Arrhythmias - madison

Question 1

What can cause sinus bradycardia

Answer 1

Drugs - beta blockers, calcium channel blockers
Conditioning - high level athletes
age

Question 2

what is the presentation of sinus bradycardia

Answer 2

asymptomatic
fatigue, DOE - chroniotropic incompetence

Question 3

what is the management of sinus bradycardia

Answer 3

nothing
remove offending agents
pacemaker? rarely

Question 4

what is seen with junctional rhythm

Answer 4

P waves hidden within or after QRS
narrow QRS
typically slow rhythm due to AV node rate.

Question 5

What is a junctional escape

Answer 5

AV junction has a faster firing rate than the SA node

Question 6

what is asystole

Answer 6

complete absence of demonstrable electrical and mechanical cardiac activity

Question 7

What is the mechanism of sinus node dysfunction

Answer 7

fibrosis of the sinus node (age)
cardiorespiratory conditioning
medication suppression (beta-blockers, CCB)
chronotropic incompetence (cannot meet the demand of exertion)

Question 8

What is the presentation of sinus node dysfunction

Answer 8

asymptomatic at rest
Exertional fatigue/DOE
unconscious

Question 9

What is the management of Sinus Node dysfunction

Answer 9

reversible causes
atropine (short term)
transcutaneous pacing vs TVP via RIJ
pacemaker

Question 10

what is the mechanism of sinus arrrhythmias

Answer 10

normal physiologic cardiac cycles
inspiration HR: increases
Expiration HR: decreases

Question 11

what is the management of sinus arrhythmias

Answer 11

none

Question 12

What is the mechanism of sinus tachycardia

Answer 12

stimulation of the sinus node
adrenergic response (fight/flight, anxiety)
infection
PE

Question 13

what is the presenation of sinus tachycardia

Answer 13

asymptomatic
variable depending on underlying cause

Question 14

what is the management for sinus tachycardia

Answer 14

First line: treat reversible causes
then consider beta-blockers

Question 15

What are the mechanisms of Afib

Answer 15

wavelets of re-entrant activation (pulmonary veins)

Question 16

what are the mechanisms of aflutter

Answer 16

circuit of re-entrant activation (cavotricuspid isthmus)

Question 17

what is the presentation of afib/aflutter

Answer 17

asymptomatic
palpitations
fatigue
DOE
stroke/CVA

Question 18

what is the management for stable afib

Answer 18

anticoagulate (CHA2DS2-VASc)
rate control
rhythm control

Question 19

what does MAT stand for

Answer 19

Multifocal atrial tachycardia

> 100bpm and 2 different shapes of P waves

Question 20

what does WAP stand for

Answer 20

Wandering Atrial Pacemaker
<100bpm and 2 different shapes of P waves

Question 21

What is the mechanism for MAT/WAP

Answer 21

mutliple atrial ectopic foci

Question 22

what is the presentation of MAT/WAP

Answer 22

can be similar to afib
most pts are hemodynamically stable

Question 23

how do you manage MAT/WAP

Answer 23

oxygen levels and treat underlying causes

Question 24

What is the mechanism of SVT

Answer 24

circuit allowing rapid conduction from A to V
AVNRT * most common
AVRT

Question 25

what is AVNRT

Answer 25

Atrioventricular nodal re-entrant tachycardia most common SVT

Question 26

what is AVRT

Answer 26

atrioventricular re-entrant tachycardia - not reliant on the node

Question 27

What is the presentation of SVT

Answer 27

palpitations lightheadedness "heart racing" presyncope/syncope History: bending down motions (AVNRT until proven otherwise)

Question 28

What is the acute management of SVT

Answer 28

vagal maneuvers adenosine (diagnostic and therapeutic) Cardioversion (DCCV)

Question 29

what is the chronic management of SVT

Answer 29

rate control antiarrhythmics (flecainide) Ablation

Question 30

What is the mechanism of heart block

Answer 30

disease of the AV node -fibrosis -beta-blockers/CCB toxicity -infection -ischemia/infarct -iatrogenic -infiltrative disease -congenital

Question 31

what is the presentation of Heart block

Answer 31

SOB lightheadedness syncope

Question 32

what is the management for heart block

Answer 32

acute (if HD unstable): transcutaneous packing vs TVP via RIJ; atropine, dobutamine chronic: pacemaker

Question 33

how do you treat torsades de points

Answer 33

*magnesium shock overdrive pace

Question 34

What are the mechanisms for Vtac

Answer 34

ischemia/infarct Drugs toxicity metabolic derangements Prolonged QTc

Question 35

what is the presentation for Vtac

Answer 35

unconscious, pulseless SOB, lightheadedness, palpitations

Question 36

what is the management for Vtach

Answer 36

ACLS amiodarone lidocaine Cardioversion Defibrillation TdP: Mag, more mag, overdrive pacing

Question 37

What is a RBBB

Answer 37

complete block of impulses along the right bundle of his "bunny ears" in V1 or V2

Question 38

what is LBBB

Answer 38

complete block of impulses along the left bundle of His deep R wave in V1

Question 39

what do bundle branch blocks cause

Answer 39

wide QRS and characteristic pattern of QRS complex

Question 40

What is the mechanism of Bundle Branch Blocks

Answer 40

fibrosis ischemia/infarct drugs/toxicity

Question 41

what is the presentation of BBB

Answer 41

usually, asymptomatic can occur int he setting of HF

Question 42

what is the management of BBB

Answer 42

usually no intervention is warranted new LBBB + ? ACS -> Sgarbossa's criteria if reduced LVEF despite GDMT and no recent revascularization - CRT

Question 43

what is the mechanism of premature complexes

Answer 43

excitable tissue catecholamines

Question 44

what is the presentation of premature complexes

Answer 44

asymptomatic palpitations

Question 45

what is the management of ectopy

Answer 45

magnesium, decrease ETOH level, stimulant use, hormonal