6 - Arrhythmias Flashcards

1
Q

Which is not one of the 3 most important steps in dx of arrhythmia?

a. rhythm regular or irregular
b. QRS complex narrow/wide
c. P wave bifid in 2, 3, aVF
d. P wave upright, inverted, saw tooth, absent

A

c

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Which is false?

a. cardioversion is best tx for sinus tachy
b. best to shock a pt w/ hemodynamically unstable tachyarrhythmia
c. AV dissoc is a characteristic of VT
d. treat underlying pulm dz is best for MAT

A

a

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

which is first question in initial approach to arrhythmia?

a. rhythm regular?
b. QRS narrow or wide?
c. P wave bifid in 2 or taller than 2.5?
d. P wave upright, inverted, saw tooth, or absent?
e. QRS axis normal/abnormal?

A

b

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

where do all arrhythmias with narrow QRS complexes arise from?

A

above the ventricles (SVT)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what are the 2 arrhythmias with wide QRS complexes?

A

SVT w/ BBB (rare)

VT (life threatening)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

arrhythmias with narrow, regular QRS complexes

A

sinus tachy
atrial tachy
atrial flutter
AVNRT / AVRT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

causes of atrial tachy

A

structural atrial disease
sympathetic stimulation
toxins/drugs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

tx of atrial tachy

A

withdraw sympathetic stimuli/drugs
rarely use antiarrhythmics
often does not respond to cardioversion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what should you think for atrial tachy with block?

A

digoxin toxicity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

sawtooth p waves =

A

atrial flutter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

cause of atrial flutter

A

diseased/dilated atria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

rate of atrial flutter vs atrial tachy

A

flutter ~ 300

tachy ~ 160

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

tx of atrial flutter

A

unstable - synchronized cardioversion
slow AV conduction (metoprolol, verapamil or diltiazem)
convert back to sinus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

sign of AVNRT

A

no p waves

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

AVNRT =

A

av nodal re-entrant tachy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

cause of AVNRT

A

micro-reentrant pathway, arrhythmia is usually paroxysmal and often triggered by PAC

17
Q

tx of AVNRT

A

unstable - cardioversion

block AV conduction - vagal enhancing maneuvers, adenosine, verapamil or diltiazem, beta blockers

18
Q

cause of AVRT

A

macro reentrant loop, often paroxysmal

19
Q

Types of Narrow Complex Regular Tachy:

  • normal p waves >
  • abnormal p waves >
  • sawtooth waves >
  • no atrial activity >
A

sinus tachy
atrial tachy
atrial flutter
AVNRT or AVRT

20
Q

differential for narrow QRS, irregular arrhythmias

A

MAT
atrial flutter w/ variable conduction
atrial fibrillation

21
Q

criteria for multifocal atrial tachy

A

narrow, irregular qrs
3+ distinct p waves
ventricular rate 100

22
Q

cause and tx of MAT

A

usually due to underlying pulm dz (ex COPD)

treat underlying dz - try to decrease sympathomimetics

23
Q

appearance of afib on ECG

A

absent p waves with irregular rate

24
Q

many cases of afib are caused by a focus in ____

A

pulm vein

25
Q

tx of afib

A

unstable - cardiovert
stable - slow ventricular response rate or electively cardiovert
if in afib for >48 hrs or unk time - anticoagulate or TEE to r/o thrombus, then cardiovert

26
Q

2 questions to ask after determining you have a wide complex tachyarrhythmia

A

are qrs complexes perfectly regular or slightly irregular?

are there p waves or evidence of atrial activity before each complex, or is there AV dissoc?

27
Q

causes of VTac

A

acute ischemia / MI
reentry around old scar or aneurysm
medications that prolong QT

28
Q

tx of VTac

A

unresponsive/pulseless - defib
unstable - synchronized cardioversion
stable - antiarrhythmic agents

29
Q

negative effects of antiarrhythmics

A

negative inotropy
QT prolongation
pro arrhythmic

30
Q

effect of suppressing PVCs

A

increased mortality

31
Q

amiodarone - mechanism

A

antiarrhythmic with beta blocking, Ca channel blocking, and direct effects on SA, AV nodes and atrial and ventricular tissues

32
Q

labs to monitor on amiodarone

A

check for bradycardia and heart block when starting

q6 mo : LFTs, thyroid, CXR for pulm fibrosis

33
Q

amiodarone drug interactions

A

blood thinners- increases INR

digoxin - increases levels