arrhythmias pt 5

Question 1

what are the features of PVCs?

Answer 1

wide QRS complexes
abnormal beats happening in ventricular tissue outside of bundle, slowing it down and making it wider

Question 2

what are the types of PVCs?

Answer 2

simple - isolated single
frequent/repetitive forms –> pairs, bigeminy, trigeminy, quadrigeminy

Question 3

what defines a PVC as being frequent?

Answer 3

at least one PVC on a 12-lead ECG or over 30 PVCs per hour

Question 4

what is the MOA of PVCs?

Answer 4

increased automaticity of ventricular muscle cells/purkinje fibers

Question 5

what are the risk factors of PVCs?

Answer 5

ischemic HD
MI
anemia
hypoxia
cardiac surgery

Question 6

what are the symptoms of PVCs?

Answer 6

usually asymptomatic
frequent/repetitive can result in palpitations, dizziness, lightheadedness

Question 7

in pts with established IHD, PVCs are associated with what?

Answer 7

increased risk of mortality

Question 8

in MI survivors, what are frequent/repetitive PVCs associated with?

Answer 8

increased risk of sudden cardiac death –> enhanced further in pts with HF

Question 9

what are very frequent PVCs associated with?

Answer 9

PVC-induced cardiomyopathy

Question 10

what are frequent PVCs associated with?

Answer 10

increased long term risk of CVD and mortality

Question 11

how should asymptomatic PVCs be treated?

Answer 11

they shouldn’t
drugs that may treat them were actually killing ppl instead

Question 12

how should pts with symptomatic PVCs who do not have CAD or HF be treated?

Answer 12

BB, diltiazem, or verapamil
if unresponsive –> antiarrhythmic medications

Question 13

how should pts with frequent symptomatic PVCs that are unresponsive to BB, CCBs, or antiarrhythmic drugs be treated?

Answer 13

catheter ablation

Question 14

how should pts with symptomatic PVCs and CAD be treated?

Answer 14

BB, diltiazem, verapamil
if unresponsive –> anti arrhythmic medication

Question 15

how should pt with symptomatic PVCs in pt who have HF be treated?

Answer 15

BB, but hopefully already on it

Question 16

what are the features of VT?

Answer 16

regular rhythm but 100-250 bpm
wide QRS complexes
defined as a series of over 3 consecutive PVCs at a rate of over 100 bpm

Question 17

what are the types of VT?

Answer 17

non sustained
sustained
sustained monomorphic VT in pts with no structural HD

Question 18

what is nonsustained VT?

Answer 18

three or more consecutive PVCs, terminates spontaneously

Question 19

what is sustained VT?

Answer 19

VT lasting greater than 30 seconds or requires termination because of hemodynamically stability in under 30 seconds

Question 20

what is sustained monomorphic VT in pts with no structural HD?

Answer 20

known as idiopathic VT
sometimes responsive to verapamil (known as verapamil-sensitive VT)
may occur in the right or left ventricular outflow tract (known as outflow tract VT)

Question 21

what is the MOA of VT?

Answer 21

increased automaticity in ventricular tissue
reentry within ventricles

Question 22

what are the risk factors of VT?

Answer 22

CAD, MI, HF
electrolyte abnormalities (low K, low Mg)

Question 23

what drugs can induced VT?

Answer 23

flecainide
propafenone
digoxin

Question 24

what are the symptoms of VT?

Answer 24

may be asymptomatic in nonsustained
hypotension
palpitations
dizziness
lightheadedness
syncope
angina

Question 25

what is significance of being diagnosed with VT?

Answer 25

sustained VT can progress to ventricular fibrillation (life threatening) at risk for the syndrome of sudden cardiac death

Question 26

what are the goals of treatment for VT?

Answer 26

terminate VT and restore normal sinus rhythm prevent recurrence of VT reduce risk of sudden cardiac death

Question 27

what drugs are used to terminate VT?

Answer 27

procainamide amiodarone sotalol verapamil BB

Question 28

what are the drug-drug interactions of procainamide?

Answer 28

cimetidine, ranitidine, and trimethorpim inhibit elimination of procainamide

Question 29

how should termination of hemodynamically VT with structural HD be handled?

Answer 29

1st line --> DCC 2a --> IV procainamide 2b --> IV amiodarone or IV sotalol

Question 30

how should a person be treated if they failed to successfully terminate their VT be treated?

Answer 30

receive DCC

Question 31

how should a person who has successfully terminated their VT be treated?

Answer 31

therapy to prevent recurrence guided by underlying HD

Question 32

how should a person without structural HD who is wishing to terminate their VT be treated?

Answer 32

based on ECG morphology so either verapamil- sensitivity VT or outflow tract VT

Question 33

how should a person with outflow tract VT be treated?

Answer 33

BB

Question 34

what is the 1st line choice to prevent recurrence/sudden cardiac death in VT pts?

Answer 34

implantable cardioverter-defibrillator (ICD)

Question 35

what is the MOA of an ICD?

Answer 35

leads implanted directly onto the heart inserted percutaneously like a pacemaker delivers electric shock to heart if VT or VF develops

Question 36

what are the AE of an ICD?

Answer 36

discomfort with shock

Question 37

when is amiodarone/sotalol recommended in the prevention of recurrence/sudden cardiac death in VT pts?

Answer 37

in pts with ICDs who have significant symptoms or frequent ICD shocks used to suppress recurrent VT and reduce frequency of shocks

Question 38

when is catheter ablation recommended in prevention of recurrence/sudden cardiac death in VT pts?

Answer 38

in pts with prior MI and recurrent episodes of VT, who present with VT and who have failed or are intolerant of amiodarone or other anti-arrhythmic drugs

Question 39

where does an ICD connect to?

Answer 39

attached to the right ventricle so its able to correct the arrhythmia

Question 40

what are the features of ventricular fibrillation (VF)?

Answer 40

irregular, disorganized, chaotic electrical activity no recognizable QRS complexes (due to no depolarization)

Question 41

what are the risk factors of VF?

Answer 41

MI HFrEF CAD

Question 42

what are the symptoms of VF?

Answer 42

syndrome of sudden cardiac death no CO, no BP, pt will pass out

Question 43

what is the goal of treatment for VF?

Answer 43

terminate VF, restore sinus rhythm and spontaneous circulation

Question 44

what is the only effective treatment of VF?

Answer 44

defibrillation ASAP drugs alone with not terminate ventricular fibrillation

Question 45

what is the MOA of defibrillation?

Answer 45

simultaneously depolarizes all myocardial cells, allowing sinus node to resume as pacemaker

Question 46

what drugs could be used to help aid in defibrillation of VF?

Answer 46

epinephrine amiodarone lidocaine

Question 47

what are the AE of drugs used to treat VF?

Answer 47

post-resuscitation tachycardia (E), hypotension (A), confusion/seizures (L)

Question 48

what is the process for termination of VF (or VT w/o a pulse)?

Answer 48

CPR x2 min, obtain IV/IO access defib shock CPR x 2min Epi Defib shock CPR x 2min Amiodarone or Lidocaine Defib shock CPR x 2min Epi Defib shock CPR x 2min Amiodarone or Lidocaine Defib shock CPR x 2min Epi continue

Question 49

what is an AED

Answer 49

easy to use - machine talks user through procedure