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Flashcards in Arrhythmias Deck (34)
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1

What are the sinus node rhythm disturbances?

Sinus Arrhythmia
Sinus Pause/Arrest
Sinus Bradycardia
Sinus Tachycardia

2

What is sinus arrhythmia? Tx

normal P, PR, QRS. rhythm sometimes appears irregular but originating from the sinus node.
-cyclic variation with respirations.

Tx: benign, not tx needed.

3

What is sinus pause/arrest? Tx

a missed beat, typically lasts 2 seconds to 2minutes.
-normal and fixed PR and RR intervals, lack p waves

Tx: -underlying cause
-pacemaker
-atropine IV if hemodynamic instability

4

Sinus Bradycarida what is this? Tx

heart rate less than 60BPM, may be caused by beta blockers and digoxin

Tx:
SHORT TERM:
-sx & hemodynamically unstable: atropine &/or temporary pacemaker
-asymptomatic:
monitor and educate

LONG TERM:
-no tx for long term if pt is asymptomatic
-will need permanent pacemaker if sx

5

Sinus Tachycardia
-what is this?
-causes
-tx

What: heart rate greater than 100BPM

Causes:
fever, pain, exercise, anemia, hypotension, thyrotoxicosis, anxiety

Tx:
-treat underlying cause
-calcium channel blockers (cardizem and verapamil)
-beta blockers

6

What are the supraventricular arrhythmias

-Supraventricular tachycardia
--WPW
--AV node re-entrant tachy (shortcut)
--atrial tachy
-afib
-aflutter

7

PSVT
-heart rate
-ekg findings
-sx
-tx
-medications to prevent recurrence

HR 140-240
-P wave buried in QRS
-QRS is narrow** and normal morphology

Sx:
-palpitations
-dizziness
-SOB
-anxiety
-chest pain

Tx:
-Vagal maneuvers (hold breath, face in cold water, cough, carotid massage)
-adenosine IV (blocks conduction at the AV Node)
-cardioversion if adenosine doesnt work OR IV beta/Ca2+ blocker

Prevention:
beta blockers
ca2+ blocker
digoxin
SVT ablation

8

WPW
-HR
-what causes this
-what is it
-sx
-EKG findings
-tx

HR: greater than 200
What causes this: congenital defect, most common causes of fast arrhythmias in infants and children.

-what is this? form of SVT that uses the normal plus accessory pathways to conduct impulses faster and in both directions .

-Sx:
palpitations, tachycardia, dizzines, dyspnea, anxiety, syncope, cardiac arrest.

EKG findings:
-PR interval is short, less than 0.12ms, Delta wave*

Tx:
-radiofrequency ablation
-beta blockers
-calcium blockers
-flecainide
-vagal maneuvers
-IV adenosine OR IV cardizem or verapamil if adenosine doesnt work.
-if hemodynamically unstable cardioversion

9

Paroxysmal Atrial Tachycardia (PAT)
-rate
-what is this?
-ekg findings
-Tx

Rate: 150-250BPM
EKG findings:
-may conduct to ventricles but the AV node will try to block impulses
-P wave morphology varies from sinus*

Tx:
-Treated with Vagal Maneuvers
-if Vagal maneuvers fail...
--adenosine**
--cardioversion
--digoxin
--beta blockers
--Calcium channel blockers to prevent recurrence

10

Premature Atrial Contractions (PACs)
-what causes this?
-EKG findings
-Tx

Cause: discharge from a non-sinus atrial pacemaker

EKG;
-p-wave preceding may not look like the p waves that originate from sinus node, may get lost in T wave.

Tx:
-non-life threatening, only treat if symptomatic w/ beta blockers.

11

Wandering Atrial Pacemaker
-Rate
-EKG findings
-Tx

Rate: 45-100BPM

EKG findings
-P wave; needs to have 3 distinctly different P waves

Tx: no tx required

12

Multifocal Atrial Tachycardia
-rate
-ekg findings
-Tx

Rate: greater than 100

EKG:
-3 different P waves in a given lead

Tx: treat the underlying medical condition
-suppress rate with AV nodal blocking agents:
--Calcium channel and beta blockers

13

A-fib
-cause
-describe this rhythm
-Rate
-EKG
-common with what underlying cardiac and pulmonary dz?

cause: multiple re-entrant loops generate chaotic atrial depolarization, AV node bombarded with rates greater than 400BPM from atrial foci..AV works hard to block impulses.

Rhythm: "irregularly irrregular"

Rate: 110-170BPM

EKG:
-no distinguishable P waves

Common w/ vavlular dz, heart failure, HTN, and sleep apnea.

14

What is the most common encountered arrhythmia in clinical practice?

Afib

15

Which lab always needs to be checked with new onset of Afib dx?

TSH!

16

Afib Tx

Stasis of blood in atria Tx: warfarin/pradaxa

Rate Control: 60-110
-Diltiazem/Beta blocker/ Digoxin


Rhythm Control if necessary:
Class 1A: Pronestyl(Procainimide), Quinidine(Cardioquin)
Class III. Satalol(Betapace), Ibutilide(Covert), amiodarone*
Class IC: propafenone(Rhythmol), Flecainide(Tambocor) *used only in pt with structurally normal heart.

Cardioversion:
-safe to cardiovert if less than 48-72hrs of afib
*make sure to get TEE prior to cardioversion to see if thrombus present in atria.

....if duration unknown:
-rate control
-anticoagulate 4-6wks then cardiovert
-anticoagulate x6wks after successful cardioversion or indefinately if pt unaware they were in afib.

.....if failure of CV and medical therapy:
atrial ablation, AV ablation in extreme cases which would require pacemaker placement.

17

What is the CHADS2 calculator? what is it used for?

CHADS2 is used to estimate embolic risk, does not apply to those with valve dz.

C=CHF 1pt
H= HTN 1pt
A=Age greater than 75 1pt
D=DM 1pt
S=stroke 2pts

*if equal to or greater than 2pts anticoagulation unless CI.

18

Evaluation of new onset afib pts

-echo: evaluate presence of valvular heart disease

Nuclear stress test: evaluate presence of ischemic heart dz

SLeep study: r/o sleep apnea

Thyroid function test*****

19

Atrial Flutter
-rate
-rhythm description
-ekg findings
-tx

Rate: atria=250-350BPM
ventricles=150

Rhythm: regularly irregular, AV node blocks at 2:1, 3:1. 4:1

EKG:
-sawtooth pattern

Tx:
ASA 325mg/day
-ablation if failed cardioversion and medical therapy
-Class 1A antiarrhythmics to convert back to sinus: Pronestyle (Procainmide)
-Ventricular rate controlled with:
--beta blocker
--calcium channel blocker
--digoxin

20

What are the AV node disturbances

-Junctional Escape
-Accelerated Junctional
-Junctional Tachy

21

Junctional Escape &Accelerated Junctional
-rate
-EKG findings
-tx

Rate:
-Junctional escape: 40-60BPM
-Accelerated Junctional:
60-100BPM

EKG findings both:
-Narrow QRS complex
-Retrograde P wave (inverted with short PR interval), P wave immediately after QRS, or no P wave

Tx:
no tx required

22

Junctional Tachycardia
-rate
-tx

Rate: 150-250BPM

Tx: Acute:
-vagal maneuvers
-adenosine (DOC)*

Long Term:
-beta blockers
-calcium channel blockers
-Class 1A, 1C, and III antiarrhythmics for resistant cases

23

What are the types of AV Blocks?

-1st degree
-2nd degree Wenkebach
-2nd degree Mobitz
-3rd degree heart block

24

1st degree AV block
-tx
-ekg findings

tx: treat the underlying cause (such as inferior MI, digitalis tox, hyperkalemia, myocarditis, rheumatic fever)

-ekg findings:
consistently prolonged PR interval greater than 0.20

25

2nd Degree Wenckebach
-tx
-where does this block occur?
-ekg findings

Tx: no tx, since generally no sx

-Block occurs in AV node and bundle of HIS

EKG: PR interval gets progressively longer until a QRS is dropped

26

2nd degree AV block Mobitz Type II
-where does this block occur?
- EKG findings
-Tx

-This block occurs below the bundle of his

-EKG findings: "out of the blue drop a Q", usually widened QRS

Tx: atrial pacing, permanent pacemaker

27

3rd Degree AV heart block
-ekg findings
-rate
-tx

EKG: atrial rate is normal, normal P-P intervals, but not married to QRS intervals.
-QRS may be normal or widened

Rate:
-atria faster than ventricles, ventricles around 70BPM

-Tx:
-external pacing and atropine for acute symptomatic episodes
-permanent pacing for chronic complete heart block.

28

What are the ventricular dysrthmyias

-Premature ventricular contraction
-Ventricular Tachycardia
-Ventricular Fibrillation
-Asystole
-Idioventricular rhythm
-PEA

29

Premature Ventricular Contractions
-causes
-EKG findings
-Sustained VT is how long? Nonsustained?
-rhthym
-tx

causes: KNOW THESE, Jen said so...
-Hypokalemia, low magnesium level, increasing catecholamines, coronary ischemia

EKG:
-P wave usually obscured by QRS
-QRS is wide, morphology is bizarre

-Sustained VT if greater than 30seconds or nonsustained if less than 30seconds.

Rhythm:
-PVCs may occur in singles, couplets(2 in a row), or triplets, or in bigeminy(every other is PVC), trigeminy(every 3rd is PVC), or quadrigeminy

Tx:
-Lidocaine Class 1B antiarrhythmic
-Rocainamide Class 1A
-Amiodarone Class III
-replace magnesium
IF PULSE:
-cardioversion & amiodorone

IF PULSELESS
-defibrillation & amiodarone


****LIFE THREATENING ARRHYTHMIA!!!***

30

Torsades de Pointes
-caused by
-Tx

Caused by: hypokalemia and hypomagnesemia

Tx:
-Cardioversion
-IV magnesium
-IV potassium
-Overdrive pacing