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Cardiovascular > Arrhythmias > Flashcards

Arrhythmias Flashcards

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1
Q

Sinus bradycardia etiology

A

Normal response to CV conditioning

Can also result from sinus node dysfunction or from B-blocker or CCB excess.

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2
Q

Signs/Symptoms of Sinus brady

A

May be Asx. May present with lightheadedness, syncope, chest pain or hypotension

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3
Q

ECG findings in sinus brady

A

Sinus rhythm

Ventricular rate less than 60bpm

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4
Q

Tx for sinus brady

A

None if ASx

Atropine may be used to increase HR

Pacemaker placement is the definitive tx in severe cases.

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5
Q

First degree AV block etiology

A

Can occur in normal individuals

Associated with increased vagal tone and with B-blocker or CCB use

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6
Q

Signs of First degree AV Block

A

Asx

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7
Q

ECG findings for First degree AV block

A

PR interval greater than 200ms

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8
Q

Tx for First degree AV block

A

None needed

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9
Q

Second degree AV block (Mobitz I/Wenckebach) etiology

A

Drug effects (Digoxin, B-blockers, CCBs) or increased vagal tone; R coronary ischemia or infarction

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10
Q

Mobitz I signs

A

Usually ASx

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11
Q

ECG findings for Mobitz I

A

Progressive PR lengthening until a dropped beat occurs; the PR interval then resets

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12
Q

Tx for Mobitz I

A

Stop offending drugs

Atropine as clinically indicated

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13
Q

Second degree AV block (Mobitz II) etiology

A

Results from fibrotic disease of the conduction system or from acute, subacute, or prior MI

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14
Q

Signs of Mobitz II

A

Occasionally syncope

Frequent progression to third-degree block

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15
Q

ECG findings of Mobitz II

A

Unexpected dropped beats without a change in PR

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16
Q

Tx for Mobitz II

A

Pacemaker placement

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17
Q

Third degree AV block (complete) etiology

A

No electrical communication between the atria and ventricles

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18
Q

Signs of complete heart block

A

Syncope, dizziness, acute heart failure, hypotension, cannon A waves

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19
Q

ECG for complete heart block

A

No relationship between P waves and QRS complexes

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20
Q

Tx for complete heart block

A

Pacemaker placement

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21
Q

Sick sinus syndrome/tachycardia-bradycardia syndrome etiology

A

A heterogeneous disorder that leads to intermittent SVT and bradyarrhythmias

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22
Q

Signs and symptoms of SSS

A

Secondary to tachycardia or bradycardia; may include syncope, palpitations, dyspnea, chest pain, TIA, and stroke

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23
Q

Sinus tachycardia etiology

A

Normal physiologic response to fear, pain, and exercise

Can be secondary to hyperthyroid, volume contraction, infection, or Pulm Embolus

This is supraventricular at Atria

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24
Q

Sinus tachycardia signs

A

Palpitations, SOB

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25
ECG sinus tachy
Sinus rhythm, ventricular rate above 100bpm
26
Tx of sinus tachy
treat underlying cause
27
AFib etiology
Acute = PIRATES. 1) Pulmonary disease 2) Ischemia 3) Rheumatic heart disease 4) Anemia/Atrial myxoma 4) Thyrotoxicosis 5) Ethanol 6) Sepsis Chronic - HTN and CHF This is supraventricular at the atria
28
Signs of AFib
Often ASx, but may present with SOB, CP or palpitations Physical exam reveals an irregularly irregular pulse
29
ECG AFib
No discernible P waves, with variable and irregular QRS response
30
Tx for AFib
Estimate risk of stroke using CHADS2 score. Anticoagulate if at or above 2. Anticoagulation if more than 48h (to prevent CVA); rate control (B-blockers, CCBs, digoxin) Initiate cardioversion only if new onset (less than 48h) or TEE shows no LA clot. OR after 3-6w of warfarin tx with a satisfactory INR of 2-3.
31
Atrial Flutter etiology
Another SVT with atrial origin Circular movement of electrical activity around the atrium at a rate of approximately 300 times per minute
32
Signs of Atrial flutter
Usually ASx, but can present with palpitations, syncope, and lightheadedness
33
ECG for Atrial flutter
Regular rhythm; "sawtooth" appearance of P waves can be seen. The atrial rate is usually 240-320bpm and the ventricular rate is about 150 bpm
34
Treatment of Atrial flutter
Anticoagulation, rate control, and cardioversion guidelines just like in AFib
35
Multifocal atrial tachycardia etiology
Another SVT with atrial origin Multiple atrial pacemakers or reentrant pathways; COPD, hypoxemia
36
Signs of MAT
May be ASx. At least 3 different P-wave morphologies
37
ECG for MAT
3 or more unique P wave morphologies Rate above 100bpm
38
Tx of MAT
Treat underlying disorder Verapamil of B-blockers for rate control and suppression of atrial pacemakers (not very effective)
39
AV nodal reentry tachycardia (AVNRT) etiology
an SVT with AV junction origin A reentry circuit in the AV node depolarizes the atrium and ventricle nearly simultaneously
40
Signs of AVNRT
Palpitations, SOB, Angina, Syncope, lightheadedness
41
ECG for AVNRT
Rate 150-250bpm P wave is often buried in QRS or shortly after**
42
Tx of AVNRT
Cardiovert if hemodynamically unstable. Carotid massage, valsalva, or adenosine can stop the arrhythmia
43
Atrioventricular reciprocating tachycardia (AVRT) etiology
an SVT with AV junction etiology An ectopic connection between the atrium and ventricle that causes a reentry circuit. Seen in WPW.
44
Signs of AVRT
Palpitations, SOB, Angina, Syncope, lightheadedness
45
ECG for AVRT
A retrograde P wave is often seen after a normal QRS. A preexcitation delta wave is characteristically seen in WPW
46
Tx for AVRT
Same as AVNRT
47
Paroxysmal atrial tachycardia
an SVT with AV junction origin Rapid ectopic pacemaker in the atrium (not sinus node)
48
Signs of PAT
Palpitations, SOB, Angina, Syncope, lightheadedness
49
ECG for PAT
Rate over 100bpm P wave with an unusual axis before each normal QRS
50
Tx for PAT
Adenosine can be used to unmask underlying atrial activity
51
Premature ventricular contraction etiology
a VT Ectopic beats arise from ventricular foci. Associated with hypoxia, electrolyte abnormalities and hyperthyroidism
52
Signs of PVC
Usually ASx but may lead to palpitations
53
ECG for PVC
Early, wide QRS not preceded by a P wave PVCs are usually followed by a compensatory pause
54
Tx for PVC
Treat underlying cause. If symptomatic give B-blockers or occasionally other antiarrhythmics
55
Ventricular tachycardia etiology
a VT (clearly) Can be associated with CAD, MI, and structural heart disease
56
Signs of VTach
Nonsustained VT is often ASx Sustained VT can lead to palpitations, hypotension, angina, and syncope Can progress to VFib and death
57
ECG for VT
3 or more consecutive PVCs Wide QRS complexes in a regular rapid rhythm May see AV dissociation
58
Tx for VT
Cardioversion and antiarrhythmics (amiodarone, lidocaine, procainamide)
59
VFib etiology
a VT Associated with CAD and structural heart disease. Also associated with cardiac arrest (together with asystole)
60
Signs of VFib
Syncope, absence of BP, pulselessness
61
ECG for VFib
Totally erratic wide-complex tracing
62
Tx for VFib
Immediate electrical cardioversion and ACLS protocol
63
Torsades de pointes etiology
a VT Associated with long QT syndrome, proarrhythmic response to meds, hypokalemia, congenital deafness and alcoholism
64
Signs of Torsades
Can present with sudden cardiac death; typically associated with palpitations, dizziness, and syncope
65
ECG of Torsades
Polymorphous QRS; VT with rates between 150 and 250 bpm.
66
Tx for Torsades
Give magnesium initially and cardiovert if unstable Correct hypokalemia Withdraw offending drugs

Cardiovascular (16 decks)

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