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Cardiology 1 > Clin Med - Arrhythmias > Flashcards

Clin Med - Arrhythmias Flashcards

1
Q

What are the types of AV blocks?

A
  • first degree
  • second degre: mobitz typ I (Wenckenbach) and mobtiz type II
  • third degree
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2
Q

general presentation on EKG of first degree AV block

A

-PR interval > .21 sec with ALL atrial pulses CONDUCTED

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3
Q

general presentation on EKG of second degree AV block

A

-INTERMITTENT blocked beats

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4
Q

general presentation on EKG of third degree AV block

A
  • COMPLETE heart block

- no atrial impulses are conducted to the ventricles

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5
Q

medications in the etiology of first and second degree heart block

A
  • digitalis
  • Ca++ channel blockers
  • beta blockers
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6
Q

chronic or transient etiologies of first and second degree heart block

A
  • ischemia
  • inflammatory dzs (lymes)
  • fibrosis
  • calcifications
  • infarction
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7
Q

in a second degree, mobitz type I (Wenchenbach), what is the pattern of the PR interval? and the cause?

A
  • PR interval progressively lengthens w/ RR interval shortening before a dropped beat
  • almost always d/t AV node conduction abnormality
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8
Q

What are the characteristics of a second degree mobitz type II AV block?

A
  • no lengthening of AV conduction
  • intermittent non-conducted atrial beats
  • usually d/t dz involving bundle of His
  • may progress to 3rd degree block
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9
Q

which AV block is usually “nodal so narrow” ?

A

-Mobitz I

narrow in terms of QRS

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10
Q

Which AV block is usually “infranodal so wide” ?

A

-Mobitz II

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11
Q

A third degree heart block is usually d/t what?

A

a lesion distal to the bundle of His

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12
Q

3rd degree heart block may be associated with what other arrhythmia?

A

bilateral BBB

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13
Q

characteristics of a third degree heart block

A
  • QRS wide and ventricular beats usual <45 BPM
  • atrial conduction through atrial node is completely blocked
  • may be asymptomatic
  • may feel fatigues, SOB, have syncope
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14
Q

EKG notes from a 3rd degree block

A
  • no dropped beats
  • all p waves come at the same interval
  • atria and ventricles are working just not working together
  • p wave may show up in the QRS
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15
Q

How is an AV block diagnosed?

A
  • incidental finding or

- symptomatic patient gets EKG

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16
Q

PE of pt w/ AV block

A
  • bradycardia

- may be asymptomatic

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17
Q

When does AV block only need monitoring?

A

-asymptomatic pts w/ good perfusion

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18
Q

What is the treatment for AV block when they do not qualify for monitoring only?

A

permanent pacing

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19
Q

When does AV block require permanent pacing as treatment?

A
  • symptomatic bradyarrhythmias
  • asymptomatic mobitz type II
  • complete heart block
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20
Q

BBB definition

A
  • a complete or partial interruption of the electrical pathways of the bundle of his
  • can be right, left, bifasciular or trifasicular
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21
Q

bifasicular

A
  • when 2 pathways are blocked

- right bundle, left bundle, posterior fascicle, left anterior fascicle

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22
Q

trifasicular

A
  • RBBB with alternating left hemi-block
  • alternating RBBB and LBBB
  • bifasicular block w/ prolonged infranodal conduction
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23
Q

T or F; BBBs can occur in normal hearts.

A

True

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24
Q

What dz processes can cause BBBs

A
  • ischemic heart dz
  • inflammatory dz
  • infiltrative dz
  • cardiomyopathy
  • postcardiotomy
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25
Q

what dz processes are specific to RBBBs

A
  • pulmonary embolism

- chronic lung dz

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26
Q

symptoms of BBB

A
  • most have none
  • syncope
  • the symptoms of the underlying cause
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27
Q

diagnosing BBB

A
  • incidental finding

- EKG if symptomatic

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28
Q

tx of BBB

A
  • tx underlying disorder
  • may need pace maker if syncope is occuring
  • most need none
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29
Q

paroxysmal supraventricular tachycardia (PSVT) definiton

A

-regular, fast (160-200) HR that originated in heart tissue other than the ventricles

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30
Q

etiology of PSVT

A
  • accessory pathways of electrical conduction b/w the atria and the ventricles
  • AV node is bypassed
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31
Q

sx of PSVT

A
  • some can have very mild sx
  • palpitations
  • dizziness
  • syncope
  • light headed
  • chest pain
  • SOB
  • weakness/fatigue
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32
Q

PE findings in PSVT

A

-tachy and regular rhythm

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33
Q

What will diagnose PSVT when using and EKG or holter monitor?

A
  • rapid regular rhythm
  • QRS could be narrow or wide
  • may have delta wave present (preexcitation)
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34
Q

vagal stimulation treatments

A
  • plunging face into ice water
  • rubbing neck just below jaw line
  • bare down
  • cough
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35
Q

when do you use medical intervention as opposed to vagal stimulation?

A
  • if vagal stim. doesn’t work
  • if episode lasts more than 20 min
  • if symptoms are severe
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36
Q

What defines a PSVT patient as unstable?

A
  • hypotension
  • altered mental status
  • signs of shock
  • chest pain
  • heart failure
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37
Q

treatment of unstable PSVT patient

A
  • try vagal maneuvers while prepping for:
  • synchronized cardioversion
  • consider adenosine 6mg
38
Q

treatment of stable PSVT patient

A
  • vagal maneuvers frist
  • consider adenosine if vagal stim. doesn’t work
  • beta blocker or Ca++ channel blocker
39
Q

Wolf-parkinson white syndrome (WPW)

A
  • supraventricular tachy arrhythmia

- preexcitation pathway

40
Q

What is the defining feature of WPW on EKG?

A

-delta wave

41
Q

What is the possible progression of WPW?

A
  • up to 30% will develop a. fib or flutter
  • can degenerate into v. fib
  • needs electrophys and often ablation
42
Q

When does a patient with PSVT need to see a specialist?

A
  • WPW pattern on EKG
  • pts w/ recurrent sx despite tx
  • pts w/ pre-excitation and hx of a fib/flutter
43
Q

When do you admit a PSVT patient?

A
  • syncope

- hx of syncope and pre-excitation on EKG

44
Q

PVC

A
  • ventricular extrasystoles

- isolated beats that originate from ventricular tissue occurring before a normal heartbeat

45
Q

sx of PVC

A
  • commonly none

- may be aware of strong/skipped beat

46
Q

if PVCs are frequent, what could the progress to?

A
  • v. tach

- v. fib

47
Q

causes/risk factors for PVCs

A
  • age
  • alcohol (boo)
  • caffeine (boo)
  • cold meds
  • CAD
  • heart failure
  • stress (boo)
  • valve disorders
  • electrolyte disorders
  • hyperthyroidism
48
Q

diagnosis of PVCs

A
  • w/ EKG or holter
  • may be individual beats
  • bigeminy or trigeminy
49
Q

increased frequency of PVCs during exercise is associated w/ what?

A

increased risk of cardiovascular mortality

50
Q

what do you rule out before treating PVCs

A
  • electrolyte disorder

- thyroid disorder

51
Q

in a generally healthy pt w/ no other problems, what is the treatment for PVCs?

A
  • none required

- avoid caffeine, stimulants and reduce stress

52
Q

in pts w/ structural herat dz or bothersome sx, what is the treatment for PVCs?

A
  • beta blockers

- weight risks w/ benefits for tx

53
Q

In pts with frequent PVCs refractory to other tx, what is the option?

A

catheter ablation

54
Q

sick sinus syndrome

A
  • sinus arrest
  • sinoatrial exit block
  • persistant sinus brady w/ no specific cause
  • can alternate brady-tachy
  • brady d/t disordered SA node or impaired conduction from SA to atrium
55
Q

what is the characteristic feature of sick sinus syndrome?

A

the heart does not respond to normal stimuli to increase the rate such as exercise

56
Q

misc. facts about sick sinus syndrome

A
  • usually asymtomatic
  • usually elderly
  • may have intermittent SVT mixed w/ the brady-arrhythmia
  • often have concomittant a. fib
  • may be caused by meds
57
Q

diagnosing sick sinus syndrome

A
  • sometime hard
  • PE
  • ECG w/ carotid sinus pressure (not done in office)
  • ambulatory monitor or electrophys studies
58
Q

what meds can cause sick sinus syndrome?

A
  • beta blockers
  • Ca++ channel blockers
  • digoxin
  • sympatholytic agents (clonidine, gaufcaine, alpha methyldopa)
  • antiarrhythmics
59
Q

what are causes of sick sinus syndrome not related to meds?

A
  • sarcoidosis
  • amyloidosis
  • Chagas dz (parasite from bug poop)
  • various cardiomyopathies
60
Q

what is NOT a common cause of sick sinus syndrome?

A

coronary dz

61
Q

symptoms of sick sinus syndrome

A
  • mostly asymptomatic
  • syncope
  • dizziness
  • confusion
  • palpitations
  • fatigue
  • heart failure
  • angina
62
Q

tx of sick sinus syndrome if pt is asymtomatic

A

-non as long as perfusion is good

63
Q

whats the first step in the tx of sick sinus syndrome?

A

remove any offending meds to see if it resolves

64
Q

what’s the tx for sick sinus syndrome in symptomatic pts?

A
  • permanent pacing
  • dual is preferred
  • pace first, then tx for the tachyarrhythmias
65
Q

torsades de pointes

A

form of ventricular tachy in which QRS morphology inverts around the baseline of the EKG

66
Q

etiology of torsades

A
  • hypokalemia
  • hypomagnesemia
  • drugs that prolong QT interval
67
Q

sx of torsades

A

(same as v. tach)

  • fainting
  • angina
  • lightheadedness
  • dizziness
  • palpitations
  • SOB
68
Q

diagnosing torsades

A
  • EKG
  • lab studies for electrolytes
  • echo
  • electrophys
69
Q

what is the treatment of choice for torsades?

A

-IV mag sulfate

70
Q

alternative treatment for torsades?

A
  • IV beta blockers

- cardiac pacing

71
Q

ventricular tachycardia

A
  • 3 or more consecutive ventricular premature beats

- >100 bpm

72
Q

sustained vs. non sustained criteria for v. tach

A
  • NON-sustained: <30s

- sustained: >30s

73
Q

sx of v. tach

A
  • fainting
  • angina
  • lightheadedness
  • dizziness
  • palpitations
  • SOB
74
Q

causes/risk factors of v. tach

A
  • structural abnormality in heart
  • prior MI
  • CAD
  • heart failure
  • previous heart surgery
  • myocarditis
  • heart valve dz
75
Q

what are other causes of v. tach

A
  • antiarrhythmic meds
  • changes in blood chemistry or pH
  • lack of O2
76
Q

PE in v. tach

A
  • rapid HR
  • low BP
  • LOC
  • absent pulse
77
Q

diagnosis of v tach

A
  • EKG
  • echo
  • CXR
  • angio if echo is inconclusive
  • electrophys
  • cardiac MRI
78
Q

what is true in all cases of sustained v tach?

A
  • all should be admitted

- emergent

79
Q

in sustained v tach, if pt has symptoms (hypotension, shock, chest pain, etc.), what is the treatment?

A
  • CPR, ACLS protocol

- cardioversion

80
Q

in cardioversion of sustained v. tach, what are the guidelines?

A
  • wide/regular: 100J synchronized

- wide/irregular: defib

81
Q

in sustained v. tach that is urgent but w/o symptoms, what is the treatment?

A
  • IV access
  • EKG
  • lab studies
  • consider adenosine
  • consider antiarrhythmic infusion
82
Q

treatment of NON-sustained v. tach

A
  • lab studies and CXR
  • if no heart dz, may not need tx
  • w/ heart dz: beta blockers
  • amiodarone is a consideration
83
Q

if a pt. w/ non-sustained v. tach has sustained v. tach during electrophys studies, what is the treatment?

A

implantable defibrillator

84
Q

v. fib

A
  • ventricles of the heart quiver or fibrilate which stops adequate blood flow from heart
  • fatal unless immediately corrected
85
Q

etiology of v. fib

A
  • v. tach
  • acute ischemia or infarct
  • complete heart block
  • sinus node arrest
  • CAD
  • acidosis
86
Q

other risk factors for v. fib

A
  • drowning/hypothermia
  • drugs (legal and illegal)
  • electrical shock
  • very low BP
  • hypo/hyperkalemia
  • previous MI
  • congenital heart dz
  • cardiomyopathy
  • pneumothorax
  • thrombosis
  • tamponade
  • hypovolemia
87
Q

S/S of v. fib

A
  • sudden loss of responsiveness

- not breathing or only gasping

88
Q

what are early signs of v. fib?

A
  • chest pain
  • rapid heartbeat
  • dizziness
  • nausea
  • SOB
  • LOC
89
Q

Tx of v. fib?

A
  • CPR ACLS
  • O2
  • attach monitor
  • check rhythm
  • shock
  • start IV
  • continue CPR
  • advanced airway
  • drug therapy (epi and amiodarone)
  • tx reversible causes
90
Q

diagnosis of v. fib

A
  • always emergent situation

- after ACLS/CPR to resume life sustaining rhythm, you can ID the cause of it

Cardiology 1 (11 decks)

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