

What is premature ventricular complexes (PVC’s)?

\-Arise from the ventricular myocardium​

\-Do not activate the atria or depolarize the sinus node​

\-Bizarre QRS​

\-Compensatory pause is common​

\-Bigeminy (every other beat) or trigeminy (every third beat)​

\-With high frequency, CO may be compromised

What is ventricular tachycardia?

\-3 or more consecutive ventricular complexes at a rate > 100 beats/minute​

\-ECG depicts a series of large, wide, undulating waves​

\-P waves are not associated with the QRS complexes​

\-May be fatal if not rapidly managed (Antiarrhythmic drugs, CPR,  cardioversion)

What is ventricular fibrillation?

\-Rapid, uncoordinated cardiac rhythm resulting in ventricular quivering and lack of effective contraction.​

\-ECG is rapid and erratic, with no identifiable QRS complexes.​

\-Results in death if not reversed within minutes.

What is AV conduction 2nd degree type 1?

Progressive lengthening of PR and then a P drops (no QRS for that P): Type I​

What is AV conduction 2nd degree type 2?

Or nonconducted P wave (no QRS for the p): Type II​

_____ has no prolonged lengthening.

type 2

What is AV conduction 3rd degree heart block?

\-No p waves are conducted to a QRS. Have a junctional rhythm only ​

\-Atria and ventricle conduction are independent, they are not communicating

What is bundle branch blocks?

\-Abnormal conduction of impulses through the intraventricular bundle branches​

\-Delay or slowed impulse to the ventricle producing a bizarre QRS (abnormal ventricular depolarization)​

\-Right BBB feeds Right ventricle​

\-Left BBB feeds Left Ventricle

What is the treatment for dysrhythmias?

\-Treated if they produce significant symptoms or progressing​ (Complaints of dizzy or fainting? ​Goal is to ensure adequate CO, BP, tissue perfusion​)

\-Antidysrhythmic drugs​

\-Pacemakers to ensure beats​

\-Defibrillation vs. cardioversion​

\-Ablation​

\-Anticoagulant therapy to minimize risk of clot formation from stasis

A FIB needs _____ therapy​.

anticoagulant

A first-degree heart block is characterized by:​

A) bradycardia​

B) dropped P waves​

C) prolonged PR interval​

D) widened QRS​​

prolonged PR interval​

Which of the following best describes dysrhythmias?​

​A) Abnormalities of the electrical conduction in the heart.​B) Diminished cardiac output.​

C) Narrowing of the coronary arteries.​

D) High blood pressure.​

abnormalities of the electrical conduction in the heart

Acyanotic shunts are associated with

A) shunting

B) Teralogy of fallot

C) severe blue color to the baby after birth

D) left to right shunting

left to right shunting

A blood clot in the right leg vein is associated with what s/s?

A) ischemia distal to the clot (the foot)

B) ischemia proximal to the clot

C) diminished pedal pulses

D) redness, swelling, and edema of the foot

redness, swelling, and edema of the foot

Which s/s is accosicated with right sided HF?

A) peripheral dependent edema

B) crackles bilaterally auscultated

C) shortness of breath

D) blood tinged sputum

peripheral dependent edema

A patient has an EF of 25%. This is consistent with a diagnosis of what heart failure?

A) ectopic

B) diastolic HF

C) right sided HF

D) systolic HF

systolic HF

Which of the following is a compensatory mechanism of HF?

A) increased PNS activity

B) decreased preload

C) myocardial hypertrophy

D) decreased SNS activity

myocardial hypertrophy

T or F: Left sided HF is associated with jugular vein distention.

false

What system is responsible for the increase of preload d/t HF?

A) the GI system

B) parasympathetic nervous system

C) RAAS

D) HTN

RAAS

What is associated with insufficiency of a valve to close completely during systole?

A) stenosis

B) fibrosis

C) anal prolapse

D) regurg

regurg

What disease is associated with leaflets on the valves following a step infection?

A) scarlet fever

B) polio

C) epiglottis (croup)

D) rheumatic HD

rheumatic HD

Stable angina is defined as

A) chest pain that does not relieve with rest

B) chest pain associated with elevated ST segment on EKG

C) chest pain associated with elevated cardial biomarkers

D) chest pain that is predictable in nature

chest pain that is predictable in nature

Which of the following is a modifiable risk factor for CAD?

A) being male

B) menopause

C) chronic inflammatory conditions

D) smoking

smoking

Cardiac tamponade will immediately lead to

A) increased blood pressure

B) decreased CO

C) increased risk of bleeding

D) decreased HR

decreased CO

What disease is associated with aschoff bodies forming on the endocardium?

A) rheumatic heart disease

B) CVD

C) CAD

D) mitral valve prolapse

rheumatic heart disease

Intracellular fluid is _____ the cells.

within

Intracellular fluid is more _____.

stable

Extracellular fluid in _____ the cell.

outside

Extracellular is more _____.

unstable

_____ carries nutrients throughout the body and moves water.

extracellular fluid

What is the ratio of total body water?

1/3 is ECF and 2/3 is ICF

What is hydrostatic pressure?

Normal movement through capillary wall depends on force of pressure

Hydrostatic pressure is controlled by the _____.

heart

_____ exerted by the force of the heart pumping.

hydrostatic pressure

What is incotic pressure?

\-Osmotic pressure generated by large particles such as plasma proteins​

\-“Holds” fluid in the vascular

_____ oncotic pressure is protein deficient.

low

What os osmolarity?

\-Concentration of solutes​

\-Determines the movement of electrolyte. Move high to low to “balance”​

What is isotonic?

normal range

What is hypotonic?

low osmolarity

What is hypertonic?

high osmolarity

0\.9% sodium chloride (normal saline) is _____.

isotonic

Lactated Ringers is roughly _____.

isotonic

0\.45% Sodium Chloride (1/2 Normal Saline) is _____.

hypotonic

Dextrose 5% Water (D5W) is _____.

hypertonic from dextrose but then dextrose is quickly metabolized and it becomes hypotonic (water)​

3% or 5% Sodium Chloride is _____.

hypertonic

What are the different fluid intakes?

\-Oral intake and absorption from GI tract​

\-IV 

What are the types of excretion?

\-Urinary tract, bowels, lungs, and skin

\-ADH and Aldosterone

What is ADH and aldosterone?

controls amount of fluid excreted in urine​

_____ causes reabsorption of water to dilute the osmolality and increase FV​.

ADH

_____ causes renal tubules to reabsorb Na and water to expand FV.

aldosterone

Fluid intake and excretion leads to…

fluid volume imbalances

_____ compares the weight of urine with that of water.

urine specific gravity

Higher the specific gravity, the more _____ the urine is​.

concentrated

What is the specific gravity of water?

1 (urine closer to 1 is more dilute, higher is more concentrated)

What is fluid volume deficit (FVD)?

Most often related to ECF as that is the more unstable location of fluid

What are the causes of FVD/dehydration?

\-GI losses—nausea, vomiting, diarrhea​

\-Wound/fistula losses—including burns​

\-Increased UO or polyuria​

\-Fever – increased metabolic rate ​

\-Sweating ​

\-Decreased oral intake—anorexia, depression, medications​

\-Third Spacing of fluid​

\-Can also be caused loss of Na (hyponatremia)​

What is third spacing?

\-Shift of fluid from vascular space to an area which it cannot be used by the body.​

\-Trapped fluid & Nonfunction to the body​

\-Weight remains same but the fluid is unusable​

What does third spacing usually result from?

\-Altered capillary permeability secondary to injury, ischemia or inflammation​ (Fluid and plasma particles leak out of the vessels​)

\-Loss of colloid oncotic pressure or poor hydrostatic pressure​

What are the causes of third spacing?

Surgery, burns, ascites, sepsis and immune responses, heart failure, low plasma protein

What are the clinical manifestations of third spacing?

similar to FVD but without change in body weight