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CSB335 > Brady and tachy dysrhythmias > Flashcards

Brady and tachy dysrhythmias Flashcards

1
Q

What does altered impulse formation with enhanced automaticity lead to?

A

Tachyarrhythmias

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2
Q

What does altered impulse formation with decreased automaticity lead to?

A

Bradyarrhythmias

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3
Q

What does altered impulse conduction with reentry (stimulation of different portions of cardiac tissue) lead to?

A

Tachyarrhythmias

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4
Q

What does altered impulse conduction with conduction blocks lead to?

A

Bradyarrhythmias

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5
Q

What is the definition of bradycardia?

A

HR <60bpm

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6
Q

What are some aetiologies of sinus bradycardia?

A

Normal aging
AMl, especially those affecting the inferior wall of the heart
Hypothyroidism, infiltrative diseases (sarcoid, amyloid)
Hypothermia, hypokalemia
Situational (micturation, coughing)
Drugs (beta-blockers, digitalis, calcium channel
blockers, amiodarone, lithium)

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7
Q

Describe extreme bradycardia and likely pt presentation

A

HR <40
Rarely physiological this requires immediate rx
Presentation would include ALOC, poor perfusion, and hypotension

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8
Q

What is the presentation of symptomatic bradycardia?

A 
Syncope/pre-syncope
Dizziness
SOB
Chest pain
ALOC
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9
Q

When externally pacing is it important to ensure the pulse correlates with or opposes the paced rhythm?

A

Correlates with

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10
Q

External pacing is only considered when…

A

Pharmacological agents are ineffective

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11
Q

What is the rate of less severe bradycardia?

A

HR 40-60

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12
Q

When does less severe bradycardia require immediate rx?

A

Systolic BP <90mmHg
Ventricular dysrhythmia
Hx of heart failure

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13
Q

Describe bradycardia due to 1st degree AV block

A

PR interval >0.2 seconds
High risk of progression to 2nd/3rd degree block if accompanied by a wide QRS
Benign if asymptomatic

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14
Q

What drug can cause 1st degree AV block?

A

Calcium channel blockers

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15
Q

What is 2nd degree AV block type 1? (Mobitz type 1; Wenckebach)?

A

Progressive PR longation with eventual non-conduction of a P wave (may be 2:1 or 3:1)

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16
Q

Describe the effect of Mobitz type 1 on patient presentation

A

Usually asymptomatic but with accompanying bradycardia can cause angina and syncope (may need pacing)

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17
Q

What are some risk factors/causes of Mobitz type 1?

A 
Elderly
Long distance runners
Beta blockers 
Calcium channel blockers 
Digoxin
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18
Q

What is the ECG effect of 2nd degree AV block type 2 (Mobitz type 2)?

A

Normal PR intervals with sudden failure of a P wave to conduce

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19
Q

What is Mobitz type 2 usually accompanied by?

A

Bundle branch or fascicular block

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20
Q

Mobitz type 2 often causes ___.

A

Syncope

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21
Q

What worsens the signs of Mobitz type 2?

A

Exercise

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22
Q

Does Mobitz type 2 generally need pacing?

A

Yes

23
Q

What is 3rd degree AV block?

A

Completely AV dissociation

24
Q

The HR in 3rd degree AV block is ____.

Note: word, not bpm

A

Ventricular

25
Q

What are some common results of 3rd degree AV block?

A

Dizziness
Syncope
Angina
HF

26
Q

3rd degree AV block can degenerate into…

A

VT and VF

27
Q

Does 3rd dergee AV block need pacing?

A

Yes

28
Q

What are some aetiologies of sinus tachycardia?

A 
Fever
Hyperthyroidism
Effective volume depletion
Anxiety
Pheochromocytmoa (adrenal tumour)
Sepsis
Anaemia
Stimulant exposure
Illicit drugs
Hypotension
Shock
Pulmonary embolism
Acute coronary ichaemia
AMI
HF
Chronic pulmonary disease
Hypoxia
29
Q

What are the S&S of tachycardia?

A

Syncope/near syncope (depending on the rate)
Dizziness
SOB
Chest pain/palpitations

30
Q

What is ‘paroxysmal’ SVT?

A

Unpredictable

31
Q

True or false: Onset and termination of paroxysmal SVT is usually gradual

A

False: both are abrupt

32
Q

What does AVNRT stand for?

A

Atrioventricular nodal reentrant tachycardia

33
Q

Describe the pathway of AVNRT

A

SA node fires normally
Charge splits into two pathways at the AV node, one fast that goes through the ventricles and one slower that cannot follow into the refractory period so it circles back up into the AV node

34
Q

AVNRT has a ____ QRS and a HR of ____.

A

Narrow, >100

35
Q

The abnormal circuit in AVNRT directly involves the ____ ____.

A

AV node

36
Q

What is a ‘typical’ AVNRT pathway?

A

Impulse travels over the slow pathway towards the ventricles and returns via the fast pathway

37
Q

What happens to the retrograde P wave in AVNRT?

A

It is lost in the QRS complex

38
Q

What are the AVNRT mx points?

A

Valsalva manoeuver
Pharmacological agents (adenosine)
Cardioversion (CCP)
Ablation (cauterising the pathway; dependent on frequency)

39
Q

How does the valsalva manoeuvre assist AVNRT?

A

Stimulates the vagus nerve to enter reflex bradycardia

40
Q

What does AVRT stand for?

A

Atrioventricular re-entry tachycardia

41
Q

What is AVRT?

A

A normal pathway and an abnormal loop of electricity/circuit

42
Q

What are the ECG changes in AVRT?

A 
Shortened PR interval 
Delta wave (slow rise of QRS)
43
Q

What are the two pathways of AVRT?

A

AV conduction pathway

Accessory pathway between the atria and ventricles

44
Q

What is an example of AVRT?

A

Wolff-Parkinson White syndrome

45
Q

What other arrhythmias can use an accessory pathway for conduction of tachycardia origin to other heart regions?

A

AF and atrial flutter

46
Q

What is the rx for a pulseless tachycardic pt?

A

Rx as CA

47
Q

What are the two possible rhythms behind regular broad complex tachycardia?

A

Ventricular origin or SVT with aberrant conduction (BBB)

48
Q

What do you do if you cannot determine which underlying rhythm is behind broad complex tachycardia, and why?

A

Treat as VT, because it is less harmful than incorrectly rx VT as SVT

49
Q

What is the most likely cause of irregular broad complex tachycardia?

A

Uncontrolled AF with a BBB

50
Q

What is it important not to rule out with irregular broad complex tachycardia?

A

AF with WPW, and Torsades de Pointes

51
Q

Regular narrow complex tachycardias include what three rhythms?

A

Sinus tachycardia
AVNRT
AVRT

52
Q

What is the rx for regular narrow complex tachycardia?

A

Valsalva manoeuvre
Adenosine (some services)
Cardioversion (CCP)

53
Q

What rhythms are likely to be the cause of irregular narrow complex tachycardia?

A

Controlled AF, or atrial flutter with a variable AV block

CSB335 (12 decks)

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