Dysrhythmias
Afib: atrial kick loss, PAC turn to Afib, control rate/rhythm (cardiovert), thrombolytic, maybe surgical ablation, bridge to heparin, feeling beats,
Vfib: PVC can turn to Vfib, chaotic rhythm/no rate, no P or P-R interval, no pulse (ABC, call code, defib, epi)
Vtach: fast, diving, no discernable waves, pulse? = EKG, unstable? Cardiovert Pulseless? = begin CPR and defibrillate
HB: (1) may be fine, unless MI then pacing (2-1) PR lengthens QRS drops <.10, pacemaker, can progress quickly, (2-2) pr nl. r wave irregular,
pacemaker (3) atria reflects underlying rhythm, no relation b/t p waves and qrs, inferior acute mi, atropine and pacemaker placement
Digitalis: prolonged pr and sagging ST, hyperkal: pointy t or wide QRS, hypokal: flat t or obv. u wave, hypercal: no st, hypocal: prolonged st/qt
Relative vs effective (absolute refectory)
Cardiac cycle = action potential = depolarization – repolarization (systole contract, depolarization electrical)
Co = sv x hr (sv = preload, afterload, contractility)
preload: amnt of bld left in vent @ end of diastole, increase: hypervolemia, increased cvp, increased atrial force, decreased HR, increase aortic
pressure, regurgitation or stenosis/decrease: hemorrhage, increase HR, decrease vent afterload, hypertrophy, stenosis
afterload: increase: aortic pressure stenosis, high bp, aortic regurg/decrease: lowering bp, mitral regurg, meds
Poor c/o = sns (adrenergic), RAAS, chemo and baro, increased contractility
LVAD: keep MAP 60-80 no palpable pulse, cpr last resort defib for vtach and vfib
PAD: worsening (CLI) rest pain 2+ wks. Gangrene and amputation