Clincial Treatment of Arrhythmia Flashcards by A B

The last portion of the PR interval is represented by conduction time through ____

bundle branches and Purkinje

How well did you know this?

Not at all

Perfectly

Two types of arrhythmias
- too slow called?

too fast called?

too slow = bradyarrhythmia

too fast = tachyarrhythmia

How well did you know this?

Not at all

Perfectly

Types of SA node bradyarrhythmia (4)

1) sinus bradycardia
2) sinus arrest/pause
3) tachy-brady syndrome
4) chronotropic incompetence (can’t make appropriate HR with exercise)

How well did you know this?

Not at all

Perfectly

Define Sinus bradycarida

SA node <60 bpm

How well did you know this?

Not at all

Perfectly

Define sinus arrest

pause in rate of SA node firing

failure of sinus node discharge –> absence of atrial depol and ventricular asystole

How well did you know this?

Not at all

Perfectly

with sinus arrest, there is ____ betwen pause and cycle length

NO RELATIONSHIP BETWEEN PAUSE AND CYCLE LENGTH

How well did you know this?

Not at all

Perfectly

brady-tachy syndrome

intermittent episode of slow and fast rates from SA node or atria

How well did you know this?

Not at all

Perfectly

how does brady-tachy manifest

atrial tachycarida, flutter, fibrillation

How well did you know this?

Not at all

Perfectly

what occurs after stopping tachycardia?

long pauses from SA node

How well did you know this?

Not at all

Perfectly

define chronotropic incompetence

cannot incr heart rate with exercise

oscillation of HR with activity

How well did you know this?

Not at all

Perfectly

Types of AV node bradyarrhythmia

1st degree AV block

Mobitz 1 2nd degree AV block (Wenkebach)

How well did you know this?

Not at all

Perfectly

Define 1st degree AV block

AV conduction delayed

prolonged PR interval (>200 ms)

How well did you know this?

Not at all

Perfectly

Define 2nd degree AV block

atrial depol sometimes don’t reach ventricle

How well did you know this?

Not at all

Perfectly

Define 2nd degree AV block - Mobitz 1 (Wenckebach)

progressive prolonging of PR interval until ventricular beat dropped (no QRS)

QRS usually normal

How well did you know this?

Not at all

Perfectly

Types of conduction problems below AV node (infranodal= His PUrkinje)

Mobitz II 2nd degree AV block

Complete heart block

How well did you know this?

Not at all

Perfectly

Define Mobitz II 2nd degree AV block

intermittent dropped ventricular beats preceded by constant PR interval

How well did you know this?

Not at all

Perfectly

how to separate Mobitz 1 vs. 2

Mobitz 1 = difference btwn PR interval > 0.02 sec

Mobitz 2 = difference between PR interval < 0.02 sec

How well did you know this?

Not at all

Perfectly

Define 3rd degree block = complete heart block

no conduction from atria to ventricles

no relationship btwn P and QRS waves (variable PR interval)

initiate new QRS below AV node
40-60 = His bundle initiate
<40 = Purkinje fiber initiate

How well did you know this?

Not at all

Perfectly

when should you be concerned about bradyarrhythmia

1) when patient symptomatic

2) when rhythm is infranodal (below AV node) –> can become 3rd degree block

How well did you know this?

Not at all

Perfectly

Steps of treating brayarrhythmia chronic

1) find and treat reversible causes - ischemia/infarct/hypothyroidism/neuro/Lyme
2) stop offending meds (antiarryhtmic, clondiine, lithium..)

How well did you know this?

Not at all

Perfectly

Steps of treating bradyarrhythmia

acute treatment for unstable

beta agonist (dopamine/isoproteronol)

transcutaneous pacing (esp if infranodal)

temporary transvenous pacing

How well did you know this?

Not at all

Perfectly

Steps of treating bradyarrhythmia

long term

Study These Flashcards

pacemaker

Two types of tachyarrhythmia

Study These Flashcards

above ventricle = supraventricular tachycardia

at ventricle = v-tach, v-fib

Types of irregular SVT

Study These Flashcards

1) atrial fibrillation = no discrete P
2) multifocal atrial tachycardia = 3+ P
3) atrial flutter = variable conduction + flutter waves

what is a regular SVT?

1:1 P:QRS

How to treat SVT

1) if unstable (hypotension/HF) = shock/cardiovert 2) if stable and irregular SVT, rate control, antiarrhythmic, or cardiovert 3) if stable and regular SVT, ADENOSINE (block AV node transiently to see P waves) to diagnose

5 C's of Afib

1) cause: Reverse 2) control rate 3) antiCoagulation 4) control rhythm 5) cure: ablation

Causes of Afib

1) HTN 2) Ischemic heart disease 3) mitral valve disease 4) alcohol 5) cardiomyopathies 6) hyperthyroidism 7) lone AF = 14%

Immediate treatment options for AFib

1) cardiovert = for unstable patients | 2) control rates

How to control rhythm in AFib via cardioversion

1) Electrical = DC shock 70-90% day procedure with sedation 2) pharm = less successful, no sedation Class 3 Class 1C

Maitenance of rhythm control in Afib

Class 1C (contraindicated in CAD and structural heart disease) Class 3 ALWAYS Anticoagulation due to thromboembolism risk

Rate control in AFib

1) beta blocker (good with exercise) 2) digoxin (not good with exercise) 3) verapamil 4) diltiazem 5) amiodarone (esp with decomp heart failure)

side effect of rate control meds

heart block

rhythm control via cardiac ablation

target triggers = mainly left atrium

atrial flutter treatment

similar to Afib | catheter ablation better than meds; can be curative

which has lower risk of ablation, atrial flutter or afib

atrial flutter

how to perform atrial flutter ablation

target isthmus in right atrium btwn tricuspid valve and IVC | to block circuit causing atrial flutter

Other SVT

1) AV node reentry tachycardia (circuit in AV node) 2) accessory pathway mediated tachy 3) focal atrial tachycardia

define accessory pathway mediated tachcyardia

abnormal connection btwn atrium and ventricle

define focal atrial tachycardia

abnromal focus of atrial tissue with incr automaticity "hotspot"

how to treat "other SVT's"

1) nonpharm = vagal 2) meds only for symptoms - beta blocker, Ca2+ ch blocker for AV node - class 1 to decr ectopic foci 3) cardiac ablation

define: ventricular tachyarrhythmia

wide complex tachy

if patient has coronary artery disease, 90% of the time the wide complex tachycardia is ____

ventricular tachycardia

acute treatment for stable v-tach

meds = amiodarone, lidocaine, procainamide treat underlying cause

acute treatment for UNSTABLE v-tach

SHOCK!!!!!! treat underlying cause meds

long term treatment for v-tach WITH NO STRUCTURAL HEART DISEASE

1) usu idiopathic = focal benign trigger 2) use meds/ablation RARELY DEFIBRILLATOR USED

long term treatment for v-tach WITH STRUCTURAL HEART DISEASE

1) treat underlying cause | 2) USE DEFIBRILLATOR because sudden death

where do v-tachyarrhythmias arise?

outflow tracts of RV or LV

what meds to use for v-tachyarrhythmias?

1) beta blocker 2) ca2+ channel blocker 3) class 1C 4) class 3

when is defibrillator needed for v-tachycarrhythmias?

1) if pt has sudden cardiac arrest due to VT or VF w/o reversible cause 2) risk of MI - ischemic heart disease, EF<35% ischemic disease, EF 35-40% + inducible VT HCM, cardiac sarcoid, congenital heart disease, ARVC

Difference betwn defibrillator implant and pacemaker

leads of defib = coils

Sudden Cardiac Death cause

due to ventricular fibrillation

treatment for sudden cardiac death

bystander basic life support early defib with an external defibrillator

if greater than 2 risk factors then blood thinner for afib is ____

warfarin

Clincial Treatment of Arrhythmia Flashcards

(54 cards)