sepsis, chest pain, hypotension ohypovolemia, anemia, hypoxia, hypoglycemia, myocardial ischemiaoHF, hyperthyroidism, anxiety, fearodrugs (epinephrine, norepinephrine, Levophed, atropine, caffeine, theophylline, or hydralazine), OTC cold remdiesTreatment: Assess SOB, chest pain, how they feeling, palpitations, dyspneaothe underlying cause guides the treatment. oIV beta blockersoAdenosineoCalcium channel blockers (diltiazem can be given to reduce HR and decrease myocardial O2 consumption)oVagal maneuvers oIn clinically unstable pts synchronized cardioversion is used.Paroxysmal Supraventricular Tachycardia: a dysrhythmia starting anywhere above the bifurcation of the bundle of His. PSVT occurs because of reentrant phenomenon-Rate > 150 bpm (150 to 220bpm)-Regularity: regular or slightly irregular-P waves submerge; The P wave is slightly hidden in the preceding T wave. -PR interval present and same-QRS complex: very narrow -Relationship between P and QRS: *assess patientsoFactors: Overexertion, emotional stress, deep inspiration, stimulants; rheumatic heart disease, digitalis toxicity, CAD, or cor pulmonale. Manifestations include hypotension, palpitations, dyspnea, and angina. oClinical Manifestations: hypotension, palpitations, dyspnea, and angina. oTreatment: vagal stimulation IV adenosine: the drug of choice (Adenosine slows cardiac conduction; the IV bolus of adenosine restores sinus rhythm)IV Beta-blockers (diltiazem) and calcium channel blockers (verapamil) If vagal stimulation and drug therapy is ineffective and the patient becomes hemodynamically unstable synchronized cardioversion is used.
Third Degree AV Block -Can be lethal -Result in low HR and low CO-Rate: 30 – 40 bpm -Regularity: irregular -P waves not all the same -PR interval different-QRS complex -Relationship between P and QRS: not consistent -Treat with pacemaker device-Factor: CAD, MI, myocarditis, cardiomyopathy, systemic disease, drugs (Beta blockers, digoxin, calcium channel blockers) -Expected findings: HF, shock, ischemia-Treatment: oA transcutaneous pacemaker until a temporary transvenous pacemaker can be inserted oMedications: dopamine and epi to increase HR and support BP until temporary pacing is started oAtropine is not an effective drug
Atrial Fibrillation -Rate: 350 – 600 bpm-Regularity: r wave is different throughout (characteristic of AFib); IRREGULAR -P waves: chaotic, fibrillatory -PR interval can’t measurable -QRS complex narrow-Relationship between P and QRS: can’t really determine-Factors: oCAD, valvular heart disease, cardiomyopathy, HF, opericarditis, hypertensive heart disease, caffeine use, oelectrolyte disturbances, stress, heart surgery, alcohol intoxication -Risks: clot stroke; MI thrombi form in the atria because of blood stasis. An embolized clot may develop and move to the brain, causing a stroke. Look for LOC changes b/c of their risks for stroke.