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CABS2: Cardiology > Arrhythmias > Flashcards

Arrhythmias Flashcards

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1
Q

What are arrhythmias and the problems with them

A

abnormal rhythm of the heart
rate: too fast, too slow (out of normal 60-100bpm)
rhythm: how regular is the heart beat
origin

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2
Q

what are the types of arrhythmias

A

Supraventricular (atrial origin, AV junction)
Ventricular

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3
Q

What is premature atrial contraction

A

PACs
supra-ventricular premature beats
not from the SA node
may originate within other areas of the atria or the AV node
more common in pts with mitral valve pathology or ventricular pathology

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4
Q

what are the causes of PACs

A

idiopathic
Toxins (smoking, ETOH, coffee)
ACS
COPD
Atrial myopathy (changes associated with aging process)

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5
Q

What are premature ventricular contractions

A

premature ventricular beats
abnormal beat coming from ventricular myocardium
leads to premature depolarization of the ventricles

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6
Q

what are the causes of PVCs

A

reentry associated with cardiac scaring
abnormal automaticity (electrolyte abnormality, ischemia, catecholamine surge)
other unique trigger

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7
Q

what are the subtypes of PVCs

A

Bigeminy (2)
Trigeminy (3)
quadrigiminy (4)
all regularly irregular

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8
Q

how can PVCs be classified

A

based on:
morphology
Frequency
symptomatic vs asymptomatic
exertional or not
if underlying cause can be identified

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9
Q

what is a block

A

delay in conduction along the ventricular pathway

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10
Q

what is first degree AV block

A

delay in transmission from atria to ventricles
PR interval prolonged >200ms

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11
Q

what is the causes of first degree AV block

A

increased vagal tone
fibrosis/scaring
idiopathic
familial disease (associated with prolonged QT syndrome)

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12
Q

what is the clinical presentation of first degree AV block

A

asymptomatic

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13
Q

what is second degree AV block

A

intermittent AV conduction
typically in a regular pattern
Mobitz type 1 (Wenckebach)
Mobitz type 2

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14
Q

what is Mobitz type 1

A

Wenckebach: Second degree AV block
progressive prolongation until beat drop
first PR segment normal

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15
Q

what is Mobitz type 2

A

second degree AV block
PR is maintained but will occasionally wont conduct through the ventricles
more dangerous than Wenckebach

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16
Q

What can cause second degree AV block

A

MI involving/near the conduction system
cardiomyopathy
myocarditis
endocarditis (abscess)
iatrogenic: medication that are AV nodal blocking

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17
Q

what is third degree AV block

A

complete heart block, no atrial impulses reach the ventricle
atria and ventricles are not communicating, firing in silos
the ventricular rhythm will maintain cardiac circulation - typically < 45bpm

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18
Q

what are the causes of third degree AV block

A

myocardial ischemia
cardiomyopathy
myocarditis
iatrogenic
lyme disease

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19
Q

what is the clinical presentation of 3rd degree AV block

A

lightheadedness
palpitations
syncope
weakness
fatigue
chest pain

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20
Q

what are bundle branch blocks

A

disruption of electrical conduction down one of the bundle branches coming off the bundle of His

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21
Q

what is Right BBB

A

branching off the bundle of His, RBB made up of fast response Purkinje fibers
blood supply from RCA
associated with:
increased right ventricular hypertrophy
increase ventricular pressure (PE)
Mi, infraction
inflammation
iatrogenic

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22
Q

what is Left BBB

A

branching off of the bundle of His, LBB made up of fast response Purkinje fibers
blood supply from RCA
pathophysiology endocarditis (abscess), post surgical changes

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23
Q

what is “bunny ears” on EKG indicative of

A

Right Bundle Branch Block

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24
Q

what is the presentation of LBBB

A

results in slower QRS complex (wide)

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25
what is sinus tachycardia
the most common tachycardia narrow, regular tachy >100bpm reactive rhythm associated with increased sympathetic tone BENIGN DYSRHYTHMIA - NORMAL RESPONSE
26
what are the causes of sinus tachycardia
increased automaticity: increased SA node firing for physiologic reasons -increased sympathetic tone (catecholamines) - associated with: hypovolemia, hypoxia, meds, pain/anxiety, increased metabolic demand increased triggering: problem with the myocardium -meds -ischemic area - cardiomyopathy
27
what is the treatment for sinus tachycardia
Treat the underlying condition! (i.e. lower anxiety)
28
what is PSVT
Paroxysmal supraventricular tachycardia AKA SVT sustained reentry loop within the AV node - may be associated with ectopic atrial source tachy, regular, narrow QRS complexes P waves typically not visualized
29
who is PSVT/SVT most common in
women, early 20s and no CV disease
30
what is the average HR for SVT
150-250 bpm
31
What is afib
irregularly irregular rhythm with narrow QRS complex due to multiple areas of automaticity that are desynchronized within the atria - SA node is not in control
32
what is RVR
rapid ventricular response
33
what is afib with RVR
tachyarhythmia; rapid heart rate
34
what are the causes of afib
typically a secondary disease process ischemic heart disease valvular heart disease congestive cardiomyopathy HTN myocardidits holiday heart thyrotoxicosis blunt chest trauma genetic link in younger pts, associated with ANS (exercise induce- sympathetic, parasympathetic source)
35
what is paroxysmal afib
lasts less then 7 days with spontaneous conversion
36
what is persistent afib
over 7 days or needs cardioversion
37
what is seen on ECG with afib
no clear P wave or isoelectic baseline QRS narrow irregularly irregular QRS complexes seen best in V1
38
what are the different types of afib
paroxysmal persistent permanent
39
what is Atrial flutter
atrial tachycardia with single reentrant circuit fixed degree of AV conduction resulting in a regular rhythm atrial rate typically 250-250 bpm regular ventricular rate 150bpm
40
what is a sawtooth on ECG
pathopneumonic for atrial flutter
41
what are the ECG findings for atrial flutter
regular rate narrow QRS Single morphology P waves in sawtooth pattern typically tachycardic rhythm around 150bpm
42
what is the most common wide complex regular tachycardia
ventricular tachycardia (VTAC) impulse originates in the myocardium of the ventricles sustained or nonsustained
43
what is vtac usually associated wtih
underlying etiology that causes pathologic myocardium reentrant circuit associated with scar formation(often associated with previous MI) Young people: myocarditis, hypertrophic cardiomyopathy, long QT, congenital causes, drugs
44
what causes Vtac
channelopathies cardiomyopathy myocarditis substance use CAD valvular disease
45
what is the number one cause of VTAC
QT PROLONGATION
46
what are the symptoms of VTAC
may range from asymptomatic to sudden cardiac death anxiety, feelings of fluttering in chest, dizziness, pain or pressures in chest, heart palpitations, fatigue, SOB, fainting
47
what is the presentation of VTAC on ECG
wide complex >120ms HR >100bpm consecutive beats uniform lasts > 30 seconds
48
What is Torsades de points
polymorphic VTAC associated with electrolyte abnormality leads to prolonged QT increased automaticity
49
what electrolyte is associated with torsades de points
magnesium*
50
What is vfib
chaotic depolarization of the ventricular myocardium no true mechanical activation no cardiac output
51
what is Vfib most commonly associated with
ischemic disease may be acute or chronic - occurs suddenly, without warning secondary disease cause more of a long progressive of LV failure
52
what needs to be assessed with any concern of Vfib
check a pulse
53
what is seen on ECG with Ventricular fib
may be course or fine no P waves, defined WRS, T waves unable to determine real rate
54
what happens with bradyarrhythmias
may be associated with decreased automaticity vagus nerve stimulation via parasympathetic NS decreasing HR Decreases conduction of the SA node
55
what causes sinus bradycardia
increased vagal tone (parasympathetic) Medications that slow AV conduction: BB, CCB, digoxin Metabolic changes (hypothermia, hypothyroidism) Electrolyte abnormality (potassium) Brain herniation
56
What is sick sinus dysfunction
also called tachybrady syndrome dysfunction with the SA node - often associated with aging process - dose not generate impulse to keep up with the demand
57
what may be seen with sick sinus dysfunction
bradycardia pause arrest inadequate HR based on physiologic demands
58
what is the pathophysiology of Sick sinus dysfunction
fibrosis of the SA node medications familial disease - cardiac sodium channel SCN5A, HCN4
59
what is the treatment of sick sinus syndrome
exercise intolerance fatigue dizziness HA Nausea palpitations Chest pain SOB
60
what is the treatment of sick sinus syndrome
observation possible need for artificial pacemaker medications: atropine, warfarin

CABS2: Cardiology (11 decks)

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