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Complex Cardiac Dysrhythmias Questions and Answers 2024
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Complex Cardiac Dysrhythmias
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Complex Cardiac DysrhythmiasJohn is a 57-year-old with a new onset of palpitations and an irregular pulse. He has a
history of heart murmur since experiencing endocarditis 5 years ago. - answerAtrial
fibrillation (AF)
- An irregular rhythm without P waves
- Caused when the SA node is no longer the primary pacemaker the atria fibrillate.
Patients can become symptomatic with
- dizziness
- drop in blood pressure
because 30% of the CO can be lost.
Another risk
- Formation of clots in the atria from pooling blood.
Treatment
- Anticoagulants, beta-blockers, calcium channel blockers, and digoxin to control HR.
- Cardioversion is sometimes considered
Mary is a 68-year-old admitted with syncope. She has a history of hyperthyroidism that
is poorly controlled. - answerAtrial Flutter (ALF)
- A dysrhythmia from atrial pacemaker cells that take over the primary SA node's
function
- NO P waves, but "flutter waves" as atrial rate ranges from 250-350 bpm
Treatment (Like AFib)
- Aim to control the ventricular rate by using medications
- Chemical conversion or cardioversion is sometimes indicated
Jason is an 18-year-old who comes to the ED because his heart is racing. He admits to
drinking 4 energy drinks at a party and "it's never done this to me before." -
answerSupraventricular tachycardia (SVT)
- a rapid rhythm from the ventricular with a narrow QRS complex and a rate > 100 beats
per minute.
The client can be symptomatic
- decreased CO
- low BP
, Kamal is 40 years old and anxious about an upcoming diagnostic test for cancer. His
father was 40 when he died of cancer. He has a history of hypertension. Kamal puts on
his call light and says it feels like his heart is skipping beats. - answerPremature
Ventricular Contractions (PVC)
- Abnormal beats that originate in the ventricles.
On the monitor
- Wide and bizarre in appearance
- > 0.12 seconds.
Can be described in many ways including by frequency (rare, occasional, frequent),
direction (unifocal, multifocal), or by patterns (couplets, triplets, bigeminal, trigeminal).
3 PVCs in a row or more is considered ventricular tachycardia.
Some patients feel the irregular beats, but unless the beats are extensive or frequent,
they are benign.
Causes = hypoxia, electrolyte imbalance, hypertension, stimulant ingestion, and
recreational drug use.
Chongan is a 72-year-old experiencing vomiting and diarrhea for the last 3 days. His
serum potassium is 2.9 mEq/dL. The nurse looks up and sees this rhythm on the
monitor. - answerVentricular tachycardia (VT)
- Defined as 3 or more PVCs.
When VT is significant and impacts the cardiac output, it can be life-threatening.
Some patients can maintain a pulse and BP for a limited time while other patients are
pulseless.
The priority is to rapidly assess the client to see how they are tolerating the rhythm.
Treatment: Stable VT
- IV antiarrhythmic meds (amiodarone) with electrolyte replacement.
- Cardioversion may be required.
If the patient becomes pulseless from the VT
- Cardiopulmonary resuscitation with defibrillation is required.
Chester, 78 years old, experiences an acute myocardial attack and collapses on the golf
course. When the paramedics arrive, they see this rhythm on the monitor. -
answerVentricular fibrillation (VF)
- Life-threatening dysrhythmia requiring immediate resuscitation with defibrillation.
It is a wide and bizarre rhythm that does not provide a cardiac output as the ventricles
fibrillate from rapid and chaotic firing.
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