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Step up - Cardiovascular > Arrhythmias > Flashcards

Arrhythmias Flashcards

(56 cards)

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1
Q

What would you see on an ECG of a patient with PAC’s?

A

Early P waves with different morphology from normal

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2
Q

How do PAC’s affect QRS complex?

A

Normal because conduction is normal below the atria.

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3
Q

PAC’s can lead to what two clinical manifestations?

A

Palpitations

PSVT

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4
Q

What is the common treatment for asymptomatic patients with PAC’s?

A

None

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5
Q

What is used for symptomatic patients with PAC’s?

A

Beta blockers

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6
Q

What ECG finding is seen in PVC’s?

A

Wide QRS complex

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7
Q

Presence of PVC’s in patients with normal hearts is associated with…

A

increased mortality

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8
Q

Patients with frequent PVC’s and underlying heart disease are at increased risk of ….

A

sudden death due to cardiac arrhythmia (especially Vfib)

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9
Q

What test should be ordered for a patient with frequent PVC’s and underlying heart disease?

A

Electrophysiologic study

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10
Q

What treatment may be used for a patient with frequent PVC’s and underlying heart disease?

A

Implantable Cardio Defibrillator

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11
Q

Patients with AFib and underlying heart disease are at a high risk for what two things?

A

Embolization and hemodynamic compromise

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12
Q

What is cardioversion?

A

Delivery of a shock that is in sync with the QRS complex

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13
Q

What is cardioversion indicated for?

A

AFib, atrial flutter, VT with a pulse, SVT

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14
Q

What is defibrillation?

A

Delivery of a shock that is OUT of sync with the QRS complex

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15
Q

What is defibrillation indicated for?

A

VFib, VT without a pulse

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16
Q

What are the three main treatment goals in a stable patient with acute AFib?

A

Rate control
Cardioversion to sinus rhythm
Anticoagulation

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17
Q

What two classes of medications can be used for rate control in acute stable AFib patients?

A

Beta blocker

Calcium channel blocker

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18
Q

What three groups of patients with stable acute AFib are candidates for cardioversion?

A

Hemodynamic instability
Worsening symptoms
First case of AFib

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19
Q

For patients with acute AFib for an unknown period of time that going through cardioversion should be anticoagulated on what schedule?

A

Three weeks before and four weeks after cardioversion

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20
Q

What is the INR goal for AFib patients?

A

2 to 3

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21
Q

Patients with stable chronic AFib, what are the treatment goals?

A

Rate control

Anticoagulation

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22
Q

What group of patients with stable chronic AFib do NOT require anticoagulation?

A

<60
No heart disease
No cardiac risk factors

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23
Q

What are the side effects of adenosine?

Study These Flashcards
A 
Headache
Flushing
SOB
Chest pressure
Nausea
24
Q

Adenosine is most commonly used to treat what?

Study These Flashcards
A

Paroxysmal Supraventricular Tachycardia

25
What are three alternatives to Adenosine for treatment of Paroxysmal SVT?
IV Verapamil, IV esmolol, digoxin
26
If drugs do not stop paroxysmal SVT, what can be done?
Cardioversion
27
Define ventricular tachycardia
Firing of three or more PVC's in a row at a rate between 100-250bpm
28
What happens to the P wave during ventricular tachycardia?
The P wave does not change and is consistent
29
Most common cause of ventricular tachycardia
CAD with prior MI is the most common cause
30
How long is sustained VT?
longer than 30 seconds
31
ECG finding in ventricular tachycardia
wide bizarre QRS complexes
32
How should a hemodynamically stable patient with sustained VTac bbe treated?
IV amiodarone or IV procainamide
33
How should a hemodynamically unstable patient with sustained VTac be treated?
Immediate synchronous DC cardioversion | IV amiodarone
34
Ideally, if a patient has VTac and decreased ejection, what should they be treated with?
ICD
35
In a patient with unsustained VTac and no underlying cardiovascular disease, how should they be treated?
Do no treat. Not at risk of sudden death
36
If a patient has nonsustained VTac with underlying heart disease, recent MI, or LV ejection dysfunction, how should they be treated?
ICD placement
37
Most episodes of VFib begin with...
VTac
38
Most common cause of VFib is...
ischemic heart disease
39
What ECG findings are seen in VFib?
No atrial P waves No QRS complexes Only very irregular rhythm
40
What are the first two treatments for someone presenting with VFib?
Defibrillation | CPR
41
What are three clinical features/findings in a patient with VFib?
Cannot measure BP, no heart sounds, no pulse Patient unconscious If untreated, leads to sudden cardiac death
42
How many sequential shocks can be given for a patient with VFib before trying medication?
3 - Check rhythm between each one
43
If defibrillation does not work in stopping VFib, what should be tried next?
Epinephrine 1mg IV every 3-5 minutes
44
After the first epinephrine dose for a patient with VFib, when should you attempt to defibrillate them again?
30-60 seconds after first epi dose
45
If epinephrine and defibrillation have failed to stop VFib, what is the next option?
Amiodarone followed by shock
46
If cardioversion is successful in stopping VFib, what two treatment should follow?
1. Continue IV infusion of whatever antiarrhythmic stopped the VFib, usually amiodarone. 2. Setup for implantable defibrillator
47
When does sinus bradycardia become clinically significant?
<45 BPM
48
What are the top three causes of bradycardia?
Ischemia Increased vagal tone Antiarrhythmic drugs
49
What is used to treat persistent bradycardia?
Cardiac pacemaker
50
What ECG change occurs in first degree AV block?
PR interval is prolonged (>0.20s)
51
Mobitz type I and Mobitz type II are what kind of block?
2nd degree AV block
52
What ECG change occurs in Mobitz Type I?
Progressive prolongation of PR interval until a P wave fails to conduct
53
What ECG change occurs in Mobitz Type II?
P wave fails to conduct suddenly, without a preceding PR interval prolongation
54
What part of the heart is responsible for Mobitz Type II?
His-Purkinje system
55
What ECG changes occur in 3rd degree AV block?
Atrial impulses do not conduct to the ventricles. P waves are consistent with each other but inconsistent with QRS complexes, which in turn are consistent with themselves.
56
Which heart blocks require pacemaker implantation?
Second degree Mobitz Type II (commonly leads to complete heart block) Third degree

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