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EOR Family med > Arrhythmias > Flashcards

Arrhythmias Flashcards

(88 cards)

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1
Q

Normal heart rate

A

60-100 bpm

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2
Q

where do electrical impulses originate

A

Sinoatrial node (SA)

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3
Q

sinus tachycardia

A

NSR > 100 bpm

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4
Q

What med can be used for sinus tachycardia in the setting of acute coronary artery syndrome

A

beta blockers

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5
Q

sinus bradycardia

A

NSR < 60 bpm

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6
Q

first line for sx or unstable sinus bradycardia – and what does it do

A

atropine (anticholinergic drug that decreases vagal tone)

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7
Q

second line for sx or unstable sinus bradycardia if unresponsive to atropine

A

epinephrine or transcutaneous pacing

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8
Q

definitive management of sinus bradycardia

A

permanent pacemaker

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9
Q

what is the most common cause of narrow QRS complex tachycardia in paroxysmal supra ventricular tachycardia

A

reentry - AV nodal reentry MC

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10
Q

paroxysmal A-fib

A

self-terminating within 7 days (usually < 24 hours) +/- recurrent

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11
Q

persistent A-fib

A

fails to self-terminate, lasts > 7 days. requires termination (medical or electrical)

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12
Q

permanent A-fib

A

persistent A-fib > 1 year (refractory to cardio version or cardio version never tried)

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13
Q

lone a-fib

A

paroxysmal, persistent or permanent without evidence of heart disease

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14
Q

risk factors for Afib

A

HTN
valvular heart disease
heart failure ischemia
advanced age
obstructive sleep apnea
pulmonary embolism
obesity
chronic kidney disease
electrolyte imbalance (hypomagnesemia, hypokalemia)
diabetes
hyperthyroidism
pheochromocytoma
alcohol consumption
omega-3 fatty acid use
inflammation

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15
Q

what percent of Afib episodes are asx

A

90%

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16
Q

sx Afib

A

palpitations
dizziness
fatigue
generalized weakness
poor exercise tolerance
mild dyspnea
presyncope

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17
Q

unstable afib

A

sx are due to hypo perfusion and can include significant hypotension (systolic BP in double digits)
altered mental status
refractory chest pain (uncontrolled angina or ischemia)
decompensated congestive heart failure

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18
Q

what can be used to diagnose afib

A

EKG
cardiac monitoring

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19
Q

what will EKG show for Afib

A

irregularly irregular rhythm w fibrillary waves
no discrete P waves
often atrial rate > 250 bpm
the AV nodal refractory period determines the ventricular rate

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20
Q

cardiac monitoring for afib

A

a holter monitor or telemetry can be used if afib is not seen on an EKG but is suspected

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21
Q

tx for stable afib

A

rate control - Beta blockers (metoprolol, Atenolol, esmolol) OR non-dihydropyridine calcium channel blockers (Diltiazem, Verapamil) to slow AV node conduction

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22
Q

when is digoxin used in Afib

A

this is another option for rate control but is usually reserved for patients in whole beta blockers or CCBs are contraindicated (severe heart failure [NYHA class III or IV], hypotension)

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23
Q

tx for unstable afib

A

direct current (synchronized) cardioversion

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24
Q

is rate control or rhythm control preferred for long-term management of afib

A

rate control

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25
long term therapy for afib
rate control direct current (synchronized cardio version) or pharmacologic cardio version radio frequency catheter ablation or surgical 'MAZE' procedure CHA2DS2-VASc criteria for nonvalvular Afib to determine patients yearly thromboembolic risk in order to select appropriate anticoagulation regimen
26
in patients w AFib, what CHA2DS2-VASc score for oral anticoagulation
2 or more
27
when is cardio version most successful in afib
performed within 7 days after onset of Afib
28
what is done prior to cardio version in patients w Afib
transesophageal echocardiogram
29
If Afib > 48 hours --- anticoagulation therapy
initiate anticoagulation therapy for at least 3 weeks before and at least 4 weeks after cardio version
30
If Afib < 48 hours --- anticoagulation therapy
cardio version may be attempted as soon as possible often without coagulation
31
how long must anticoagulation be continued after cardio version in Afib
for 4 weeks after cardio version
32
CHA2DS2-VASc criteria
Congestive heart failure (1) HTN (1) Age >/= 75 (2) DM (1) Stroke, TIA, thrombus (2) Vascular disease (prior MI, aortic plaque, peripheral arterial disease) (1) Age 65-74 (1) Sex (female) 1
33
recommended therapy for CHA2DS2-VASc 2 or more
moderate to high risk chronic oral anticoagulation therapy recommended
34
recommended therapy for CHA2DS2-VASc 1
low risk anticoagulation may be recommended in some cases
35
recommended therapy for CHA2DS2-VASc 0
no anticoagulation needed
36
tx for afib in stable patient
anticoagulation - warfarin, apixaban, rivaroxaban, edoxaban, heparin, dabigatran
37
tx for afib in the presence of heart failure
digoxin amiodarone dronedarone
38
tx for afib for RATE control
BB or CCB metoprolol esmolol diltiazem verapamil
39
atrial flutter
rapid, regular atrial depolarizations at a characteristic rate around 300 bpm due to 1 single irritable atrial focus firing at a fast rate w some degree of AV node conduction block
40
what percent of pts w atrial flutter have coronary artery disease or hypertensive heart disease
60%
41
what is the range for bpm in atrial flutter
240 - 400 bpm characteristically around 300 bpm
42
sx atrial flutter
palpitations dizziness fatigue poor exercise tolerance mild dyspnea pre syncope
43
unstable atrial flutter
sx are due to HYPOPERFUSION systolic BP in double digits altered mental status refractory chest pain
44
diagnosis of atrial flutter
EKG transthoracic echocardiography
45
what will EKG show for atrial flutter
flutter "sawtooth" atrial waves usually ~300 bpm (atrial rate usually 240-400 bpm) but no discernible P waves
46
what is the preferred initial imaging modality for evaluating atrial flutter
transthoracic echocardiography
47
what will transthoracic echocardiography show for aflutter
can evaluate right and left atrial size, size and fin of right and left ventricles, assess for valvular heart disease, LVH, pericardial disease
48
tx for stable aflutter
vagal maneuvers rate control w beta blockers (metoprolol, atenolol, esmolol) or non-dihydropyridine calcium channel blockers (Verapamil, Diltiazem)
49
when is Digoxin used for aflutter
another option for rate control but usually reserved for pts in whole beta blockers or CCBs are contraindicated (severe heart failure class III or IV,) hypotension -- due to ADE and toxicity
50
tx for unstable aflutter
direct current (synchronized) cardio version
51
definitive management for aflutter
radiofrequency catheter ablation
52
PVC
premature beat originating in the ventricle --> wide, bizarre QRS occurring earlier than expected With a PVC, the T wave is in the opposite direction of the QRS usually Associated w a compensatory pause = overall rhythm is unchanged (AV node prevents retrograde conduction)
53
tx for PVC
asx --> no tx sx --> beta blockers (MC) or non-dihydropyridime CCB radio frequency catheter ablation if refractory
54
ventricular tachycardia
3 or more consecutive PVCs (Wide complex QRS duration > 120 ms) at a rate > 100 BPM (usually between 120 and 300 bpm)
55
what can sustained vtach lead to
Vfib
56
what is sustained vtach
duration at least 30 seconds or cause hemodynamic collapse in < 30 seconds
57
causes of vtach
underlying heart dz: ischemic heart dz MC (post MI 70%), structural heart defects, cardiomyopathies Prolonged QT interval Electrolyte abnormalities (hypomagnesemia, hypokalemia, hypocalcemia) Digoxin toxicity
58
sx vtach
palpitations dizziness fatigue dyspnea chest pain
59
unstable vtach
hypo perfusion can cause hypotension (systolic BP in double digits), altered mental status, refractory chest pain, acute pulmonary edema
60
what will EKG show for vtach
regular, wide complex tachycardia w no discernible P waves
61
tx for stable vtach
Amiodarone Procainamide
62
tx for unstable vtach
direct current (synchronized) cardio version
63
tx for pulseless vtach
unsynchronized cardio version (defibrillation) + CPR
64
chronic therapy for Vtach
beta blockers
65
torsades de pointes and what will EKG show
variant of polymorphic Vtach polymorphic Vtach (cyclic alterations of the QRS amplitude around the isoelectric line) aka sinusoidal waveform
66
what labs should you do when someone has torsades
rule out hypomagnesemia and hypokalemia
67
tx for recurrent TdP
IV magnesium sulfate Isoproterenol or Transvenous overdrive pacing if refractory
68
Tx for congenital TdP
beta blockers Avoid Isoproterenol
69
Tx for hemodynamically unstable TdP
synchronized cardio version
70
tx for pulseless TdP
prompt defibrillation (unsynchronized) cardio version
71
Vfib
a type of sudden cardiac arrest or sudden cardiac death with ineffective ventricular contraction
72
RF for Vfib
Ischemic heart disease (MC) structural heart defects Sustained Vtah electrolyte abnormalities - hypokalemia, hyperkalemia, hypomagnesemia, acidosis, hypoxia
73
what will EKG show for vfib
disorganized high frequency undulations w erratic pattern of electrical impulses, fibrillation waves of varying amplitude, shape, and periodicity, occurring at a rate above 320 bpm No identifiable P waves, QRS complexes, or T waves
74
tx for vfib
Unsynchronized cardioversion (defibrillation) + CPR Epi and Amiodarone per ACLS protocol
75
prevention for Vfib
secondary prevention - implantable cardioverter-defibrillator placement in people w prior VF and sustained VT primary prevention - ICD placement (pts w left ventricular ejection fraction < 35%)
76
First degree AV block
PR internal > 0.2
77
second degree AV block MOBITZ 1
progressive PRI lengthening until occasionally non-conducted atrial beats (one or more P waves without corresponding QRS)
78
second degree AV block MOBITZ 2
constant PRI length occasionally non-conducted atrial beats
79
third degree AV block
AV dissociation - normal P-P and R-R - atrial beats are not related to ventricular beats
80
aortic dissection
hx of uncontrolled HTN sudden onset severe chest pain that radiates to back
81
pericarditis
hx of viral infection retrosternal stabbing, chest pain that improves when leaning forward, worsens w deep inspiration
82
congestive heart failure
sx - cough exacerbated by lying down at night and improved by propping with pillows, exertion dyspnea
83
costochondritis
hx of viral infeciton sx - stabbing chest pain that worsens w deep inspiration, relieved by aspirin chest wall tenderness
84
pulmonary embolism
hx of recent immobilization sx - acute onset SOB at rest and pleuritic chest pain, tachycardia, hypotension, tachypnea, fever
85
pulmonary edema
sx worsening dyspnea of 6 hours + cough w pink, frothy sputum
86
GERD
retrosternal burning sensation that occurs after heavy meals and when lying down; relieved by antacids
87
sickle cell disease - acute chest syndrome
sx - acute onset severe chest pain w hx of sickle cell disease
88
what murmur might people w Afib have
mitral stenosis

EOR Family med (25 decks)

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