Ventricular Rhythms - Adult Nursing Care I

Type of abnormal rhythm where there are are extra heartbeats that start in the ventricles.

Premature ventricular complexes (PVCs)

What's it called when there are 3 or more PVCs at a rate greater than 100 bpm?

Ventricular tachycardia (VT)

In ventricular tachycardia is the ventricular rhythm regular or irregular?

The ventricular rhythm is essentially regular

In ventricular tachycardia what is the rate?

101-250 bpm

In ventricular tachycardia what do the P waves look like?

The P waves are usually NOT SEEN, if present, they have no set relationship with the QRS

In ventricular tachycardia what does the PR interval look like?

There is NO PR interval

In ventricular tachycardia, how long is the QRS duration?

The QRS duration is 0.12 seconds OR greater; often difficult to differentiate between the QRS and T wave

What medication doesn't work on atrial flutter, atrial fibrillation, or ventricular tachycardia?

Adenosine

What 5 things set ventricular tachycardia apart from other abnormal rhythms?

1. The ventricular rhythm is essentially regular

2. The rate is 101-250 bpm

3. The P waves are usually NOT SEEN, if present, they have no set relationship with the QRS

4. There is NO PR interval

5. The QRS duration is 0.12 seconds OR greater; often difficult to differentiate between the QRS and T wave

What type of ventricular tachycardia lasts less than 30 seconds?

Non-sustained ventricular tachycardia

What type of ventricular tachycardia lasts more than 30 seconds?

Sustained ventricular tachycardia

What type of ventricular tachycardia has waveforms that are the same size and amplitude?

Monomorphic ventricular tachycardia

What rate does ventricular flutter have?

150-300 bpm

What type of ventricular tachycardia has QRS vary in shape and amplitude? (appear to twist from positive to negative and back again, resembling a spindle)

Polymorphic (Torsades de Pointes) VT (has a rate of 150-300bpm)

How long is the QT interval in polymorphic (Torsades de Pointes)?

Prolonged QT (typically 0.45 seconds or more)

How is polymorphic (Torsades de Pointes) treated? (2 ways)

1. Antitachycardia pacing- a therapy that uses an implantable cardioverter-defibrillator (ICD) to stop ventricular tachycardias without causing pain.

2. Magnesium sulfate

All of these things can cause what type of abnormal rhythm?

- Acid-base imbalance

- Acute coronary syndromes

- Cardiomyopathy

- Cocaine abuse

- Digitalis toxicity

- Electrolyte imbalance

- Mitral valve prolapse

- Trauma: myocardial contusion

- Trauma: Invasive cardiac procedures

- Tricyclic antidepressant overdose

- Valvular heart disease

Ventricular tachycardia

If someone has ventricular tachycardia and they are stable WITH a pulse what 4 things should you do?

1. Assess ABCs

2. Administer oxygen

3. Check vital signs

4. IV access --> amiodarone

If someone has ventricular tachycardia and they are unstable (CONSCIOUS) WITH a pulse what 2 things should you do?

Do same as stable PLUS synchronized cardioversion

If someone has ventricular tachycardia and they are unstable WITHOUT a pulse what 3 things should you do?

1. CPR

2. Defibrillation (higher shock than cardioversion)

3. Administer epinephrine or vasopressin (stimulates the heart and improves coronary perfusion)

What are the 5 H's for potential reversible causes?

1. Hypovolemia

2. Hypoxia

3. Hypothermia

4. Hypo-/hyperkalemia

5. Hydrogen ion (acidosis)

What are the 5 T's for potential reversible causes?

1. Tamponade, cardiac

2. Tension pneumothorax

3. Thrombosis: lungs (massive pulmonary embolism)

4. Thrombosis: heart (acute coronary syndromes)

5. Tablets/toxins: drug overdose

What kind of long term treatment involves a procedure that assesses the heart's electrical activity to identify and treat abnormal heart rhythms either with ablation or resection?

Electrophysiology (EP) study

What kind of long term treatment involves a small device that's surgically implanted in the chest to monitor and correct irregular heart rhythms?

An implantable cardioverter defibrillator (ICD)

What kind of rhythm does ventricular fibrillation have?

Rhythm is rapid and chaotic with no patter or regularity

What kind of rate does ventricular fibrillation have?

The rate CANNOT be determined

What kind of P waves should ventricular fibrillation show?

The P waves are NOT discernible

In ventricular fibrillation, what does the PR interval show?

The PR interval is NOT discernible

In ventricular fibrillation, what does the QRS duration show?

The QRS duration is NOT discernible

What type of ventricular fibrillation appears as large waves on an ECG?

Coarse ventricular fibrillation (VF)

What type of ventricular fibrillation has waveforms that are very small and almost looks like a straight line?

Fine ventricular fibrillation (VF)

What 5 things set ventricular fibrillation apart from other abnormal rhythms?

1. The rhythm has NO patter or regularity

2. The rate CANNOT be determined

3. The P waves are NOT discernible

4. The PR interval is NOT discernible

5. The QRS duration is NOT discernible

All of these factors increase the susceptibility of developing what type of abnormal rhythm?

- Acute coronary syndromes

- Dysrhythmias

- Electrolyte imbalance

- Environmental factors (e.g., electrocution)

- Hypertrophy

- Increased sympathetic nervous system activity

- Pro-arrhythmic effect of medications

- Severe heart failure

- Vagal stimulation

Ventricular fibrillation

What is the first thing you should do if someone has ventricular fibrillation?

Perform high-quality CPR

In ventricular fibrillation you should perform high-quality CPR until what device is available?

A defibrillator is available. Perform defibrillation as soon as a defibrillator (or AED) arrives

When someone has ventricular fibrillation besides performing CPR and performing defibrillation what else should you administer?

Administer medications and perform additional interventions in accordance with current ACLS guidelines

What 2 abnormal rhythms are considered shockable and a defibrillator/AED can be used?

1. Pulseless ventricular tachycardia

2. Ventricular fibrillation

What 2 abnormal rhythms are considered unshockable?

1. Asystole

2. Pulseless electrical activity (PEA)

In asystole, is the ventricular rhythm discernible or not discernible?

The ventricular rhythm is NOT discernible

In asystole, is the atrial rhythm discernible or not discernible?

The atrial rhythm MAY BE discernible

In asystole, is the ventricular rate discernible or not discernible?

The ventricular rate is NOT discernible

In asystole, is the atrial rate discernible or not discernible?

The atrial rate MAY BE observed in P-wave asystole

In asystole, are the P waves discernible?

The P waves are usually NOT discernible

In asystole, what is the PR interval like?

The PR interval is NOT measurable

In asystole, what is the QRS duration like?

The QRS duration is ABSENT

Type of abnormal heart rhythm where the heart completely stops beating

Asystole

A cardiac rhythm where only P waves are present on the ECG without any ventricular activity, indicating that the atria are firing but the ventricles are not responding, leading to no cardiac output.

P wave asystole

What 5 things set asystole apart from other abnormal rhythms?

1. The ventricular rhythm is NOT discernible, the atrial rhythm MAY BE discernible

2. The ventricular rate is NOT discernible, the atrial rate MAY BE observed in P-wave asystole

3. The P waves are usually NOT discernible

4. The PR interval is NOT measurable

5. The QRS duration is ABSENT

Asystole may occur following termination of a tachycardia with what 3 things?

1. Medications such as adenosine (lowered HR too much)

2. Defibrillation

3. Synchronized cardioversion

What is the first thing you should do if you notice someone has asystole?

Begin high-quality CPR

If someone has asystole what 2 things would you check before giving CPR?

Confirm that the patient is unresponsive and has no pulse

What are 3 other things you should do if someone has asystole?

1. Establish vascular access

2. Consider the possible causes of the arrest

3. Administer medications and perform additional interventions in accordance with current ACLS guidelines

What kind of medical condition shows organized electrical activity on an ECG but the client is unresponsive, not breathing, and has no pulse?

Pulseless electrical activity (PEA)

What should you do if you notice someone has pulseless electrical activity (PEA)? (5 things)

1. Perform CPR

2. Give oxygen

3. Start an IV

4. Possible placement of an advanced airway

5. Aggressive search for the underlying cause of the situation (tension pneumothorax, cardiac tamponade, massive PE, etc.)