Atrial Arrhythmias Flashcards Preview

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Flashcards in Atrial Arrhythmias Deck (34)
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1

Sinus Rhythm

Present when the dominant pacemaker controlling impulse generation is the sinus node

60-100 BPM
Regular Rhythm
P wave present in front of all QRS (1:1 ratio)
PR Intervan normal (0.12-0.2 s)
QRS normal width (<0.12s)

2

Common in the young or elderly, an EKG finding of respiratory variation in rhythm - slower during exhalation and faster during inhalation - due to increased venous return / lower intrathoracic pressure during inhalation.

Sinus Arrhythmia

3

5 potential causes of Sinus Bradycardia

(<60 BPM)

1. Organic disease of SA node
2. Increased Vagal or decreased sympathetic tone
3. Medications (beta blockers)
4. Ischemia
5. Exceptional physical condition

4

What should be included in evaluation of Sinus Bradycardia?

1. Stress test - HR should increase with exercise
2. Rule out drug toxicity or electrolyte imbalances
3. Thyroid function test
4. EKG, Holter monitor

5

Treatment of Sinus Bradycardia

1. Treat contributing factors (removal of drugs, balance electrolytes
2. Atropine, Epinephrine, Dopamine
3. Pacemaker

6

Causes of Sinus Tachycardia that you might not have known

Sepsis
Fever
Pulmonary Embolism
Hypoxia

7

Evaluation for Sinus Tachy

Underlying cause workup
EKG
Holter monitor

8

Treatment for Sinus Tachy

*treat underlying cause*

usually not symptomatic until rate >150bpm

Vagal maneuvers
Nodal blocking agents
Decrease stimulants

9

The most common chronic arrhythmia. Incidence and prevalence increase with age.

Atrial Fibrillation

By 80 yrs age, 10% of people

10

Most common cause of embolic cerebrovascular accidents (CVAs), 25%

Atrial Fibrillation

11

"Holiday Heart"

Atrial Fibrillation - excessive alcohol intake or withdrawal

12

Usually occurs in patients with COPD, heart failure, ASD (atrial septal defect), or CAD

Atrial Flutter

13

Transient absent of P waves on EKG

Sinus Arrest

14

Causes of Sinus Arrest

SA node disease (ischemia, inflammation, fibrotic)

Excessive vagal tone

Sleep apnea

Digitalis tox / other drugs

15

EKG of Sinus Arrest

Irregular rhythm
Dropped beats

16

Treatment Sinus Arrest

Usually nothing

Or Pacemaker / stop drugs

17

Impulse originates from tissue other than SA node - either from another pacemaker cell that is firing faster than the SA node, or the SA node slows down and another foci takes over

Ectopic Rhythm

18

3 Types of Ectopic Beats

PAC - premature atrial, pacemaker is in atra

PJC - premature junctional, pacemaker is in AV junction

PVC - premature ventricular, pacemaker is in ventricle

19

Other pacemaker cell in Atria fires faster than SA node, triggering a premature heartbeat. Acceleration of HR usually obliterates this. Often asymptomatic. Can be predictive of...

Premature atrial contraction

can be predictive of future Atrial Fibrillation / Flutter

20

run of PACs

Ectopic Atrial Tachycardia

Regular Rhythm, Rate 100-180bpm with "ecoptic foci"

21

Irregularly irregular R, rate 100bpm, 3 different P wave morphologies. Created by multiple atrial pacemakers, each firing at its on pace.

Wandering Atrial Pacemaker (WAP)

22

A "fast WAP", associated with Pulmonary Disease (COPD)

(Irregularly Irregular R, 3 different P wave morphologies, rate >100bpm)

MAT (Multifocal Atrial Tachycardia)

23

Treatment for MAT

Improve underlying problem (COPD)

Verapamil, Beta Blockers

24

Most common paroxysmal tachycardia. Regular, narrow-complex, buried P waves. Sudden onset and termination.

PSVT - Paroxysmal Supraventricular Tachycardia

aka "AV Nodal Reentrant Tachycardia"

25

PSVT treatment

1. Stable patients, usually mechanical (Valsalva, carotid massage)
2. Adenosine via IV

3. Beta blockers of Ca Channel blockers

4. Hemodynamically unstable patients - synchronized cardioversion

5. Recurrent / sustained PSVT - catheter ablation

26

Rapid, regular atrial depolarizations at 250-350 bpm. "Saw-tooth" P waves, 2:1 atrial to ventricle rate,

Atrial Flutter

27

Treatment, Atrial Flutter

Rate control w CCB or BB / Digoxin / Amiodarone

Anticoagulants (Heparin or warfarin) before conversion

Hemodynamically unstable patients - cardioversion 50J

28

Chaotic firing of numerous pacemaker cells which results in -

No atrial contraction / No P wave
Irregular Ventricular contraction

Atrial Fibrillation

29

Complications of A Fib

CVA (causes 25% of CVAs)
CHF
MI

30

Nonvalvular A Fib

AF in the absence of rheumatic mitral stenosis, a mechanical or biprosthetic heart valve, or mitral valve repair