Sinus Bradycardia Slow heart rate, less than 60/min Asymptomatic? Monitor Symptomatic?

Atropine, pressors, epinephrine, dopamine Nursing? Watch for s/s of decreased loc, respiratory, decreased CO, ABCs Complications? Stop: betablockers, calcium channel blockers, dig Do not give: tikosyn Sinus Tachycardia Fast heart rate, over 100/min Symptomatic? Beta-blocker, calcium channel blocker, CP, palpiations Nursing? Watch blood pressure, orthostatic hypotension, teach how to take pulse/blood pressure, find out about drug/alcohol use, I&O, LOC related to cerebral prefusion, calm environment, thrombo precautions, prolonged tachy following MI indicates further damage Stop: atropine, pressors, epinephrine, dopamine PACs Premature P wave, (lost in the T) Nursing? Continue to monitor, watch in pts in heart disease can lead to a-fib/a-flutter, electrolyte imbalance, early sign of heart failure, can occur during periods of anxiety Meds: dig, procainamide, quinidine Stop: nicotine, caffeine, recreational drugs SVTs HR from 150-250 Symptomatic: adenosine, Hyundai sign, valsalvas maneuver, carotid massage (vagal them down)(not on older pts), dig, betablockes, ccbs Nursing? Continuous ECG during admin, large bore IV (for push), flush after push, CP, s/s decreased CO, HF, MI, check the dig level A-flutter 250-350 atrial rhythm, multiple p waves, SAWTOOTH Symptomatic: cardioversion with R wave, anti-coags, dig, cardizem, amiodarone Nursing: s/s of low cardiac output, dig levels r/t SA node depression, IV access, sedative for cardioversion, crash cart, bradycardia A-fib Quivering atria, more common then flutter or a-tach, occurs commonly with other cardiac problems, drugs (aminophylline and dig) Uncontrolled (greater than 100): angina, syncope

Intervene: cardioversion and drugs to slow the HR (sodium channel blockers, magnesium, beta-blockers, amiodarone, verapamil), anti-coags/thrombolytics, radiofrequency ablation, Cant cardiovert if on warfarin for 3-4 weeks. Nursing: call if syncope, dizziness, CP, dyspnea, peripheral edema. Watch fluid balance PVCs Wide and bizarre PVCs together: 2=couplet, 3=salvo PVCs patterns: every other=bigeminy, every third=trigeminy, multi-focal PVCs=WORST and can lead to V-tach Causes: caffeine, nicotine, alchohol, ischemia, DIG TOXICITY, electrolyte imbalance, OSA Intervene: monitor, procainamide, lidocaine, amiodarone, sotalol Nursing: check dig level, stop caffeine nicotine and alcohol, check electrolyte levels, sleep study for OSA V-Tach Undetermined rhythm, big mountains, long run of PVCs Pulse and Stable Intervene: amiodarone, cardiovert, beta adrenergics, beta blockers, sodium channel blockers, magnes Nursing: sedative for cardioversion, teach to take pulse/bp, diet, mag considerations Pulsess Intervene: ET tube, CPR, de-fib, amdiodarone, lidocaine, mag, epi, pressors, Nursing: ET tube (skin, hygiene, lung sounds, ROM, appearance) ACLS (epi, then atropine) V-FIB Non-specific rhythm, little mountain, no effect contraction/output Intervene: d-fib, CPR, ETT, epi, pressors, surgical d-fib placement Asystole Dead CPR, ETT, epi, atropine, transcutaneous pacing AV block Progressive widening PR interval