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Junior - Cardiology 2 > 11 - Arrhythmias P. 2 > Flashcards

11 - Arrhythmias P. 2 Flashcards

1
Q

Bradyarrhythmias

A

Sinus Brady
Conduction Blocks
Ventricular escape rhythm

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2
Q

Tachyarrhythmias

A 
Sinus Tach
PAC’s 
Atrial Flutter
Atrial Fibrillation
PSVT
PVCs
Ventricular tachycardia
Torsades de pointes
Ventricular fibrillation
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3
Q

Arrhythmias

SA Node

A

Brady
- Sinus bradycardia

Tachy
- sinus tachycardia

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4
Q

Arrhythmias

Atria

A

Brady:
- none

Tachy:

  • PAC’s
  • atrial flutter
  • atrial fibrillation
  • PSVT
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5
Q

Arrhythmias

AV Node

A

Brady:
- Conduction block

Tachy:
- none

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6
Q

Arrhythmias

Ventricles

A

Brady:
- ventricular escape rhythm

Tachy:

  • PVCs
  • Ventricular Tachycardia
  • torsades de pointes
  • ventricular fibrillation
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7
Q

Bradycardia drugs

A

Atropine
Dopamine
Epinephrine

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8
Q

Sinus brady treatment

A

Asymptomatic - monitor

Symptomatic

  • check meds (BB, CCB)
  • atropine
  • pacing
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9
Q

Long term pharm therapy for sinus bradycardia

A

Ineffective

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10
Q

Sinus bradycardia Identification

A

P wave and QRS complexes are normal, but rate is < 60bpm

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11
Q

Junctional/ventricular escape rhythms

A

Occur when SA node is impaired or blocked

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12
Q

Junctional escape rhythm

A

Arise from AV node or bundle os His

  • 40-60 bpm
  • no P waves or p waves after QRS and inverted
  • narrow QRS
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13
Q

Ventricular escape rhythms

A

Arise from bundle branches or myocardium

  • 20-40 bpm
  • no P waves
  • wide complexes
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14
Q

Wide QRS is typical of ?

A

Ventricular escape rhythm

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15
Q

Conduction blocks

A

1 AVB - long p-r interval
2 AVB type 1 - (wenckeback): going going gone
2 type 2 - (mobitz II) - long, long, drop
3 AVB - complete heart block

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16
Q

1st degree av block reversible causes

A

Heightened vagal tone
Transient AV node ischemia
Drugs (CCB, digitalis, Anti-arrhythmics)

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17
Q

1st degree av block structural causes

A

MI

Degenerative (aging)

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18
Q

1st degree av block treatment

A

Nothing, typically asymptomatic

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19
Q

2nd degree type 1

A

Wenckeback

  • Intermittent failure of av conduction
  • Some p not followed by QRS
  • Benign
  • seen in kids, athletes and high vagal tone
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20
Q

Wenckeback treatment

A

Acute and symptomatic: atropine, isoproterenol

Chronic: permanent pacemaker

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21
Q

2nd degree type II

A

Mobitz II

Sudden intermittent failure of AV conduction

Causes: extensive MI of septum, chronic degeneration of His/purkinjie

Severe heart disease -> 3ABV w/o warning

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22
Q

2nd degree type II tx

A

Pacemaker, even if asymptomatic

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23
Q

3rd degree block

A

Complete heart block - no communication

No relationship between P and QRS

Causes - MI, chronic degeneration of conduction pathways

Lightheadedness and syncope

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24
Q

3rd degree treatment

A

Permanent pacemaker

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25
Q

Supraventricular tachyarrhythmias with regular rhythm (consistent P-P)

A

Sinus tachycardia
Reentrant SVT
Focal atrial tachycardia
Atrial flutter

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26
Q

Supraventricular tachyarrhythmias

A

Multifocal atrial atrial tachycardia

Atrial fibrillation

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27
Q

Sinus tachycardia

A

“Its there for a reason”

- always find and treat the underlying cause

28
Q

Supraventricular tachycardia

A

Over 150 bpm p waves are hard to distinguish so you cant assume its atrial

29
Q

Premature Atrial Contractions (PAC)

A

Palpitations (maybe asymptomatic)

30
Q

PACs treatment

A

Asymptomatic: no tx

Symptomatic:

  • avoid known triggers
  • beta blockers
  • catheter ablation
31
Q

Atrial flutter

A

Rapid regular activity 180-350 bpm sawtoothed p waves

Ventricular rate slower: 2:1, 3:1

Typically asymptomatic < 100bpm

32
Q

A flutter has an increased of

A

Thromboembolic events

33
Q

CHA2DS2VASc

A 
C - CHF
H - HTN
A - Age (>75) - 2
D - DM
S - Stroke/tia/thromboembolism - 2
V - Vascular disease
A - Age 65-74
S - Sex category
34
Q

A fib etiologies

PIRATES

A 
P - pulmonary
I - iatrogenic (cardiac surg)
R - rheumatic heart disease
A - acute coronary syndrome
T - thyroid (hyper)
E - ETOH
S - sleep/sick heart
35
Q

A fib

A

350-600, no p wavesa

Irregularly irregular

Pirates

36
Q

A fib classification

A 
Paroxysmal AF
- self terminating w/in 7 days
Persistent AF
- fails to self terminate w/in 7 days
Long-standing persistent AF
- > 12 months
Permanent AF
- cardiology gave up on fixing
37
Q

A fib range of symptoms

A

From asymptomatic to disabling

Palpitations
Tachy
Fatigue
Weakness
Lightheaded
Polyuria
Dypsnea
R sided HF
38
Q

A fib treatment

A

3 pronged approach

  1. Ventricular rate control
  2. anti-coagulation
  3. restore sinus rhythm
39
Q

Atrial fib is characterized by:

A

Chaotic atrial activity w/o organized P and irregularly of the ventricular (QRS) rate

40
Q

A fib stable vs unstable

A

Unstable: >100
- cardiovert
Stable: <100
- ignore

41
Q

A fib rate control vs rhythm control

A

No mortality benefit for one over the other

Rate control: typically older pts
Rhythm control: typically younger

  • both require anticoagulation for strokes
42
Q

New onset AF that is high risk <48 hrs

A

Start ASAP:
Heparin or LMWH or anticoagulant

Cardiovert w/in 48

43
Q

AF > 48 hrs or duration UKN

A

3 weeks of anticoagulation
- INR 2.0-3.0

TEE if no delay in cardioversion due to symptoms or bleeding risk/concerns

44
Q

A fib after cardioversion

A

One month after cardioversion - oral anticoagulants

After one months is determined by CHA2DS2-VASC or CHADS2 score

45
Q

A fib rate control

A
  1. Pharm - BB, CCB (verapamil/diltiazem)

2. Electrically - anticoagulation first if stable

46
Q

AF WPW caution

A

No CCB, BB or Digoxin - can paradoxically increase ventricular response in pts ventricular response in pts

Stable - procainamide or ibutilide
Unstable - Cardioversion

47
Q

AF Rhythm control

A

1st line = AAD, antiarrhythmic drug therapy

  • Not for younger patients
  • Not for persistent or longstanding persistant
48
Q

When dont you use NOAC

A

(New oral anticoagulants)

  1. Sever impaired renal function
  2. Prosthetic heart valves
  3. MS
  4. Valvular lesions - may need valve replacement
49
Q

Refractory A fib

A

EP intervention
RFA (radiofrequency ablation)
MAZE procedure
Obliteration of L atrial appendage

50
Q

PSVT

A

Paroxysmal supraventricular tachycardia

  • no p waves

Most common causer of narrow QRS complex tachycardia

51
Q

Orthodromic

A

Impulses going in normal direction

52
Q

Antidromic

A

Impulses going in opposite of normal direction

53
Q

PSVT rate vs rhythm control

A 
Not all need long term tx
Decision to treat is based on: 
- freq of arrhythmia
- significance of symptoms
- tolerance of meds
- pt preference
54
Q

PSVT mgmnt

A

WPW - catheter ablation
AT (FAT and MAT)
- drugs (CCB/BB)
- ablation

55
Q

PVCs

A

Wide QRS w ventricular origin

Usually asymptomatic
May have palpitations or skipped beats

56
Q

PVC presentations

A 
Single
Couplet
Triplet
Bigeminy
Trigemini

Frequent = >10 per hour

57
Q

PVC’s and exercise

A

Suppression w exercise = benign

Persistence/increase w exercise -> pathological

58
Q

PVC’s workup

A 
Likelihood of undrelying disease
PE 
ECG (wide and bizarre QRS)
Ambulatory monitoring
Echo
Exercise testing
59
Q

PVC’s treatment

A

Asymptomatic -> benign neglect
Symptomatic w/o underlying disease -> avoid triggers + BB
symptomatic w disease -> treat disease

60
Q

Aberrated QRS

A

Transient intreventricular conduction
Wider > 0.12 sec
Look like RBBB, LBBB, IVCD (intraventrucular conduction disturbance)

61
Q

Ventricular Tachycardia

A 
Wide QRS
>120
Regular rhythm
RAD
VT vs SVT (have pt bear down, no change = VT)
62
Q

VT clinical features

A 
Cardiac insults
Ischemia
Electrolyte disturbance
Drugs/med toxicity
Prolonged QT
63
Q

VT management

A 
Stable VT cardioversion
Refractory VT class 1 class 3 antiarrhythmic drugs
Syndrome of VT - structurally normal hearts: CCB or BB
64
Q

VT Therapy

A

Prevention of SCD

  • implantable cardiovert/defib
  • BB

Adjunctive therapy:

  • antiarrhythmic meds
  • goal is to prevent ICD shocks
65
Q

Ventricular fibrillation

A

Disordered, uncoordinated, ventricular contractions leading to pulseless state w no effective cardiac output that is INVARIABLE FATAL W/OUT TX

Sudden cardiac death

Junior - Cardiology 2 (3 decks)

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