Arrhythmias

Question 1

Sxs: syncope, dizziness, lightheadedness, may have chest pain or SOB, but also mb Asx
EKG shows sinus rhythm

Answer 1

Dx: Sinus Bradycardia
Tx: consider tyrosine, dopamine, 5HTP, AA protocol, pacemaker if

Question 2

Sxs: mb Asx or have palpitations, hypotension, cyanosis, syncope, dizziness, weakness, chest pain, SOB, altered mental status

EKG shows: sinus rhythm >100bpm

Dx? Tx?

Answer 2

Sinus Tachycardia

Tx: treat cause, consider Ach protocol, B-vitmains, B-blocker, Ca Channel blocker, Mg, K

Question 3

Sxs: mb asx, common in children

EKG shows: Irregular rhythm, with R-R variation that widens during expiration, narrows during inspiration.

Answer 3

Sinus arrhythmia

Question 4

Sxs: feeling of a missed beat, irregular pause, common, benign

EKG shows: Premature/abnormal/absent P-wave, irregular rhythm, normal QRS, wide R-R interval

Answer 4

PACs
Tx: Lycopus
can deteriorate into Afib, Aflutter or PSVT

Question 5

Sxs: feeling of a missed beat, irregular pause, flip/flop,

EKG shows: early beat, no P wave, wide bizarre QRS complex

Answer 5

PVCs
can appear as bigeminy, trigeminy, quadrigeminy,…
may deteriorate into Vtach, Vfib, systole

Tx: reduce triggers, leonorus, exercise (unless PVCs worsen), Ach protocol, Thiamine deficiency, Avena, Cactus, crataegus,….

Question 6

Sxs: palpitations, weakness, arrest

EKG shows: wide bizarre QRS complexes, HR 100-200bpm

Answer 6

V-tach

Causes: Ischemic heart disease, MI, increased catecholamines, Epinephrine dose

Question 7

Sxs: pulseless, breathless

EKG shows: no true QRS complexes, wandering undulating baseline

Answer 7

V-fib

Tx: CPR, electrical defibrillation

Question 8

Sxs: racing heart beat

EKG shows: irritabel atrial focus, HR around 150bpm, normal wave sequence, no p-waves seen bc rate is too fast.

Answer 8

Paroxysmal atrial tachycardia

Question 9

Sxs: racing heart beat

EKG shows: irritable atrial focus, HR around 250bpm, no p=waves seen bc rate is too fast

Answer 9

PSVT

Tx: vagal maneuvers, Ca/Mg IV, Squill, Digitalis, Adenosine, Lycopus, Diltaiem

Question 10

Sxs: palpitations, weakness, faintness
EKG shows: QRS complex followed by definite and regular sequence of P-waves in a saw-toothed pattern. No T waves, no PR interval, no ST segment
Atrial HR 220-430bpm

Answer 10

Atrial flutter

Causes: PACs, ischemic heart disease, re-entry phenomenon, PE…

Question 11

Irregular rhythm, atrial HR 350-650bpm, no p-waves

Sxs: palpitations, angina, dizziness, fatigue

Answer 11

Atrial fib

Question 12

EKG shows: 
PR intervals greater than .20 sec
every atrial impulse results in nml QRS
Every QRS proceeded by a p-wave, but slightly elongated PR interval
Regular rhythm

Answer 12

1st degree heart block

Question 13

EKG shows:
progressive lengthening of PR interval
sudden QRS dropping, normal rhythm then re-established

Answer 13

2nd degree heart block Moritz Type 1 (Wenckebach)

conduction defect below AV node

Question 14

EKG shows:
series of normal beats with normal PR intervals
sudden p-wave occurs with dropped QRS, then normal rhythm restarts

Answer 14

2nd degrees heart block Moritz type II
defect in bundle of his
more dangerous as can degenerate into 3rd degree block more readily

Question 15

EKG shows:
p waves not associated with QRS
ventricular escape rhythm of 30-45bpm

Answer 15

3rd degree AV (complete) block

results in decreased CO, LOC and usually requires a pacemaker

Question 16

What are some treatments for 1st degree heart block?

Answer 16

Treat causes (eg, hypocalcemia, hypomagnesemia, hyponatremia, tyrosine deficiency, dopamine, NE, Epi deficiencies….dietary triggers, carbohydrates…)

Question 17

EKG shows:

Rabbit ear peaks (R and R’) in V1 and V2

Answer 17

Right bundle branch block

Question 18

EKG shows: double-peaks mountain in V5 and V6

Answer 18

Left Bundle Branch block