QUOTE FOR THURSDAY:

“Multiple myeloma is cancer that develops in the plasma cells. A type of white blood cell found mainly in the bone marrow, plasma cells help the immune system fight off infection by making antibodies that help kill germs. When cancer grows in these cells, it causes an excess of abnormal plasma cells, which form tumors in multiple locations throughout the bone marrow and crowd out and prevent the production of normal blood cells.”
 
National Foundation for Cancer Research

QUOTE FOR WEDNESDAY:

“On September 11, 2001, 19 militants associated with the Islamic extremist group al-Qaida hijacked four airplanes carring out suicide attacks against targets in the United States. Two of the planes flew into the twin towers of the World Trade Center in New York City, a third plane hit the Pentagon, & the fourth plane crashed in a field in Shanksville, Pennsylvania. Almost 3,000 people were killed during the 9/11 terrorist attacks, which triggered major U.S. initiatives to combat terrorism and defined the presidency of George W. Bush.”

History.com

QUOTE FOR TUESDAY:

“Gynecologic cancer is any cancer that starts in a woman’s reproductive organs. Cancer is always named for the part of the body where it starts. Gynecologic cancers begin in different places within a woman’s pelvis, which is the area below the stomach and in between the hip bones.  The areas included uterine, cervical, ovary (s), vaginal and vulvar.”

Centers for Disease Control and Prevention

 

 

 

QUOTE FOR MONDAY:

Most cancers are solid—a collection of mutated cells that grow out of control and form a tumor. The six most common cancers—breast, lung, prostate, colorectal, melanoma and bladder—are solid cancers that account for almost 1 million new cases a year. Cancers that are not considered solid cancers are often lumped together in the category of blood cancers: leukemia, lymphoma and myeloma. ”

Cancer Treatments of America

QUOTE FOR THE WEEKEND:

“Ventricular tachycardia (VT or V-tach) is a type of abnormal heart rhythm, or arrhythmia. It occurs when the lower chamber of the heart beats too fast to pump well and the body doesn’t receive enough oxygenated blood.”

John Hopkins

Part III What is and what does a cardiac rhythm tell us?

Ventricular Rhythms Part III

  PVC1PVC  ventrhy2PVC after every one normal beat

PVC1BIGEMINI-PVC AFTER 2 NORMAL BEATS (TRIGEMINI-AFTER 3 BEATS)

PVC3 PVC3QUADROGEMINI -AFTER 4 NORMAL BEATS

ventrhy1a 40 to 60 beats is just Idioventricular Rhythm, ventrhy4Monomorphic V-Tacventrhy3

ventrhy6Below is 2 views of Torsades de Pointes (article describes)

torsades de pointes & Torsades de pointes2

When the atriums aren’t working as the natural pacemaker, called the SA Node located in the top L corner of the right atrium.  The atriums that took over for the sinus node now fail don’t work so now the ventricles take over and the rhythms of all ventricle rhythms will show on the EKG which present NO p waves since the atriums are not working so no p wave is involved but we have QRS waves but their wide in measurement because the rhythm starts in the ventricles. The rhythms are PVC (Premature Ventricular Contractions), Idioventricular Rhythm, Ventricular tachycardia (Monomorphic and Polymorphic-rhythm getting more irregular. When regular and monomorphic=looking identical with every ventricular beat or contraction as opposed to polymorphic=not looking identical each contraction but each one is a ventricular contraction), Torsades De Pointes Ventricular Tachycardia (the rhythm starts upright but turns upside down but each contraction without a p wave and a wide contraction meaning a ventricular contraction), and Ventricular Fibrillation, to asystole.

Here’s what they look like:

 Accelerated Idioventricular Rhythm

Accelerated idioventricular rhythm occurs when three or more ventricular escape beats appear in a sequence. Heart rate will be 50-100 bpm. The QRS complex will be wide (0.12 sec. or more).

A regular QRS measures less than 0.12 which is with all atriums rhythms. 

Asystole

Asystole is the state of no cardiac electrical activity and no cardiac output. Immediate action is required.

Idioventricular Rhythm

Idioventricular rhythm is a slow rhythm of under 50 bpm. It indicates that then ventricules are producing escape beats.

Premature Ventricular Complex

Premature ventricular complexes (PVCs) occur when a ventricular site generates an impulse. This happens before the next regular sinus beat. Look for a wide QRS complex, equal or greater than 0.12 sec. The QRS complex shape can be bizarre. The P wave will be absent.

Premature Ventricular Complex – Bigeminy a QRS after every 2 regular beats

Premature Ventricular Complex – Trigeminy a QRS after every 3 regular beats

Premature Ventricular Complex – Quadrigeminy a QRS after every 4 regular beats 

Ventricular Fibrillation

Ventricular fibrillation originates in the ventricules and it chaotic. No normal EKG waves are present. No heart rate can be observed. Ventricular fibrillation is an emergency condition requiring immediate action.

Ventricular Tachycardia

A sequence of three PVCs in a row is ventricular tachycardia. The rate will be 120-200 bpm. Ventricular Tachycardia has two variations, monomorphic and polymorphic. These variations are discussed separately.

Ventricular Tachycardia Monomorphic

Monomorphic ventricular tachycardia occurs when the electrical impulse originates in one of the ventricules. The QRS complex is wide. Rate is above 100 bpm.

Ventricular Tachycardia Polymorphic

Polymorphic ventricular tachycardia has QRS complexes that very in shape and size. If a polymorphic ventricular tachycardia has a long QT Interval, it could be Torsade de Pointes.

Torsade de Pointes

Torsade de Pointes is a special form of ventricular tachycardia. The QRS complexes vary in shape and amplitude and appear to wind around the baseline.

Ventricular ending line needs to be treated stat to be switched back to atrial since the heart is missing ½ of the conduction it’s to normally receive from the atriums and if not reversed the heart will go into failure to heart attack or to asystole flat line and go into a cardiac arrest.

With PVCs=Premature Ventricle Contractions asymptomatic we just closely monitor the pt and telemetry the pt is on. Now a pt with PVCs and symtomatic usually meds with 0xygen (sometimes 02 alone resolves it but other times with meds) but if it gets worse into V Tachycardia the treatment is below.

Idioventricular Rhythm is usually with a slow brady pulse and needs meds.                           AIVR is usually hemodynamically tolerated and self-limited; thus, it rarely requires treatment.

Occasionally, patients may not tolerate AIVR due to (1) loss of atrial-ventricular synchrony, (2) relative rapid ventricular rate, or (3) ventricular tachycardia or ventricular fibrillation degenerated from AIVR (extremely rare). Under these situations, atropine can be used to increase the underlying sinus rate to inhibit AIVR.

Other treatments for AIVR, which include isoproterenol, verapamil, antiarrhythmic drugs such as lidocaine and amiodarone, and atrial overdriving pacing are only occasionally used today.

Patients with AIVR should be treated mainly for its underlying causes, such as digoxin toxicity, myocardial ischemia, and structure heart diseases. Beta-blockers are often used in patients with myocardial ischemia-reperfusion and cardiomyopathy

With Ventricular rhythms with fast pulse over 100 with symptomatic signs for the patient we may use as simple as valsalva pressure on the neck that medical staff only do but when pt is in asymptomatic (no symptoms) Ventricular Tachycardia (V-Tac) to even medications but when symptomatic if in V-Tac start cardioversion with a pulse if no pulse called pulseless V-Tac we use a defibrillator since there is no pulse there is no QRS to pace with in having the shock hit at the R wave, why? NO PULSE.

Treatment for Torsade de Pointes is Magnesium deficiency and Mag. Supplement given IV 2gms. Usually effective but if necessary the same as above as directed for it with a pulse or the other V Tac. (without a pulse)-See above.

Ventricular Fibrillation is when the ventricles are just quivering and the atriums in any ventricular rhythm doing nothing. The pt needs CPR and ASAP a defibrillator in hopes the shock will knock the rhythm back to a normal sinus or some form of a real rhythm.

Asystole which is a straight line, no pulse and this is CPR with epinephrine or Vasopressin 40 for only the replacement of the 1st or 2nd dose of Epinephrine 1mg. This is given 3-5 minutes (epinephrine). No defibrillation since no pulse. A rhythm may come back and if not the MD will call when CPR stops. Asystole is hard to resolve in most cases highier probability of resolution if in a hospital where close monitoring is done and its detected quicker.

The PURPOSE to all treating rhythms for all patients to the best optimal rhythm they can live with and hopefully reaching the best NSR-Normal Sinus Rhythm is give effective oxygen perfusion to the heart to allow it to do its function and get good amounts of oxygen to all our tissues to keep us alive. A human without oxygen or low oxygen to their tissues or any tissue is starvation to the tissues (in general) or to a tissue (Ex. Diabetic the foot to lack of 02 to cyanotic purple tissue to necrotic black tissue=dead to amputated since the tissue is dead.).

 

 

QUOTE FOR FRIDAY:

“Heart rhythm problems (heart arrhythmias) occur when the electrical impulses that coordinate your heartbeats don’t work properly, causing your heart to beat too fast, too slow or irregularly.

Heart arrhythmias (uh-RITH-me-uhs) may feel like a fluttering or racing heart and may be harmless. However, some heart arrhythmias may cause bothersome — sometimes even life-threatening — signs and symptoms.”

MAYO CLINIC

Part II What is and what does a cardiac rhythm tell us?

HeartBlocks2 HeartBlocks1

Than when AV nodes which can be blocked=atrio-ventricular block (AV heart block)=HB is a type of heart block in which the conduction between the atria and ventricles of the heart is impaired. Under normal conditions, the sinoatrial node (SA node) in the atria sets the intial pace for the heart, and these impulses travel down to the atriums than passing the AV valves into the ventricles and up the purkinje fibers . In an AV block, this message does not reach the ventricles or is impaired along the way. The ventricles of the heart have their own pacing mechanisms, which can maintain a lowered heart rate in the absence of SA stimulation.

The causes of pathological AV block are varied and include ischemia, infarction, fibrosis or drugs, and the blocks may be complete or may only impair the signaling between the SA and AV nodes.

Types of AV blocks: 1st degree HB which is NSR with a prolonged PR interval and can live a totally normal life with it. PR interval is the time from beginning of the p wave to the beginning of the qrs wave.  In all degrees of HB the PRI interval is prolonged. 

2nd degree HB-Mobitz I called Wenkebach is a NSR with a progressing increasing PR interval longer and longer till it actually drops a QRS and you see just the p wave without a QRS once and the rhythm restarts the pattern all over again.

Than 2nd degree HB-Mobitz II and this is a NSR with a prolonged PRI that measures the same amount each time but even though its not progressively getting longer its worse than Mobitz I always.  This is because with the same measurement prolonged PRI interval you only see 2 or 3 or more  p waves without the QRS and these need immediate external subcutaneous pacing or just as effective if its not available (external subcutaneous pacing) than a dopamine IV drip 2-10 mcg/kg/min or epinephrine IV drip 2 to 10 mcg/min.

Than there is complete HB 3rd degree heart block where no conduction from atriums to ventricles is going throught so the atriums are contracting the way they want and the ventricles contracting the way they want and total disassociation between the upper and lower chambers. Treatment is a most patients with acquired complete heart block will require a permanent pacemaker or an implantable cardioverter defibrillator (ICD).  Temporarily till OR try a subcutaneous pacing but may not work at all.

QUOTE FOR THURSDAY:

“An arrhythmia is a problem with the rate or rhythm of the heartbeat. During an arrhythmia, the heart can beat too fast, too slowly, or with an irregular rhythm. When a heart beats too fast, the condition is called tachycardia. When a heart beats too slowly, the condition is called bradycardia.  Arrhythmia is caused by changes in heart tissue and activity or in the electrical signals that control your heartbeat.  Often there are no symptoms, but some people feel an irregular heartbeat. The most common test used to diagnose an arrhythmia is an electrocardiogram (EKG).”

National Heart, Lung and Blood Institute

QUOTE FOR WEDNESDAY:

“Despite the limitations of the study designs, there is consistent evidence that higher amounts of body fat are associated with increased risks of a number of cancers.”

National Cancer Institute