All dysrhythmias are life threatening

T/F?

False.

Some dysrhythmias are life threatening, and others are not.

What does Conductivity result in?

excitable cells depolarize in rapid succession from cell to cell until all cells have depolarized.

The wave of depolarization causes the deflections of the electrocardiogram (ECG) waveforms that are recognized as the P wave and the QRS complex.

from the beginning of the P wave to the end of the PR segment.

It normally measures from 0.12 to 0.20 second

(five small blocks).

the time required for depolarization of both ventricles.

It is measured from the beginning of the QRS complex to the J point (the junction where the QRS complex ends and the ST segment begins).

It normally measures from 0.04 to 0.10 second

(up to three small blocks).

It occurs from the J point (the junction where the QRS complex ends and the ST segment begins) to the beginning of the T wave.

Its length varies

The six second method is the most accurate.

T/F?

False.

This method is the least accurate; however, it is the method of choice for irregular rhythms.

1. Determine the heart rate.

2. Determine the heart rhythm.

3. Analyze the P waves.

4. Measure the PR interval.

5. Measure the QRS duration.

6. Interpret the rhythm.

Determine the heart rate.

A nurse should now that a normal heart rate is:

 between 60 and 100 beats/min.

A rate less than 60 beats/min is called bradycardia.

A rate greater than 100 beats/min is called tachycardia.

Determine the heart rhythm.

What should the nurse know when determining the heart rhythm?

Determine the heart rhythm.

by assessing the PP intervals-

placing one caliper point on a P wave, and placing the other point on the precise spot on the next P wave. Then move the caliper from P wave to P wave along the entire strip ("walking out" the P waves) to determine the regularity of the rhythm.

essentially regular

if the P waves are all of the same shape.

by assessing the RR intervals-

placing one caliper point on a portion of the QRS complex (usually the most prominent portion of the deflection) and the other point on the precise spot of the next QRS complex. Move the caliper from QRS complex to QRS complex along the entire strip

Are P waves present? 

Are the P waves occurring regularly? 

 Is there one P wave for each QRS complex? 

Are the P waves smooth, rounded, and upright in appearance, or are they inverted? 

Do all the P waves look similar?

One P wave occurring before each QRS complex

This relationship indicates:

Measure the PR interval.

How should it be measured?

What should the measurment be?

Place one caliper point at the beginning of the P wave and the other point at the end of the PR segment.

The PR interval normally measures between 0.12 and 0.20 second. about 3 small boxes no more then 5

Measure the QRS duration.

 How should it be measured?

What should the measurment be?

Place one caliper point at the beginning of the QRS complex and the other at the J point, where the QRS complex ends and the ST segment begins.

The QRS duration normally measures between 0.04 and 0.10 second. about two small boxes

What are the types of Cardiomyopathy?

3

Hypertrophic cardiomyopathy

Dilated Cardiomyopathy

Restrictive Cardiomyopathy

SUDDEN DEATH may be the first sign of the disease.

also- exertional dyspnea, angina at rest, and syncope. there is a high incidence of ventricular dysrhythmias.

a structural abnormality in about 87% of cases there is extensive damage to the myofibrils and this interferes with myocardial metabolism.

There is normal ventricular wall thickness with dilation of both ventricles.

Some clients have no symptoms for months or years.

sudden symptoms of L sided heart failure. A-fib occurs in about 25% of these clients.

If there is R sided heart failure, the the prognosis is poor.

the least common form of cardiomyopathy.

There is restrictive filling since the fibrosed walls cannot expand or contract.

The heart chambers are narrowed and this causes emboli. 

What are the S/S of Restrictive Cardiomyopathy?

Why?

exertional dyspnea as the CO cannot increase with the demands of exertion due to the fixed ventricular volume.

Other S/S include exercise intolerance, palpitations, and syncope.

Non-surgcial management:

For RCM and DCM

Non-surgcial management:

HCM

Surgical management of Cardiomyopathy

4

excision of the hypertrophied septum,

cardiomyoplasty,

batista,

heart transplant

heart transplant (usu. reserved for DCM).

Transplant consideration has specific national and sate criteria which include:

an expected life expectancy of < 1 yr., age < 65, class iii, or iv of the New York heart association, normal to slightly increased pulmonary vascular resistance, stable psychsocial status, no current ETOH or drug abuse.

Additional UT requirements include: PRV < 3 WOOD, negative hep and HIV, well controlled DM with no end organ damage, family support, documented hx of compliance.

1. is to maintain the pt. for cardiac transplant

2.  destination therapy, is used to prolong the pts. life who is not going to receive a transplant. Thus the destination therapy could be considered death.

Complex clinical syndrome Can result from cardiac or chronic metabolic disorder, ischemic heart dx., HTN, cardiomyopathy, or hyperthyroidism. 

Impairs the ability of the ventricle to eject blood. 

Heart Failure=Pump failure.

Inability of the heart to pump enough blood at a rate sufficient to meet the metabolic needs of the body or can do so only with an elevated filling pressure. 

Can be seen acutely (MI) usually chronic, progressive changes. = Insufficient perfusion of body tissues.

Only cardiac disorder that is still increasing Death rate up 135% from 1979-1998.

Afflicts 10% of the population over the age of 70.

Most common admitting dx. among clients over the age of 65.

Females account for over 50%

Left ventricle can no longer pump enough blood to the system CO decreases and increased pressure in LV, LA, and pulmonary vaculature. 

HP forces fluid into pulmonary tissues

What are the Clinical manifestations

of L- sided Heart failure?

Exertional dyspnea presents as orthopnea and PND Pulmonary edema manifests as crackles Expiratory rhonchi and/or a non-productive cough 

S4 

Decreased CO leads to fatigue, confusion, nocturia

Typically follows L-sided heart failure 

HP forces more blood into the venous circulation Increased JVD, peripheral edema, weight gain, engorgement of the hepatic and gastric vessels.

peripheral edema hepatomegaly, ascities JVD, hepatojugular reflux increased 1 cm with moderate pressure Impaired GI blood flow, gut edema causes anorexia, N/V. 

Cyanosis (late sign), VS may be normal Cool extremities, diaphoresis

Classification: New York Heart Association Functional Classification system: 

Heart failure grading system: Four stages: (1-4)

1- Symptomatic only with strenuous activity that exceeds usual level. 

2- Symptomatic with usual level of activity 

3- Symptomatic with minimal activity, but asymptomatic at rest 

4- Symptomatic at rest.

Labs: CBC, urinalysis, T4, TSH, AST, PTT, hyperbilirubinemia

Test-EKG-non-specific T and ST wave changes Chest x-ray

PCAWP above 20-25 Echo- determines EF, wall motion abnormalities

Heart cath if refractory to standard therapy, MI possible, surgical procedure

furosemide(Lasix)

How does the Aims help with heart failure?

How do Vasodilators[clonidine (Catapres)]

 help with heart failure?

Decrease peripheral resistance, decrease afterload, improving SV and CO Isosorbide- venous dilator 

Hydralizine- arterial dilator NTG- venous and arterial dilator

ALSO INCLUDS  ACE inhibitors: decrease preload and afterload- (captopril and enalapril)

Increased myocardial contractility- it inhibits the Na/K pump causing a buildup of cellular Na. Na is exchanged for Ca which enhances the actinomycin cross-bridge formation

Efficacious in CHD caused by AF

Narrow therapeutic margin 0.9-2.0 ng/ml