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| What is meant by symptomatic bradycardia? What signs and symptoms would you see? | Many patients continue to maintain adequate cardiac output, despite a lowered heart rate. Symptomatic bradycardia results in deceased cardiac output. Symptoms include decreased level of consciousness, hypotension, chest pain, shortness of breath, pulmonary congestion, and syncope. |
| What drugs cause bradycardia? | Drugs with negative chronotropic actions decrease the heart rate. These include digoxin, beta blockers, and calcium channel blockers. |
| Why might prolonged tachycardia result in heart failure? | The faster the heart rate, the less time there is for ventricular filling, resulting in a decreased cardiac output. |
| The patient comes to the emergency department complaining of headache, numbness of his or her left arm and hand, and slurred speech. His or her pulse is 120 beats/minute and irregular. His or her blood pressure is 136/88 mm Hg. What is a probable cause for his or her symptoms? | These symptoms may indicate an acute stroke. The irregular heart beat may be caused by atrial fibrillation. A common complication of atrial fibrillation is thromboembolism. The blood that collects in the atria is agitated by fibrillation, and normal clotting is accelerated. Small thrombi, called mural thrombi, begin to form along the walls of the atria. These clots may dislodge, resulting in pulmonary embolism or stroke. |
| Why are multifocal PVCs considered more dangerous than unifocal PVCs? | Multifocal PVCs are a sign of multiple areas of irritability and present a greater chance for lethal dysrhythmia than unifocal PVCs. |
| The nurse is talking with the patient. Suddenly, the nurse looks up at the monitor and sees a ventricular fibrillation pattern. What should he or she do? | If the nurse is talking with the patient, the rhythm on the monitor is not likely ventricular fibrillation. The nurse should immediately assess the patient and check the patient’s leads to see if one has fallen off. A disconnected lead can sometimes mimic fibrillation. |
| Why is the demand mode of pacing preferred? | Pacemakers can be operated in a demand mode or asynchronous mode. The demand mode paces the heart based on need. The asynchronous mode may compete with the patient’s own rhythm and deliver an impulse on the T wave (R on T), with the potential for producing ventricular tachycardia or ¬fibrillation. The demand mode is safer and is the mode of choice. |
| What is the benefit of a dual-chamber pacemaker? | Dual-chamber pacing allows for stimulation of both atria and ventricle as needed to produce a near-normal cardiac contraction. |
