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CSB335 > Brady and tachy dysrhythmias > Flashcards

Brady and tachy dysrhythmias Flashcards

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1
Q

What does altered impulse formation with enhanced automaticity lead to?

A

Tachyarrhythmias

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2
Q

What does altered impulse formation with decreased automaticity lead to?

A

Bradyarrhythmias

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3
Q

What does altered impulse conduction with reentry (stimulation of different portions of cardiac tissue) lead to?

A

Tachyarrhythmias

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4
Q

What does altered impulse conduction with conduction blocks lead to?

A

Bradyarrhythmias

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5
Q

What is the definition of bradycardia?

A

HR <60bpm

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6
Q

What are some aetiologies of sinus bradycardia?

A

Normal aging
AMl, especially those affecting the inferior wall of the heart
Hypothyroidism, infiltrative diseases (sarcoid, amyloid)
Hypothermia, hypokalemia
Situational (micturation, coughing)
Drugs (beta-blockers, digitalis, calcium channel
blockers, amiodarone, lithium)

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7
Q

Describe extreme bradycardia and likely pt presentation

A

HR <40
Rarely physiological this requires immediate rx
Presentation would include ALOC, poor perfusion, and hypotension

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8
Q

What is the presentation of symptomatic bradycardia?

A 
Syncope/pre-syncope
Dizziness
SOB
Chest pain
ALOC
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9
Q

When externally pacing is it important to ensure the pulse correlates with or opposes the paced rhythm?

A

Correlates with

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10
Q

External pacing is only considered when…

A

Pharmacological agents are ineffective

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11
Q

What is the rate of less severe bradycardia?

A

HR 40-60

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12
Q

When does less severe bradycardia require immediate rx?

A

Systolic BP <90mmHg
Ventricular dysrhythmia
Hx of heart failure

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13
Q

Describe bradycardia due to 1st degree AV block

A

PR interval >0.2 seconds
High risk of progression to 2nd/3rd degree block if accompanied by a wide QRS
Benign if asymptomatic

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14
Q

What drug can cause 1st degree AV block?

A

Calcium channel blockers

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15
Q

What is 2nd degree AV block type 1? (Mobitz type 1; Wenckebach)?

A

Progressive PR longation with eventual non-conduction of a P wave (may be 2:1 or 3:1)

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16
Q

Describe the effect of Mobitz type 1 on patient presentation

A

Usually asymptomatic but with accompanying bradycardia can cause angina and syncope (may need pacing)

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17
Q

What are some risk factors/causes of Mobitz type 1?

A 
Elderly
Long distance runners
Beta blockers 
Calcium channel blockers 
Digoxin
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18
Q

What is the ECG effect of 2nd degree AV block type 2 (Mobitz type 2)?

A

Normal PR intervals with sudden failure of a P wave to conduce

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19
Q

What is Mobitz type 2 usually accompanied by?

A

Bundle branch or fascicular block

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20
Q

Mobitz type 2 often causes ___.

A

Syncope

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21
Q

What worsens the signs of Mobitz type 2?

A

Exercise

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22
Q

Does Mobitz type 2 generally need pacing?

23
Q

What is 3rd degree AV block?

Study These Flashcards
A

Completely AV dissociation

24
Q

The HR in 3rd degree AV block is ____.

Note: word, not bpm

25
What are some common results of 3rd degree AV block?
Dizziness Syncope Angina HF
26
3rd degree AV block can degenerate into...
VT and VF
27
Does 3rd dergee AV block need pacing?
Yes
28
What are some aetiologies of sinus tachycardia?
``` Fever Hyperthyroidism Effective volume depletion Anxiety Pheochromocytmoa (adrenal tumour) Sepsis Anaemia Stimulant exposure Illicit drugs Hypotension Shock Pulmonary embolism Acute coronary ichaemia AMI HF Chronic pulmonary disease Hypoxia ```
29
What are the S&S of tachycardia?
Syncope/near syncope (depending on the rate) Dizziness SOB Chest pain/palpitations
30
What is 'paroxysmal' SVT?
Unpredictable
31
True or false: Onset and termination of paroxysmal SVT is usually gradual
False: both are abrupt
32
What does AVNRT stand for?
Atrioventricular nodal reentrant tachycardia
33
Describe the pathway of AVNRT
SA node fires normally Charge splits into two pathways at the AV node, one fast that goes through the ventricles and one slower that cannot follow into the refractory period so it circles back up into the AV node
34
AVNRT has a ____ QRS and a HR of ____.
Narrow, >100
35
The abnormal circuit in AVNRT directly involves the ____ ____.
AV node
36
What is a 'typical' AVNRT pathway?
Impulse travels over the slow pathway towards the ventricles and returns via the fast pathway
37
What happens to the retrograde P wave in AVNRT?
It is lost in the QRS complex
38
What are the AVNRT mx points?
Valsalva manoeuver Pharmacological agents (adenosine) Cardioversion (CCP) Ablation (cauterising the pathway; dependent on frequency)
39
How does the valsalva manoeuvre assist AVNRT?
Stimulates the vagus nerve to enter reflex bradycardia
40
What does AVRT stand for?
Atrioventricular re-entry tachycardia
41
What is AVRT?
A normal pathway and an abnormal loop of electricity/circuit
42
What are the ECG changes in AVRT?
``` Shortened PR interval Delta wave (slow rise of QRS) ```
43
What are the two pathways of AVRT?
AV conduction pathway | Accessory pathway between the atria and ventricles
44
What is an example of AVRT?
Wolff-Parkinson White syndrome
45
What other arrhythmias can use an accessory pathway for conduction of tachycardia origin to other heart regions?
AF and atrial flutter
46
What is the rx for a pulseless tachycardic pt?
Rx as CA
47
What are the two possible rhythms behind regular broad complex tachycardia?
Ventricular origin or SVT with aberrant conduction (BBB)
48
What do you do if you cannot determine which underlying rhythm is behind broad complex tachycardia, and why?
Treat as VT, because it is less harmful than incorrectly rx VT as SVT
49
What is the most likely cause of irregular broad complex tachycardia?
Uncontrolled AF with a BBB
50
What is it important not to rule out with irregular broad complex tachycardia?
AF with WPW, and Torsades de Pointes
51
Regular narrow complex tachycardias include what three rhythms?
Sinus tachycardia AVNRT AVRT
52
What is the rx for regular narrow complex tachycardia?
Valsalva manoeuvre Adenosine (some services) Cardioversion (CCP)
53
What rhythms are likely to be the cause of irregular narrow complex tachycardia?
Controlled AF, or atrial flutter with a variable AV block

CSB335 (12 decks)

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