Atrial Fibrillation
Ventricular Tachycardia
Ventricular Fibrillation
1st Degree Block
2nd Degree(T1)
2nd Degree (T2)
3rd Degree
100
The hallmark ECG finding in atrial fibrillation.
Absent P waves
Rhythm: irregularly irregular
100
How to recognize V tach on an ECG.
Wide QRS complexes at a rate over 100bpm, regular or slightly irregular. P waves are absent.
100
How to recognize V fib on an ECG.. 
Wide complex tachycardia with irregular electrical activity and a ventricular rate of typically greater than 300 beats/min with no identifiable P waves or QRS complexes on the ECG.
100
How to identify first degree AV block
Prolonged PR interval that will be > 0.20 seconds. The length of the PR interval will be consistent through the cardiac cycles.
100
This block is also known as _________
And can be recognized on ECG by ________ 
Wenckebach
Progressive prolongation of the PR interval until an atrial impulse is blocked. When an atrial impulse is blocked, there will be a P wave without a QRS complex. Following the blocked impulse, the sequence will continue to repeat.
100
How to recognize this type of AV block.
PR interval that is constant and P waves and P to P intervals that occur consistently. Suddenly occurring intermittent dropped QRS complex.
100
How to recognize a 3rd degree block (complete heart block) 
Completely independent atrial and ventricular activity. The P wave has no relationship with the QRS complex. The atrial rate (P wave) will be faster than the ventricular rate (QRS complexes). The width of the QRS complex is dependent on the location of the block.
The ECG will also identify an acute MI.
200
These are common risk factors that predispose a patient to A fib.
Diabetes, hyperthyroidism, and obstructive sleep apnea.
Hypertension, heart failure, advanced age, and valvular disease.
History of smoking or excessive intake of alcohol.
Having a sedentary lifestyle or minimally exercising.
200
These are common risk factors for developing V tach.
Most commonly caused by underlying ischemic heart disease.
Ischemic or non-ischemic dilated cardiomyopathy, electrolyte imbalances (hypokalemia, hypocalcemia, hypomagnesemia) structural heart disease, infiltrative cardiomyopathy, illicit drugs such as methamphetamine or cocaine, and digitalis toxicity.
200
Common risk factors for Vfib include...
Underlying structural heart disease.
Clients with anterior wall infarction, a complete coronary occlusion found on an angiogram, pre-infarction angina, and atrial fibrillation and are more prone to develop VF.
Electrolyte abnormalities such as hypomagnesemia, hypokalemia or hyperkalemia, hypoxia, acidosis, hypothermia, congenital QT abnormalities, cardiomyopathies, family history of sudden cardiac death, and alcohol use.
200
Causes of this type of block include _________.
Increasing of age, history of cardiac disease (MI or CAD), electrolyte imbalances (hypokalemia and hypomagnesemia), and certain antiarrhythmic medications. Infectious processes (endocarditis, rheumatic fever, COVID-19) Autoimmune disorders (rheumatoid arthritis, lupus, and sarcoidosis)
Athletes may unknowingly experience this caused by a higher resting vagal tone that allows for tolerance of slower heart rates.
200
Causes of this type of block include _________.
Medications that decrease AV conduction (calcium channel blockers, beta-blockers, digitalis, amiodarone, and adenosine)
An increase in vagal tone, following cardiac surgery, autoimmune disorders, reversible myocardial ischemia, hyperkalemia, cardiomyopathy, Lyme disease, and myocarditis. Additional causes include rheumatic fever, hyperthyroidism, and malignancies.
200
Causes/Risk Factors 2nd degree type 2
Anterior myocardial infarction (causes septal necrosis of the bundle branches)
Idiopathic fibrosis of the electrical conduction system, autoimmune disorders (SLE), myocardial disease related to sarcoidosis, electrolyte imbalances (hyperkalemia), medication-induced heart block from beta-blockers, calcium channel blockers, amiodarone, digoxin, or adenosine, or following cardiac surgery.
200
Clinical Presentation/Manifestations
Bradycardia, chest pain, shortness of breath, generalized fatigue, or syncope. Clients may display a decreased level of consciousness and have hemodynamic instability. Clients with an acute MI and third-degree heart block will report chest pain or dyspnea. The client’s jugular vein pressure will reveal cannon A-waves due to the simultaneous contraction of the atria and ventricles. A large pressure will be palpated against a vein. The nurse should also assess the client for a murmur. Assess the client for any signs of infection or skin rashes indicative of rheumatic fever, Lyme disease, and endocarditis.
300
Manifestations of A fib include...
May be asymptomatic!
Symptomatic: irregular apical pulse, hypotension, heart palpitations, and increased heart rate.
Client may report chest discomfort, shortness of breath (either at rest or with activity), exertional fatigue, anxiety, dizziness or lightheadedness, and possible syncopal episodes. Weight gain and increased urination may also be reported.
300
Clinical Presentation/Manifestations of V tach.
Palpitations, syncope, chest pain, shortness of breath, cardiac arrest, or even sudden cardiac death.
300
Treatment for V fib ...
The nurse must determine the client has no pulse or respirations and verify the rhythm of VF on the monitor. ACLS protocols are initiated beginning with CPR. The nurse will administer epinephrine 1 mg every 3 to 5 minutes per protocol and amiodarone 300 mg (preferred) or lidocaine 1 to 1.5 mg/kg. The nurse will apply defibrillator pads and defibrillation will occur between each CPR cycle of two minutes. Clients in cardiac arrest will also require intubation for airway control.
300
Clinical Presentation/Manifestations
Typically, clients experience no physical manifestations.
Presentation of dizziness with changes in position or shortness of breath with activity could indicate a worsening condition.
300
Nursing interventions for 2nd degree AV block type 1.
Identify potential causes for the arrhythmia and to identify any manifestations that could indicate progression to a higher degree heart block.
300
Manifestations/Clinical Presentation
Bradycardia, fatigue, syncope, dyspnea, dizziness, palpitations, shortness of breath, and nausea.
Clients with severe bradycardia may present with subsequent hemodynamic instability, such as hypotension and decreased CO.
Following an MI may present with chest pain.
300
Treatments/Therapies
Initially the administration of IV atropine per ACLS guidelines. If ineffective, the next line treatments include dopamine and epinephrine. Transcutaneous pacing should be implemented if medication therapies are unsuccessful.
Pacemakers are artificial electrical pulse generators that can be adjusted and can be temporary or permanent. Clients who did not respond to medications or temporary pacing will need a permanent pacemaker inserted.
400
Name the interventions or treatments commonly used for A fib...
Administering rhythm control medications (diltiazem, verapamil, digoxin, beta blockers).
Anticoagulants
Monitor for stroke (blood pooling in the heart can lead to clots)
400
Priority interventions for client's with VT include....
- Stable
- Unstable
- Pulseless
Clients who are stable and have VT are treated with antiarrhythmic drugs.
Clients who have a pulse but are hemodynamically unstable are treated with cardioversion.
Clients in pulseless VT are resuscitated using ACLS protocol. Treatments include defibrillation, intubation of the airway, CPR, and administration of epinephrine and amiodarone or lidocaine IV.
400
Manifestations that may be present before/during V fib..
Prior to the onset of VF, the client may present with palpitations, angina, orthopnea, dyspnea, paroxysmal nocturnal dyspnea, and pedal edema. Clients may also present in cardiac arrest.
400
What heart sounds are possible for 1st degree AV block?
Auscultate heart sounds and identify if S1 sound is diminished, or a murmur is heard.
400
Treatments/Therapies
If hypotension caused by bradycardia occurs, atropine is given IV. If the client is unresponsive to atropine, then transcutaneous pacing is utilized.
Clients on calcium channel blockers, beta-blockers, or digoxin will need reduction or discontinuation by the provider.
400
Treatments/Therapies
Transcutaneous pacing as this rhythm often deteriorates into third-degree heart block.
A pacemaker insertion may be necessary to keep the heart rate within the acceptable range and to restore hemodynamic stability.
400
How is a pacemaker inserted and what should the nurse educate the client and family on after the procedure.
Pacemakers are typically placed by a transvenous route in a procedural suite or operating room. Clients are sedated or placed under general anesthesia for the placement of these devices. The pacemaker pulse width, rate, and voltage will be adjusted by the cardiologist. The nurse should inform the client and family about follow-up care, battery status, stimulation and sensing thresholds. These are dependent on the type of pacemaker the client has.
500
This is the most serious potential complication of untreated atrial fibrillation.
Stroke due to atrial thrombus formation.
500
Lab Testing and Diagnostic Procedures for identifying Vtach include..
12-lead ECG to identify a possible cause, an echocardiogram to identify cardiac structure and function, and coronary angiogram to evaluate CAD and guide revascularization of coronary arteries.
Laboratory testing will include electrolyte levels of magnesium, potassium, and calcium to identify possible causes of VT and cardiac troponin to identify an MI.
500
What laboratory testing is done if the client survives V fib.
Clients who survive resuscitation will have serum electrolytes, arterial blood gases, drug levels, such as digoxin, cardiac enzymes, complete blood count, toxicology screen, and BNP levels.
500
What is the pathophysiology of 1st degree AV block?
Cardiac conduction system is delayed in transmitting an electrical signal through the right atrium to the AV node. The signal is not actually blocked from being sent but the process is slowed down. There is no electrical block but rather a slowing or delay of the signal.
500
What is transcutaneous pacing?
Temporary electrode-based device used to regulate and maintain an adequate heart rate and subsequent cardiac output. This method is used to maintain cardiac output until the condition resolves, or a permanent pacemaker is implanted.
500
Client Education on Pacemakers.
Always carry a pacemaker identification card as well as an identification bracelet. Inform airport security personnel that the pacemaker may set off the security detectors and to avoid holding handheld wands over the pacemaker for more than a few seconds.
Certain pacemakers should not have an MRI and should avoid large magnetic fields. Avoid large motors due to the potential for magnetic fields. Avoid radar machinery, electric arc welders, and radar installations.
Inform providers for planned procedures. Avoid contact sports and protect the pacemaker from trauma. Keep cell phones at least 6 inches away from the pacemaker and avoid placing them in their chest pocket.