Chapter 26 Review

First degree/second degree heart block

Impulse is delayed.

Implanted pacemaker

A totally implanted electrical device used to manage a chronic bradydysrhythmia.

Who does a pacemaker patient need to tell they have a pacer after insertion?

Obtain or wear a MedicAlert bracelet or tag identifying that pacemaker is implanted. Request hand scanning during airport security checks. MRI technicians, x-ray, cat scan.

Atrial flutter

A disorder in which a single atrial impulse outside the SA node causes the atria to contract at an exceedingly rapid rate (200 to 400 contractions/min).

Supraventricular tachycardia

A dysrhythmia in which the heart rate has a consistent rhythm but beats at a dangerously high rate (>150 beats/min).

Sinus tachycardia

A dysrhythmia that proceeds normally through the conduction pathway but at a faster than usual rate (100 to 150 beats/min).

Sinus bradycardia

A dysrhythmia that proceeds normally through the conduction pathway but at a slower than usual rate (<60 beats/minute).

Elective electrical cardioversion

A non-emergency procedure done by a physician to stop rapid, but not necessarily life-threatening, atrial dysrhythmias.

Radiofrequency catheter ablation

A procedure in which a heated catheter tip destroys dysrhythmia-producing tissue.

Transcutaneous pacemaker

An emergency measure for maintaining adequate heart rate.

What happens in atrial fib and how it can be treated

Atria quiver rather than contract. Ventricles respond to atrial stimulus randomly, causing an irregular ventricular heart rate, which may be too infrequent to maintain adequate cardiac output. TX: Heparin, warfarin (coumadin), Covert an antidysrhythmic, flecainide (Tambocor), and propafenone (Rythmol), dabigatran (Pradaxa).

An internal electrical device used for selected clients with recurrent life-threatening tachydysrhythmias.

Automatic implanted cardioverter defibrillation

What is included in preop teaching for the pacemaker patient?

Avoid strenuous movement, especially of the arm on the side where the pacemaker is inserted. Delay for at least 8 weeks such as swimming, bowling, tennis, vacuum cleaning, mowing, carrying heavy objects. Avoid sourced electrical interference.

Scheduled procedure one to several days in advance. Used to eliminate atrial dysrhythmias (atrial flutter, atrial fibrillation). Uses less electrical energy (50-100 joules). Delivers electrical energy when the machine senses R wave of ECG.

Cardoversion

Ventricular tachycardia

Caused by a single, irritable focus in the ventricle that initiates and then continues the same repetitive pattern.

Self-activate when client's pulse falls below a certain level. Set at 72 beats/min and will not activate unless pulse falls below 72.

Demand (synchronous) mode pacemakers

Systole

Determined by the force of volume of blood that the left ventricle ejects during systole and the ability of atrial system to distend at the time of ventricular contraction.

Class I Antidysrhythmics: Sodium channel blockers: procainamide (Pronestyl), Lidocaine (Xylocaine), flecainide (Tambocor). Class II Antidysrhythmias: Isoproterenol (Isuprel). Class III Antidysrhythmias: Amiodarone (Cordarone). Class IV Antidysrhythmias: Verapamil (Calan). Mischellaneous: Epinephrine (Adrenalin), Atropine sulfate, Adenosine (Adenocard).

Drugs used to treat different arrhythmias

Digitalis and diuretics are withheld for 24 to 72 hours before cardioversion.

Elective Electrical Cardioversion

A procedure that enables the physician to examine the electrical activity of the heart; produce actual dysrhythmias by stimulating structures in the conduction pathway; determine the best method for preventing further dysrhythmic episodes; and in some cases, eradicate tissue in the area of the heart that is producing the dysrhythmia.

Electrophysiology study

What are some complications of atrial fib?

Formation of blood clots within atria that may become stroke-causing emboli if they enter circulation.

Refers to disorders in the conduction pathway that interfere with the transmission of impulses from the SA node through the AV node to the ventricles.

Heart block

Transthoracic pacemaker

Inserted during open heart surgery.

Premature atrial contraction

Neural tissue in the atrial conduction system initiates an early electrical impulse, which is identified by an irregularity in the underlying rhythm.

Defibrillation

Only treatment for life-threatening ventricular dysrhythmia. Used when there is no functional ventricular contraction. Emergency procedure performed during resuscitation. Used to eliminate ventricular dysrhythmias (ventricular fibrillation, asystole). Client not sedated but responsive. Uses more electrical energy (200-360 joules) Delivers electrical energy whenever the buttons on paddles are pressed.

Ventricular contraction that occurs early and independently in cardiac cycle before SA node initiates electrical impulses.

PVc's

Fixed-rate (asynchronous) mode pacemakers

Produce an electrical stimulus at a preset rate (usually at 72 to 80 beats/min despite client's natural rhythm.

Pacemaker

Provides an electrical stimulus to the heart muscle to treat an ineffective bradydysrhythmia (slow abnormal rhythm).

What does BP measure?

Reflects the ability of the arteries to stretch and fill with blood, efficiency of the heart to pump, and the volume of circulating blood.

Ventricular fibrillation

Rhythm of a dying heart.

Atrial fibrillation

Several areas in the right atrium initiate impulses resulting in disorganized, rapid activity.

Pallor, nervousness, sweating, faintness, usually harmless. May be related to stress, anxiety, fatigue, alcohol withdrawal, or tobacco use.

Signs and symptoms of PVc's

A temporary pulse-generating device that sometimes is necessary to manage transient bradydysrhythmias such as those occur during acute MIs or after coronary artery bypass graft surgery or to override tachydysrhythmias.

Transvenous pacemaker

Asystole

Used during pulseless ventricular tachycardia, ventricular fibrillation, and (cardiac arrest) when no identifiable R wave is present.

Premature ventricular contraction (PVC)

Ventricular contraction that occurs early and independently in the cardiac cycle before the SA node initiates an electrical impulse.

Most common cause is ischemic heart disease. Drug therapy, electrolyte disturbances, metabolic acidosis, hypothermia, and degenerative age-related changes.

What causes arrhythmia's

Dysrhythmia

also called arrhythmia is a condition disorder that results in an abnormally slow or rapid heart rate or one that does not proceed through the conduction system in the usual manner.

Diastole

reflects arterial pressure during ventricular relaxation.