NCLEX Focus - Supraventricular & Ventricular Arrhythmias

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The following are high yield points from the Supraventricular & Ventricular Arrhythmias tutorial to help you prepare for the NCLEX.

Review Supraventricular Arrhythmias and Ventricular Arrhythmias for further details.

Supraventricular and Ventricular Arrhythmias

NCLEX Focus

Atrial Flutter

ECG: Regular, rapid "sawtooth" P waves; atrial rate ~300 bpm, ventricular rate ~150 bpm.
Symptoms: May be asymptomatic or cause palpitations, chest discomfort, syncope, dyspnea.
Treatment:

Rate control: Beta blockers, nondihydropyridine calcium channel blockers (verapamil, diltiazem).
Rhythm control: Cardioversion, antiarrhythmic drugs, or ablation.
Stroke prevention: Anticoagulation (e.g., warfarin).

Risk Factors: Cardiac disease, binge alcohol, diabetes. Clinical Concerns: Can lead to stroke, ventricular weakening, and atrial fibrillation.

Atrial Fibrillation

ECG: Irregular, rapid P waves; no organized atrial contraction; irregularly irregular rhythm.
Symptoms: Fatigue, palpitations, dizziness, dyspnea; can be asymptomatic.
Treatment:
Rate control: Beta blockers or calcium channel blockers.
Rhythm control: Anticoagulation before cardioversion.
Avoid AV node blockers in WPW syndrome — can be fatal.
Risk Factors: Cardiac disease, hyperthyroidism, lung disease, obesity, alcohol.
Clinical Concerns:
High risk of stroke/systemic embolism.
Evaluate with echocardiography, thyroid function tests.
Must rule out Wolff-Parkinson-White (WPW) before certain treatments.

Asystole

ECG: Flatline; no electrical activity.
Description: Complete cardiac standstill.
Treatment: CPR and epinephrine (1 mg IV every 3–5 min).
Clinical Concern: Non-shockable rhythm; fatal without immediate intervention.

Pulseless Electrical Activity (PEA)

ECG: Normal or abnormal rhythm without a palpable pulse.
Treatment: CPR + epinephrine, treat underlying cause (H’s and T’s).
Clinical Concern: One of the most common rhythms in cardiac arrest.

Premature Beats (PACs/PVCs)

ECG: Early atrial or ventricular beats from ectopic focus.
Symptoms: “Skipped beats,” palpitations.
Treatment: Usually none if asymptomatic; avoid unnecessary antiarrhythmics.
Risk Factors: Caffeine, stress, alcohol, hypoxia, electrolyte disturbances.
Clinical Concern: May progress to atrial flutter/fibrillation.

Wolff-Parkinson-White (WPW) Syndrome

ECG: Short PR interval, delta wave, broad QRS.
Cause: Accessory pathway (Bundle of Kent) bypassing AV node.
Symptoms: Palpitations, dizziness, tachycardia; can be asymptomatic.
Treatment: Cardioversion; definitive = catheter ablation.
Avoid AV node blockers (e.g., digoxin, CCBs) — may induce ventricular fibrillation.
Risk Factors: Congenital, linked to Ebstein anomaly.
Clinical Concern: Can lead to fatal arrhythmias if mismanaged.

Ventricular Tachycardia (VT)

ECG: 3+ consecutive ventricular beats >120 bpm; wide QRS.
Symptoms: Palpitations, dizziness, fainting, dyspnea; may be asymptomatic if short (paroxysmal).
Treatment: Cardioversion, antiarrhythmics, or defibrillator implant.
Risk Factors: Heart disease, medications, electrolyte imbalances.
Clinical Concern: Can cause sudden death, heart failure, or loss of consciousness.

Torsades de Pointes

ECG: Twisting, spiral-shaped QRS pattern on a fluctuating baseline.
Subtype: Polymorphic VT associated with prolonged QT.
Symptoms: Palpitations, dizziness, fainting, dyspnea.
Treatment: IV magnesium is first-line.
Risk Factors: Hypokalemia, hypocalcemia, QT-prolonging drugs (e.g., levofloxacin, erythromycin).
Clinical Concern: Can lead to ventricular fibrillation and death.

Long QT Syndrome

ECG: Prolonged QT interval due to defective repolarization (ion channel issues).
Inherited Forms:
Romano-Ward Syndrome (Types 1–3)
Jervell and Lange-Nielsen Syndrome (with congenital deafness)
Acquired Causes:
Medications (e.g., antiarrhythmics, antidepressants, antihistamines, diuretics)
Electrolyte imbalances (hypokalemia, hypocalcemia)
Clinical Concern: Leads to Torsades de Pointes, syncope, sudden death.

Ventricular Fibrillation (VF)

ECG: Chaotic, disorganized electrical activity; no identifiable waves.
Symptoms: Unresponsiveness, cardiac arrest.
Treatment: Immediate defibrillation + CPR.
Risk Factors: Ischemic heart disease, cardiomyopathies, Brugada syndrome.
Clinical Concern: Always fatal without prompt defibrillation.

NCLEX Questions

A 61-year-old woman presents after a syncopal episode at home. She was recently prescribed levofloxacin for a urinary tract infection. Her EKG reveals prolonged QT interval. What is the most likely cause of her syncope?

A 58-year-old male with ST-elevation myocardial infarction suddenly becomes unresponsive and pulseless. Cardiac monitoring shows chaotic, irregular electrical activity without identifiable P, QRS, or T waves. What is the nurse’s next best action?

A 19-year-old patient with Wolff-Parkinson-White (WPW) syndrome is experiencing supraventricular tachycardia. Which of the following medications should be avoided due to risk of triggering ventricular fibrillation?

A 76-year-old male presents with fatigue and palpitations. ECG shows irregularly irregular rhythm with no distinct P waves. What is the most likely diagnosis?

A code is called for a 70-year-old patient who is unresponsive and pulseless. The cardiac monitor shows organized electrical activity without a palpable pulse. What is the nurse’s next best step?

A nurse is assessing a patient admitted with new-onset atrial fibrillation. Which of the following findings is most concerning for decreased cardiac output?

NCLEX Focus - Supraventricular & Ventricular Arrhythmias

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