arrhythmias

Question 1

What are some sinus node disturbances

Answer 1

Sinus Brady
Sinus node dysfunction
Junctional Brady cardia
sinus arrest
sinus tachy

Question 2

What drugs can cause bradycardia

Answer 2

beta blockers
calcium channel blockers

Question 3

What is chronotropic incompetence

Answer 3

SA is not responding to stress placed on it

Question 4

What is the cause of sinus exit block

Answer 4

an issue with transition cells

Question 5

What is sinus arrest

Answer 5

Long pauses in between regular beats

*if longer than 3 seconds-> need a pacemaker

Question 6

What is junctional bradycardia

Answer 6

AV node fires faster than the SA node

P waves are hidden within or after QRS

Narrow QRS

**because its originating in the AV node, it will be slow

Question 7

What does an escape beat look like on an EKG

Answer 7

A beat that comes later than expected

Question 8

What is asystole

Answer 8

complete absence of demonstrable electrical and mechanical cardiac activity

Question 9

What is sick sinus syndrome

Answer 9

Sinus node dysfunction

Question 10

What causes sick sinus dysfunction

Answer 10

fibrosis of the SA node
Medication suppression
Chronotropic incompetence
cardiorespiratory conditioning

Question 11

How do you manage someone with sick sinus syndrome

Answer 11

Atropine (better for SA node vs junctional rhythm)

temporary pacing wire

possible pacer

Question 12

What is a sinus arrhythmia

Answer 12

A normal cardiac cycle where you see and increase of HR on inspiration and a decrease on expiration

Question 13

What causes sinus tachycardia

Answer 13

stimulation of the sinus node

*adrenergic response (fight or flight)

Question 14

What is one of the most sensitive findings of a PE

Answer 14

sinus tachy

Question 15

What is the first line treatment of sinus tachycardia

Answer 15

treat reversible causes

then consider beta blockers

Question 16

What are atrial rhythm disturbances

Answer 16

Atrial fibrillation
atrial flutter
wandering atrial pacemaker
SVT

Question 17

What is the mechanism of Aflutter

Answer 17

circuit of re-entrant activation (cavotricuspid isthmus)

Question 18

Where does afib generally originate

Answer 18

transition tissue of the pulmonary vein

Question 19

What is the mechanism of afib

Answer 19

wavelets of re-entrant activation

Question 20

What is the management of afib/flutter

Answer 20

anticoagulate
rate control (beta blocker)
rhythm control (Na+ / K+ blocker)

Question 21

What is a WAP rhythm

Answer 21

Wandering atrial pacemaker
rate <100bpm
polymorphic P waves

Question 22

What is a MAT rhythm

Answer 22

Multifocal atrial tachycardia
Rate >100
Polymorphic P waves

Question 23

Which patient population are at higher risk of developing MAT / WAP

Answer 23

Those with pulmonary disease
-COPD

Question 24

What is the mechanism behind WAP / MAT

Answer 24

multiple atrial ectopic foci

Question 25

How do you treat MAT / WAP

Answer 25

Oxygen levels treat underlying causes

Question 26

What are the two kinds of SVT

Answer 26

AVNRT (most common) AVRT

Question 27

How will someone with SVT present

Answer 27

Palpitations lightheadedness heart racing pre syncope / syncope

Question 28

If someone complains that their heart feels funny when they bend forward, what is their most likely dx

Answer 28

AVNRT until proven otherwise

Question 29

How do you manage SVT acutely

Answer 29

Vagal maneuvers Adenosine Cardioversion

Question 30

Why do vagal maneuvers help with SVT

Answer 30

b/c vagus nerve innervates the AV node and will slow it down

Question 31

Why does Adenosine help treat SVT acutely

Answer 31

Adenosine blocks the AV node so the rate can get back to a regular rhythm

Question 32

Which patients do you NOT want to use adenosine on

Answer 32

Afib and WPW *use procainamide instead

Question 33

How do you control chronic SVT

Answer 33

Rate control antiarrythmics (flecainide) ablation

Question 34

What will an EKG in someone with WPW look like

Answer 34

There will be no PR interval Will see a delta wave

Question 35

What are the A-V junctional rhythm disturbances (heart block)

Answer 35

First degree Second degree (mobitz 1&2) Third degree

Question 36

What is second degree heart block known as

Answer 36

Wenckebach

Question 37

Which second degree heart block is more unstable

Answer 37

type 2

Question 38

What occurs in third degree heart block

Answer 38

complete atrial ventricular dissociation

Question 39

What causes junctional rhythm disturbances

Answer 39

Disease of the AV node -lyme carditis -congenital -fibrosis (m/c) -iatrogenic (TAVR)

Question 40

How will someone with a junctional rhythm present

Answer 40

SOB Lightheadedness syncope

Question 41

How do you manage junctional arrhythmias

Answer 41

Acute (HD unstable) -Atropine / dobutamine -temp pacer wire Chronic -pacer

Question 42

What causes ventricular dysrhythmias

Answer 42

VT torsades VF

Question 43

What is brugada's sign

Answer 43

time from onset of R wave to lowest point of S wave >100ms

Question 44

What is Josephson's sign

Answer 44

notching near the lowest point of the S wave

Question 45

What are the mechanisms of ventricular tachyarrythmias

Answer 45

Ischemia / infarct drugs toxicity metabolic derangement prolonged QT

Question 46

How will patients present with ventricular tachyarrythmias

Answer 46

unconscious / pulseless SOB Lightheadedness palpitations

Question 47

How do you manage tachyarrythmias

Answer 47

Amioderone Lidocaine Cardioversion (if regular) Defib (if irregular) TdP: Mag, Mag, more Mag

Question 48

What is seen on both RBBB and LBBB EKGs

Answer 48

wide QRS complex

Question 49

What will be seen on an EKG with RBBB

Answer 49

Wide QRS ST segment depression T wave inversion **rabbit ears in V1 or V2 **broad S wave in V6

Question 50

What will be seen on an EKG in someone with a LBBB

Answer 50

Wide QRS RR in V6 Dominant S wave in V1

Question 51

When is Sgarbossas criteria used

Answer 51

A new LBBB w/ question of ACS

Question 52

What generally causes BBB

Answer 52

Fibrosis Ischemia / infarct Drugs / toxicity