RESUMO
Junctional ectopic tachycardia is a common dysrhythmia after congenital heart surgery that is associated with increased perioperative morbidity and mortality. Risk factors for development of junctional ectopic tachycardia include young age (neonatal and infant age groups); hypomagnesemia; higher-complexity surgical procedure, especially near the atrioventricular node or His bundle; and use of exogenous catecholamines such as dopamine and epinephrine. Critical care nurses play a vital role in early recognition of dysrhythmias after congenital heart surgery, assessment of hemodynamics affecting cardiac output, and monitoring the effects of antiarrhythmic therapy. This article reviews the underlying mechanisms of junctional ectopic tachycardia, incidence and risk factors, and treatment options. Currently, amiodarone is the pharmacological treatment of choice, with dexmedetomidine increasingly used because of its anti-arrhythmic properties and sedative effect.
Assuntos
Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Enfermagem de Cuidados Críticos/normas , Enfermagem Pediátrica/normas , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/enfermagem , Taquicardia Ectópica de Junção/diagnóstico , Taquicardia Ectópica de Junção/enfermagem , Adulto , Enfermagem de Cuidados Críticos/educação , Currículo , Educação Continuada em Enfermagem , Cardiopatias Congênitas/cirurgia , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Enfermagem Pediátrica/educação , Complicações Pós-Operatórias/tratamento farmacológico , Complicações Pós-Operatórias/etiologia , Guias de Prática Clínica como Assunto , Taquicardia Ectópica de Junção/tratamento farmacológicoRESUMO
Supraventricular dysrhythmias are abnormalities in the rhythm of the heart caused by ectopic impulses originating from the SA node, atria, and AV junction. Certain electrocardiographic characteristics facilitate identification of these dysrhythmias. Supraventricular dysrhythmias are not as dangerous as ventricular dysrhythmias, but they may affect the patient's cardiovascular function significantly. The effects of supraventricular dysrhythmias on the patient are physiologic--those relating to changes in cardiac output and cardiac workload--and psychological--those relating to the patient's perception of the sensations associated with the dysrhythmia. The nurse plays an important role in the care of patients with supraventricular dysrhythmias. Nursing functions include prompt identification and appropriate management consistent with the medical and nursing plans, alleviation of anxiety, and patient education.
