Normal Sinus Rhythm
Premature
Ventricular Contraction
Extra
heart beat arising from an excitable focus somewhere in the ventricles
Ventricle
contracts before completely filling
Can
cause decreased cardiac output
Coupled,
bigeminy, trigeminy, unifocal, multifocal
Tx of
choice: Lidocaine
Sinus Tachycardia
HR
>100bpm with decreased ventricular filling time
Causes
include stress, pain, exercise, fever, shock, hypovolemia, hypoxia, respiratory
difficulties and MIs
S&S-dizziness,
palpitations, shortness of breath
Treat
the underlying cause
Sinus
Bradycardia
HR
<60bpm
Causes
vagal stimulation, medications IE: beta-blockers, digoxin, or CCBs, increased
intracranial pressure
Treat
if symptomatic
n
Change
in LOC, vertigo
Atropine
Pacer
Atrial
Flutter
Causes include CAD, hypertension, mitral valve
disorders, PE, chronic lung disease, cor pulmonale, cardiomyopathy,
hyperthyroidism, drugs such as digitalis, quinidine, and epi
Goal=slow
the ventricular response
n
Electrical
cardioversion
n
Drugs
IE: digoxin, Beta blockers (atenolol, metoprolol, esmolol), antiarryhmics IE:
amiodarone, Rhthmol, Betapace etc.
Atrial
Fibrillation
Occurs
with CAD, rheumatic heart disease, cardiomyopathy, hypertensive heart disease,
CHF, pericarditis
Complications=emboli!
Treatment
n
Drugs-Beta
blockers, CCB, Aminodarone, etc.
n
Cardioversion
Ventricular
Tachycardia
LIFE
THREATENING ARRHYTMIA
Causes
include CAD, MI, significant electrolyte imbalances IE: K+
3 or
more PVCs in a row
Treatments
n
If
pt stable (won’t be for long) administer Amiodarone or lidocaine
n
If
unstable administer same meds but use synchronized cardioversion
n
If
pulseless-defibrillate and treat as ventricular fibrillation beginning with 200
joules
Ventricular Fibrillation
LIFE
THREATENING ARRHYTMIA
Occurrence
same as VT
Treatment
n
CPR
n
ACLS
protocol with Defibrillation and
emergency medications
Drugs
|
Inotropes |
Vasodilators (nitrates)
|
Anti Arrhythmic |
Beta
Blockers (Neg
inotropes) |
Calcium
Channel Blockers (Neg
inotropes) |
ACE
inhibitor |
|
Goal:
Provide sufficient support for heart to maintain tissue perfusion |
Coronary
artery dilitation |
Decreases
speed of conductivity along pathways |
LOLs Beta-1=heart
selective Beta-2=not
heart selective |
Causes
slowing of heart rate, dilates coronary arteries & relaxes coronary
smooth muscle |
PRILS Antihyper- tensive
|
|
Increases SV, C.O. & Contractility |
Decreases B/P,
SVR, CO,
preload & afterload |
Decreases Ventricular Ectopy |
Decreases HR, and Oxygen
demand, & myocardial ischemia |
Used
with chronic stable angina, hypertension and SVT |
Decreases B/P
& SVR |
|
Examples: Dobutamine Dopamine Milrinone Digoxin |
Examples: Nitroglycerine Nipride Apresoline |
Examples: Amiodarone Lidocaine Adenosine |
Examples: Beta1-Esmolol Beta-2=Inderal
& Labatolol |
Examples: Calan Cardizem Procardia |
Examples Monopril Capoten Lotensin Vasotec |