if there is a P-wave, the rhythm will be one of these sinus rhythms
sinus rhythm: normal sinus rhythm, sinus bradycardia, or sinus tachycardia
if you do not have a P-wave, the rhythm is
ventricular
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determine the rate
60-100 (NSR or AJR) <60 (SB or JR) >100 (ST or JT)
PR interval=0.12-0.20 (3-5 little boxes)
sinus rhythm, sinus brady, sinus tach
PR interval= <0.12 (less than 3 boxes)
junctional rhythm, next look at rate
PR interval=>0.20
1st degree heart block--type of rhythm with 1st degree heart block
no p-wave
ventricular tachycardia, ideoventricular, atrial flutter, fixed conduction
regular QRS
0.06-0.10
super ventricular tachycardia
<3 little boxes
when do you cardiovert
when you have a pulse
when do you defibrulate
when you have no pulse
what drug(s) do you use for asystole
epinephrine, atropine
the drug used to chemically cardiovert SVT is
adenosine
nursing diagnosis related to CABG
fear, deficient knowledge, ineffective cardiac tissue perfusion, decreased cardiac output, impaired gas exchange, risk for imbalanced fluid volume, disturbed sensory perception, acute pain, ineffective tissue perfusion, ineffective thermoregulation
CVP normal value: wedge pressure: PAP
CVP: 0-4 wedge pressure: 8-15 PAP 20-30/5-15
pulmonary edema
massive left sided heart failure, full of fluid, pink frothy secretions
treatment: diuretics (lasix first line); if pt has renal failure (nitroglycerin and morphine)
irregular rhythms
a-flutter, sinus arrhythmia, 2 degree or 3 degree heart block, a-fib
narrowing pulse pressure would be seen in which patient
tamponade, also massive JVD
pacemaker information required on chart
model of pacemaker, type of generator, date and time of insertion, location of pulse generator, stimulation threshold, pacer settings (eg, rate, energy output, sensitivity, duration of interval between atrial and ventricular impulses)
endocarditis infective risk factors
risk factors: heart valve prosthesis, hx of heart disease (mitral valve prolapse), chronic dibilitatin disease, IV drug abuse and immunosuppression
pericarditis
friction rub, notched T wave
S/S: fever, positional chest discomfort, nonspecific ST segment elevation, elevated ESR erythrocyte sedimentation rate, retrosternal pain that worsens during supine positioning, pulsus paradoxus
hypokalemia wave from changes
U waves after the T
hyperkalemia
tall QRS complexes
hypomagensium
torsades de pointes
medications to treat ventricular dysrhythmias
lidocaine, beta blockers, amiodarone (drug of choice for v-tac)
right heart failure (chronic condition)
JVD, dependent edema, right upper gastric pain (right heart handles systemic blood return)
left heart failure
bibasilar fine crackles, dyspnea, tachycardia, S3 and S4 heart sounds, fatigue, hemoptysis, non-productive cough, cool pale skin, PMI displaces toward the left anterior axillary line
inferior wall myocardial infarction
t-wave inversion: inadequate blood supply
ST segment elevation: injury, prolonged ischemia
pathological Q waves: are all signs of tissue hypoxia
digoxin
hold if apical pulse is less than 60bpm
digitalis toxicity=vision changes (halos), dysrhythmia, anorexia, nausea, vomiting, headache, and malaise
increases force of myocardial contraction and decreases HR
a-fib
warfarin to prevent clots and decrease risk of stroke, digoxin to control HR
12 lead EKG
ST elevation indicates immediate myocardial injury
ST depressions indicate myocardial ischemia
Q wave forms several days after a myocardial infarction
U wave is a sign of hypokalemia
lasix furosemide
IV push: give at a rate of 20mg/min or less
rapid injection can cause hearing loss as a result of ototoxicity
normal daily dose: 40mg loop diuretic
nitroglycerin
reduces oxygen consumption to reverse ischemia and relieve pain. vasodilator mainly in veins and reduces blood return to heart and preload is reduced. may cause a significant drop in cardiac output and BP if pt is hypovolemic at higher doses
calcium channel blockers
slows heart rate and decreases strength of contraction which decreases workload of heart. relaxes blood vessels decreasing BP and increases coronary artery perfusion
rheumatic fever
caused by strep
s/s of infective endocarditis
osler's nodes (red, painful nodules on the fingers and toes), splinter hemorrhages, fever, diaphoresis, joint pain, weakness, abdominal pain, new murmur, Janeway's lesions (small, hemorrhagic areas on fingers, toes, ear, and nose)
myocarditis s/s
flu-like symptoms, fatigue, dyspnea, palpitations, and occasional discomfort in the chest and upper abdomen. may develop dysrhythmias, or ST-T wave changes. systolic murmur, gallop rhythm
ACE inhibitors
promote vasodilation and diuresis by decreasing afterload and preload
dobutamine
left ventricular dysfunction. increases cardiac contractility. at high doses, it also increases HR and incidence of ectopic beats and tachydysrhythmias. take care in pt with a-fib
CK-MB earliest increase, peak and return to normal
4-8hrs, peaks 12-24hrs, and retunrs to normal 1-3 weeks
troponin earliest increase, peak and return to normal
3-4hrs, peaks in 4-24hrs and returns to normal 1-3weeks
labs for heart failure
BUN, TSH, CBC, BNP
mitral stenosis: rhythms, S/S
dyspnea, progressive fatigue, hemoptysis, paroxysmal nocturnal dyspnea, cough, wheeze, repeated respiratory infections
dysrhythmias like a-fib
tests doppler echocardiography
aortic regurgitation: cause
caused by inflammatory lesions that deform the leaflets of the aortic valve. also infective or rheumatic endocarditis, congenital abnormalities, diseases such as syphilis, dissecting aneurysm, blunt chest trauma, or valve replacement
aortic regurgitation: S/S
forceful heartbeats in head and neck, arterial pulsations that are visible or palpable at the carotid or temporal arteries. exertional dyspnea, fatigue, progressive s/s of left ventricular failure including breathing difficulties, orthopnea, PND
valve replacement teaching: pre and post
take long term anticoagulant therapy, frequent follow up appointments and blood lab studies. may need to take aspirin, prescribed medication teaching
cardiac tamponade: S/S
life threatening need stat interventions, fullness within the chest, substantial or ill defined pain, sob, massive JVD, falling systolic blood pressure, narrowing pulse pressure, rising venous pressure (increased JVD) and distant heart sounds
cardiac tamponade treatment
pericardiocentesis, pericardiotomy (pericardial window)
CABG
70% occlusion (60% if in the left main), artery must be patent beyond the occlusion. use greater saphenous vein, lesser saphenous, cephalic and basilic veins