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NUR 435 EKG
| Question | Answer |
|---|---|
| if symptomatic, treat w/ atropine to block parasympathetic stimulation; increase SNS stimulation w/ dopamine, epinephrine, isoproterenol; transcutaneous pacing; pacemaker | sinus bradycardia |
| rate is usually 100-160 bpm | sinus tachycardia |
| Treat the cause! Beta-blockers may be used to decrease HR and myocardial consumption for the patient with ischemic heart disease. Additional drugs that slow the sinus rate include Ca channel blockers, digoxin, and sedatives | sinus tachycardia |
| normal sinus rhythm, sinus bradycardia, and sinus tachycardia | sinus rhythms |
| Ectopic beat will interrupt the regularity of the underlying rhythm | premature atrial contraction |
| P wave of the premature beat will have a different morphology than the P waves on the remainder of the strip. | premature atrial contraction |
| Usually no treatment is indicated if occur infrequently. An increase in frequency indicates an increase in atrial irritability. Antiarrhythmic drugs may be used to suppress frequent. | premature atrial contraction |
| HR is usually 150-250 bpm | atrial tachycardia |
| No treatment indicated if terminates spontaneously. If persists and unstable, immediate cardioversion, if stable, vagal maneuver may be attempted to terminate or adenosine may be given IVP. Ca channel blockers, beta blockers, amiodarone, or digoxin. | atrial tachycardia |
| Atrial rate may be 250-400 bpm (most often 300 bpm). | atrial flutter |
| Slow the ventricular response with Ca channel blockers, beta blockers, or digoxin. Convert to sinus with amiodarone, procainamide, or ibutilide. Cardioversion may be indicated. Radiofrequency catheter ablation increasing use. | atrial flutter |
| Atrial and ventricular rhythm is irregular; no pattern to the irregularity, known as “irregularly irregular”. | atrial fibrillation |
| Goal of treatment is to reduce ventricular response. Ca channel blockers, beta-blockers, or digoxin may be used to slow the ventricular rate. Procainamide, amiodarone, or ibutilide. Coumadin used in chronic A Fib to reduce risk of thromboembolism. | atrial fibrillation |
| ectopic beats with uniform appearance | unifocal PVCs |
| ectopic beats with a variety of configurations | multifocal PVCs |
| two PVCs in succession without a normal beat in between | couplet |
| PVCs that occur in the relative refractory period (the downslope of the T wave of the preceding beat) are considered to be very serious because they are more prone to result in uncontrolled repetitive ectopics. This is called what? | R-on-T phenomenon |
| 2 signs of increasing irritable ventricular focus | R-on-T phenomenon and couplet |
| # of PVCs in a minute to initiate treatment | 6 |
| 3 or more PVCs in succession | run of PVCs |
| PVC every other beat | bigeminy |
| two normal beats with a PVC | trigeminy |
| 3 normal beats with a PVC | quadrigeminy |
| QRS will be wide and bizarre; measures ≥0.12 seconds. T wave often in the opposite direction from the QRS. | premature ventricular contraction |
| 4 indications to treat PVCs | (1) 6 or more PVCs per minute, (2) couplets or runs, (3) multifocal PVCs, (4) R-on-T phenomenon |
| The antiarrhythmic drugs amiodarone, lidocaine, or procainamide may be used. Electrolyte imbalances and ischemia should be corrected. | PVCs |
| Atrial rate cannot be determined. Ventricular rate is usually 150-250 | ventricular tachycardia |
| Assessment of the patient for symptoms of decreased CO is the essential first step because treatment depends on rhythm tolerance | ventricular tachycardia |
| • If stable, amiodarone IV dose followed by continuous infusion. Procainamide or lidocaine may also be used. • If unstable with a pulse, immediate cardioversion. • If pulseless, immediate defibrillation. | ventricular tachycardia |
| No waves or complexes that can be analyzed to determine regularity. Baseline is totally chaotic | ventricular fibrillation |
| Defibrillation is the only definitive treatment ASAP. CPR is administered if a defibrillator is not immediately available. Drug therapy may include vasopressin, epinephrine, amiodarone, lidocaine, magnesium, or procainamide | ventricular fibrillation |
| Ventricular inherent rate is 20-40 | ventricular escape rhythm (idioventricular rhythm) |
| Emergency transcutaneous pacing is usually necessary. Therapy is aimed at regaining SA node function with drugs such as atropine, epinephrine, or isuprel. Rhythm should not be suppressed, as there is no other pacemaker functioning | ventricular escape rhythm (idioventricular rhythm) |
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