CMA > EKG Unit 17 > Flashcards

EKG Unit 17 Flashcards

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1
Q

What are antirhythmics?

Chapter 16

A
  • Treat/prevent Arrhythmias
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2
Q

What are the four classes of antirhythmics and how do they work?

Chapter 16

A

Class I: Interferes with sodium influx in Phase 0

Class II: Prolongs Phase 4

Class III: Interferes w K+ influx during Phase 3

Class IV: Interferes w Ca+ influx into cardiac cells during Phase 2 and 4, Slows Phase 4

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3
Q

What are two types of C1A antiarrhythmics?

Chapter 16

A

Quinidine
Procainamide

Both:
- Prolong QT interval and decrease cardiac contractility
- Cause hypotension

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4
Q

What are two types of C1B antiarrhythmics?

Chapter 16

A

Lidocaine
Tocainde
Both:
- Local anesthetic
- Treat ventricular arrhythmias
- Raise fibrillatory threshold

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5
Q

What are two types of C1C antiarrhythmics?(3)

Chapter 16

A

Flecainide
Propafenone
Both:
- Slow impulse conduction
- Treat SVT and Ventricular arrhythmias
- Cause arrhythmias

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6
Q

What are two types of beta-blockers?

Chapter 16

A

Beta-1: Decrease HR, Conductivity, Contractility

Beta-2: Relax smooth muscle in arteries and bronchi

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7
Q

What are two types of C2 beta-blockers?(2)

Chapter 16

A

Propranolol
Atenolol
Both:
- Decrease automaticity of sinus node, AV conduction, and depolarization
- Treat SVT

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8
Q

What are two types of K+ channel blockers?

Chapter 16

A

Amidarone: SVT and ventricular tachyarrhythmias
Ibutilide: SVT
Both:
Interfere with K ion movement during Phase 3
- Prolong PR, QRS, QT interval

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9
Q

What are two types of CIV Ca+ channel blockers?

Chapter 16

A

Veropamil
Diltiazem
Both:
- Interfere with influx of Ca into cardia cells in Phase 1/2 and slow Phase 4
- AV conduction prolonged, contractility decrease
- PR interval increase, HR slows
- SVT

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10
Q

What class is Adenosine and what does it treat?

Chapter 16

A
  • Unclassed
  • Treat SVT
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11
Q

What class is Digitalis and what does it treat?

Chapter 16

A
  • Cardiac glycoside
  • Heart failure and supraventricular arrhythmia
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12
Q

What does atropine do? When is it used?

Chapter 16

A
  • Increases HR
    • reverses vagal influence
  • Inserted in marrow of large bone
  • Used in arrhythmia induced life threatening emergencies
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13
Q

What does Epinephrine do? When is it used?

Chapter 16

A
  • Vasoconstricts increasing BP
  • Restores/increases HR in cardia arrest
  • Used in arrhythmia induced life threatening emergencies

Used for asystole,vfib,pulseless vtach,profound brady

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14
Q

What does Dopamine do? When is it used?

Chapter 16

A
  • Increases HR and Renal Blood flow
  • Used in arrhythmia induced life threatening emergencies

Infusion in bradycardias

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15
Q

What does Amiodarone do? When is it used?

Chapter 16

A
  • C3 antiarrhythmic
  • Treats Vfib and pulseless Vtach
  • Used in arrhythmia induced life threatening emergencies
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16
Q

What does adenosine do? When is it used?

Chapter 16

A
  • Convert SVT to sinus/slower HR
  • Results in transient asystole for6-7s before conversion to sinus
  • Used in arrhythmia induced life threatening emergencies
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17
Q

What does Sodium Bicarbonate do? When is it used?

Chapter 16

A
  • Decreases CO2 buildup of blood in cardiac arrest
  • Used in arrhythmia induced life threatening emergencies
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18
Q

What does oxygen do? When is it used?

Chapter 16

A
  • Provides oxygen to defficent tissue
  • Used in arrhythmia induced life threatening emergencies
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19
Q

What are diuretics and how do they affect the heart?

Chapter 16

A
  • Increase urine output
  • Can result in dehydration and electrolyte disturbances
  • Can cause tachycardias/ ventricular arrhythmias
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20
Q

What are bronchodilators and how do they affect the heart?

Chapter 16

A
  • Dialate airways
  • Cause tachycardia
  • Decrease cardiac output, cause ischemia, and chest pain
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21
Q

What are Antihypertensives and how do they affect the heart?

Chapter 16

A
  • Treat HBP
  • Inculdes diuretics, Beta blockers, vasodilators
  • Can cause AV block or Bradycardia
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22
Q

What are Nitrates and how do they affect the heart?

Chapter 16

A
  • Dialate coronary arteries
  • Reduce chest pain
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23
Q

What are glaucoma medications and how do they affect the heart?

Chapter 16

A
  • Decrease eyeball pressure
  • (beta blocker) Causes bradycardia
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24
Q

What are ED meds and how do they affect the heart?

Chapter 16

A
  • Cause profound drop in BP, ischemia, MI, Tach
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25
What are TCA and how do they affect the heart? ## Footnote Chapter 16
- Treat clinical depression - Cause bradycardia, AV block, sinus tachy, ventricular arrhythmia, asystole, Wide QRS, long PR/QT
26
What are illegal drugs and how do they affect the heart? ## Footnote Chapter 16
- Used for buzz - Cause torsades, long QT,hypotension,hyper, tachy, AV blocks, and more
27
What are Thrombolytics and how do they affect the heart? ## Footnote Chapter 16
- Dissolve blood clots - Result in bleeding and increased HR
28
What are Anticoagulants and how do they affect the heart? ## Footnote Chapter 16
- Prevent blood clots - Can cause bleeding leading to tachy
29
What is electrical therapy? ## Footnote Chapter 16
- Therapy involving electrical stimuli to speed up or slow down heart and shock the heart out of an unstable rhythm - Artifical pacemakers - Cardiodiversion/defibrillation
30
What is a pacemaker? ## Footnote Chapter 16
- Prevent heartrate from being too slow by providing electrical stimulus when th heart cannot - Can pace the atrium, ventricles, or both
31
What are indications that a pacemaker is necessary? ## Footnote Chapter 16
Symptomatic sinus bradycardia Junctional rhythms Idioventricular rhythm Dying heart Asystole 2:1 AV block Mobitz II second-degree AV block Third degree AV block Antitachycardia pacing
32
What is antitachycardic pacemaking? ## Footnote Chapter 16
- Interrupts tachychardia by interjecting paced beats allowing sinus node to resume control
33
What is a permanent pacemaker? Where is it placed? How long does it last? ## Footnote Chapter 16
- A pacemaker that is used when an arrhythmia is permanent - Battery is placed in pocket near clavicle, Pacemaking catheter enters the left subclavian vein - Last 5-15 years
34
What is a temporary pacemaker? ## Footnote Chapter 16
- Given to patients afteran MI or other problem causing temporary bradycardia Transvenous: Pacing catheter inserted in large vein into righ atrium and ventricle Transcutaneous: Large electrode placed on chest and back
35
What do firing, capture, and sensing refer to with respect to pacemakers? ## Footnote Chapter 16
Firing: - Pacemakers generation of an electrical stimuli Capture: - Presence of P wave or QRS after a pacemaker spike (a paced chamber is captured) Sensing: - The ability for the pacemaker to recognize the patient's intrinsic beats to decide if firing is needed
36
What is the three letter coding for pacemaking? ## Footnote Chapter 16
1st & 2nd Letter: V - ventricle A - atrium D - dual O - none Third (response) I - inhibited T - triggered D - dual O - none
37
What are VVI pacemakers? ## Footnote Chapter 16
- Most common (and DDD) - Pace ventrile providing spike then wide QRS
38
What two things can VVI pacemakers do? ## Footnote Chapter 16
Intrinsic beats: pacemaker does not pace as it isnt needed Paced QRS dissociated intrinsic P waves: - Pacemaker only paces ventricle and spikes precede QRS complexes, P waves if present are ignored
39
What is a DDD pacemaker? ## Footnote Chapter 16
- Modern and universal pacemaker for both chambers - P waves are sensed intrinsically and artial pacemaker is inhibited - If QRS does not trigger in a set length of time it will step in - DDD are able to be inhibited and step in when needed
40
What is rate responsiveness in respect to DDD pacemakers? ## Footnote Chapter 16
- Will provide a paced QRS to follow intrinisc P waves of patient - If P waves are within limit (60-125 bpm) no pace making is needed
41
What four options do DDD pacemakers provide? ## Footnote Chapter 16
Intrinsic beats only: - Doesn't fire because it doesnt need to Paced P wave, Intrinisc QRS: - Atrium is paced, patient has their own QRS Paced P wave, Paced QRS: - Both P wave and QRS are paced for providing both spikes Intrinsic P wave, Paced QRS: - Patient's own P waves but QRS is paced for
42
What is signal averaging?
- About 250 consecutive QRS are collected and averaged to cleanse background noise and artifacts - Calculations are performed and software can uncover QRS variations that arise from scarred myocardial tissue - Late potentials outline QRS variations
43
What is stress testing?
- Procedure to determine risk of coronary artery disease (CAD) - Heart is stressed via excersise or meds - EKG is recorded and analyzed revealing patency of coronary arteries
44
What is the goal of a stress test?
- Increase HR to be able to get information on if ischemia or infarction are occuring - Test ends when patient's symptoms preclude continuing or target HR is reached
45
What are indications for stress testing?
- Postangioplasty evaluation - Diagnosis/treatment of excersise-induced arrhythmias - Follow up to cardiac rehab - Family history
46
What are contraindications for stress testing
- Acute MI less than 48H - Uncontrolled symptomatic heart failure - Unstable angina - Uncontrolled arrhythmia w/ signs of decreased cardiac output - Symptomatic severe Aortic stenosis - Dissecting aneurysm - Acute myocarditis or pericarditis - Acute pulmonary embolus (PE)
47
What are relative contraindications
- Left main coronary artery stenosis - Mental/physical issues - Uncontrolled tachyarrhythmias - Severe hypertension - High degree AV block (2nd & 3rd) - Electrolyte abnormalities - Moderate stenotic heart valve disease - Hypertrophic cardiomyopathy
48
How is an stress test conducted?
- Baseline vitals are taken - Excersise test begins with periodic vitals being taken - Depending on type of test different additional test of substances can be administered
49
What is the target heart rate of a stress test?
(220-age) x 85%
50
What are the three excersise protocols?
Bruce Modified Bruce Naughton
51
What is a MET
- Metabolic equivalent - The amount of O2 consumed by a person sitting
52
What is Bruce protocol?
- Most common - Treadmill speed and incline increase every 3 min for 21 min
53
What is modified Bruce protocol?
- Less strenuous initial stages - For patients who may not tolerate Bruce
54
What is Naughton Protocol?
- Slower moving submaximal test - Settings change every 2 minutes - More gradual - Often used on post MI patients before discharge
55
When should the stress test be immediately stopped?
- ST segment elevation - Sustained ventricular tachycardia - Moderate to severe chest pain (esp if w ST depression/elevation) - Drop in BP >10 mmHg w/ additional evidence of ischemia - Technical problems with treadmill - Patient becomes dizzy, stumbles, or feels faint - Patient becomes diaphoretic
56
What are normal changes during a stress test EKG?
- Shorter PR - Tall P waves - Lower voltage QRS Increased HR (RR)
57
What are normal signs and symptoms of a stress test?
- Decreased systemic vascular resistance due to vasodilation - Increased Resp rate - Sweating - Fatigue - Increase BP - J point depression
58
What is a positive stress test?
- Abnormal Test - ST depression >/= 1.0-1.5 mm. DOesn't return to baseline within .08/2 blocks - Downsloping ST depression is most indicative of CAD | Horizontal is intermediate indicator
59
This stress test indicates transmural myocardial ischemia. What indicates this? What should be done?
- Downsloping ST depression in lead II, III, aVF - Rare U wave inverdsion is observed indicating coronary ischemia - ST segment elevation - The stress test should be stopped to prevent permanent tissue damage
60
How reliable are stress tests?
- False positives and negatives do occur therefore the only absolute determinability is angiogram - For stress test to show CAD, coronary artery must be 75% narrowed
61
What is sensitivity and specificity with respect to the stress test?
Sensitivity: % of patients who test positive for CAD as proven by angiogram Specificity: Percent of patients who have negative test and negative angiogram and do not have CAD
62
What are the four stress test results
63
What is Baye's theorem
True predictive value comes not only from a stress test but also patient history, heredity, and physical exam
64
What is a holter monitor
- An ambulatory EKG machine used to rule out intermittent arrhythmias - Used on outpatient basis - Stores EKG info throughout the day
65
What are indicators for Holter monitor use?
- Syncope or near-syncopal episodes - Intermittent Chest pain/SOB - Suspicion of arrhythmia - Determination of arrhythmiatreatment effectiveness
66
What is the setup like? (7)
- 5+ electrodes placed on trunk - Taped to the skin - 24+ hour monitoring - At leat two leads (V1V5 or V1II) - Do not remove electrodes or shower - Go about all normal activites - Button will highlight when patient felt symptoms
67
What is a positive Holter test? Negative?
Abnormalities were observed: - Tachycardia - Bradycardia - Pauses - ST segment elevation/depression - No significant arrhythmias/ST changes
68
What is an event monitor?
A device that a patient carries that can record abnormalities when a patient has symptoms
69
What are the two types of event monitors?
1. - Continuous monitoring - Only prints abnormalitites - Can be patient activated 2. - Can only be activated by patient when symptoms occur Both are intended to be worn for longer than 24h
70
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