CABS Arrhythmias Flashcards by Nicole Quinn

PAC’s (premature atrial contraction) is when
May originate within ______ area of the atria or the _______ node.

atria getting wonky and cause premature contraction
not from sinus nodal cells

may originate within another area of the atria or the AV node

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PAC’s morphology

narrow; looks like everywhere else just coming in early (QRS complex)
will have a change in the PR interval

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PAC’s can degenerate into ________ __________ and can cause _________.

other arrhythmias
Atrial myopathy (atria might enlarge)

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PVC’s (premature ventricular contraction) is when

abnormal beats are coming from ventricular myocardium

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PVC’s morphology

wider - did not come from the Atria came from the ventricles since it had to go around-about way to stimulate the electrical impulse so it takes longer

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PVC subtypes (descriptions on the ratio)

Bigeminy - every 2 beats
Trigeminy - two normal, PVC
Quadrigeminy - three normal, PVC

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Blocks are a delay in conduction along the _________ pathway

Ventricular

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1st degree block is a delay in transmission from _______ through the ______ node to the ________

atria
AV node
Ventricles

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On ECG in first degree block you will see ___________.

prolonged PR interval (> 200ms or 3+ boxes)

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1st degree AV block has no impact on ______________.

Cardiac output

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2nd degree Atrioventricular Block (AV Block) has two types =

Mobitz Type 1 (Wenckebach)
Mobitz Type 2

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Mobitz Type 1 =

Wenckebach - progressive prolongation until beat drop (first PR segment is normal)

beat, beat, beat, drop - now you got a Wenckebach

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Mobitz Type 2 =

PR is maintained but will occasionally not conduct through to the ventricles (worse, more unpredictable loss of QRS complex)

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Second degree may be associated with ______ involving/ near the conduction system

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3rd degree Atrioventricular Block (AV Block) =

complete heart block, no atrial impulses reach the ventricle (not sharing the electricity, wide QRS complex, p waves are normal but do not really correlate with one another)

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In 3rd degree block, the atria and ventricles are ______ communicating and HR is typically < ______ bpm

not
45 bpm

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A result of 3rd degree block is bradycardia and decreased end diastolic filling, pt may present with:

lightheadedness
palpitations
syncope
weakness
fatigue
chest pain (not enough O2)

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Bundle branch blocks is

disruption of electrical conduction down one of the bundle branches coming off of the Bundle of His

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Right bundle branch block (RBBB) are associated with increased ___________ ventricle hypertrophy, increased ventricular ________, MI, infarction, inflammation and iatrogenic meds

right
pressure

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Left Bundle Branch Block (LBBB) are often associated with ______/_________, __________ (abscess), post _______ changes.

MI/ infarction
endocarditis
post surgical changes

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RBBB on ECG

“bunny ears” in V1-3
Normal speed and pattern down the left bundle, RV contraction is activated via the septum, R-wave is delayed

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LBBB on ECG

Wider QRS complex
Normal speed/pattern down the right bundle, bulk of ventricular depolarization and muscle tone is on the left side, results in slow QRS complex (Wide)

Things to ask yourself about arrhythmias

regular or irregular
fast or slow
wide or narrow
P-waves

Tachyarrhythmias that are Narrow and Regular on ECG

sinus tachycardia
supraventricular tachycardia
atrial flutter

Tachyarrhythmias that are narrow and irregular on ECG

multifocal atrial tachycardia atrial fibrillation

tachyarrhythmias that are wide and regular on ECG

ventricular tachycardia hyperkalemia

Tachyarrhythmias that are wide and irregular on ECG

polymorphic ventricular tachycardia ventricular fibrillation

tachyarrhythmias: are typically associated with

increased automaticity increased triggering re-entry circuit

Sinus tachycardia is the m/c tachyarrhythmia they are usually - HR > than _____ bpm and is a ________ dysrhythmia

100 bpm benign (no end organ damage)

Tx of sinus tachycardia

treat the underlying cause

Causes of sinus tachycardia

increased automaticity (increased SA node firing) increased sympathetic tone (catecholamines)

Paroxysmal Supraventricular tachycardia is a sustained ________ loop within the ________ node, _____-waves are typically not visualized

re-entry AV node P-waves

Difference between PSVT and sinus tach

sinus tach = HR will always stay high but rate will fluctuate PSVT = HR never changes

PSVT on ECG

rate 150-250 P-waves are buried within the QRS complex or P on T (no PR interval) Narrow QRS

Tx for PSVT

adenosine - slow down HR vasovagal maneuver - bear down, blow up a syringe while doing sit up carotid massage - one at a time to stimulate baroreceptors

Atrial fibrillation is ... due to _______ areas of _________ that are desynchronized within the ________.

irregularly irregular rhythm with narrow QRS complex (not a sinus rhythm) multiple automaticity atria (SA node is not in control)

3 types of Afib are

paroxysmal persistent permanent

Paroxysmal Afib lasts less than ...

7 days with spontaneous conversion

Persistent Afib is over _____ or needs _______.

7 days or needs cardioversion

Permanent Afib is ...

Long standing (staying in Afib for forever)

Afib on ECG shows

No clear P waves QRS are narrow Irregularly irregular QRS complex seen best in V1

Left atrial appendage has a big tendency to lead to

Stroke

Atrial flutter on ECG looks like ...

regular rate (R-R is regular) narrow QRS single morphology P-waves in sawtooth pattern typically 150 bpm

For ventricular tachycardia impulses originate in the myocardium of the __________ and is most associated with previous _______.

Ventricles MI

#1 cause of ventricular tachycardia is

long QT

Torsades de Pointes is

twisting of the points - a polymorphic VT (wide and narrow) from prolonged QT, increased automaticity

Tx of torsades de pointes

magnesium IV bollus

Ventricular fibrillation - primary disease is most commonly associated with

ischemic disease

two types of ventricular fibrillation

coarse and fine

Ventricular fibrillation on ECG looks like

course or fine No P-waves, defined QRS, T waves unable to determine real rate (very irregular)

Bradyarrhythmia may be associated with decreased

automaticity

sinus bradycardia causes

increased vagal tone (parasympathetic) medications that slow AV conduction metabolic changes electrolyte abnormalities brain herniation (cushing triad)

sick sinus dysfunction is

dysfunction within the SA node, tachy brady syndrome