Clinical arrhythmia lecture Flashcards Preview

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Flashcards in Clinical arrhythmia lecture Deck (45):
1

Some antiarrhythmics (Class 1A, 1C, Class III), erythromycin, antifungals, tricyclic antidepressants

...can cause?

Prolonged QT interval

2

Atrial fibrillation with controlled or slow rate in absence of meds that slow AV conduction.

Sick sinus syndrome variation

3

Brady-Tachy Syndrome- paroxysmal atrial tachyarrhythmias accompanied by sinus node dysfunction and symptomatic bradycardia.

Sick sinus syndrome variation

4

Presence of symptoms clearly related to sinus node dysfunction (pauses) proven by ECG.
40% will have concomitant AV Node dysfunction, heart block.

Sick sinus syndrome

5

Most common cause of sick sinus syndrome?

AGING

6

Sinus node dysfunction
AV node dysfunction

...treatment

permanent pacemaker

7

Sick sinus syndrome tx

step 1...eliminate offending drug (if applicable)

step 2..pacemaker

8

PAC precipitating factors

ETOH
caffeine
adrenergic stimulation

9

*Paroxysmal and persistent forms.**
May be seen in healthy individuals (5%) without HD
*can be precipitated by emotional stress, use of stimulants, following surgery, or with acute ETOH intoxication (“holiday heart”).
*Also occurs in absence of a precipitant

A fib

10

95% of A fib cases seen in the presence of...

underlying cardiac or pulmonary pathology

11

_____ most often seen in valvular, hypertensive and coronary heart disease
*frequently develops in adults with atrial septal defects

A fib

12

Irregularly irregular rhythm
atrial depol 400-600/min

*if new/untreated...ventricular rate tachycardia (often 120-180)

A fib

13

If rate continuously exceeds 200 bp, consider A fib with...

WPW

14

First priority when assessing A fib patient....

ASSESS HEMODYNAMIC STABILITY

(most yes. if no...cardioversion)

15

Must worry about thromboembolic if in A fib for longer than....

48-72 hours

16

Diagnostic test that all new onset A fib patients must have

Cardiac ultrasound (echo)

17

If hemodynamically stable, initial goal for a fib tx

Rate control

18

IV _____ is best for rapid rate control in ED for A fib

Diltiazem

19

Oral diltiazem, verapamil, or beta blockers

Best for chronic rate control of A fib

20

If A fib present for longer than 72 hours...

MUST FULLY ANTICOAGULANT

(no cardioversion until 3 weeks of anti coagulation)

21

2 chronic A fib management strategies

1. rhythm control
2. rate control

22

cardioversion to NSR+ drug Rx to maintain sinus rhythm→↑ CO/function, but side effects of meds, recurrences of Afib.

Rhythm control strategy of A fib

23

leave in afib, control ventricular rate + anticoagulate (warfarin* for most patients)

Rate control strategy of A fib

24

CHADS2 or CHADS VAS

used to calculate risk of stroke

25

If a pt with a fib has a CHADS score of 0...

Can leave in a fib, don't need to anticoagulate

26

Definitive treatment for A fib rhythm control...

Ablation with surgery or catheter

(65-90% success)

27

This drug class appears to increase risk of developing a fib or a flutter

NSAIDs

28

Underlying heart disease always present.
**Paroxysmal and persistent forms.
Embolization risk less than Afib but occurs.

*Rate usually 240-350; ventricular rate most often 1/2 the flutter rate; less stable hemodynamically; difficult to slow with meds.

A flutter

29

Most effective tx for A flutter

DC cardioversion

(often need meds to prevent recurrence)

30

If you see a 4:1 atrial flutter..is this person already being treated?

Most likely yes

31

Re-entry is responsible for vast majority of cases
Seen in any age group, especially healthy young adults.
***Narrow complex, regular tachycardia, rate usually 150-220.
**P waves usually not identifiable; may come after QRS

PSVT

32

2 pathways of AV node

Alpha and beta

33

Requires dual AV nodal (α & ß pathways) that can conduct in either direction.
**Initiated by PAC conducted antegrade down one (β) AV pathway; if conduction slow enough to allow previously refractory other (α) pathway time to recover, impulse will be conducted retrograde back through the AVN initiating a re-entry circuit

PSVT

34

DOC for PSVT

Adenosine

35

Interventions that increase vagal tone (e.g. carotid message or valsalva) may abruptly terminate the rhythm.

PSVT

36

Selective ablation of AV node can be tx for

PSVT

37

Accessory A-V bypass tract (Kent Bundle) allows conduction to ventricles as alternative to the AV node.
ECG findings: Short PR interval and Delta waves

WPW

38

Can you use Adenosine, ß-Blockers, Diltiazem, Verapamil in a WPW pt with A fib or A flutter?

NO!!!!

(can use Procainamide or Amiodarone)

39

Lidocaine will slow conduction through...

kent bundle! (in WPW)

40

Radio Frequency Ablation: Catheter ablation of the bypass tract is effective (90%) and curative. Treatment of choice for most ____ patients.

WPW

41

Most patients developing VF within 1st 48 hrs of an acute MI have a _____ prognosis if successfully resuscitated

good long term

42

Resuscitated VF unassociated with acute MI has a very high recurrence rate (> 30% recur within the first year following the initial event), and carries a....

very poor prognosis

*tx with ICD

43

most common cause of sudden cardiac death

V fib

44

V fib sometimes occurs following administration of antiarrhythmic drugs - especially in patients with....

prolonged QT interval

45

prominent jugular pulsation and palpable parasternal lift
*harsh systolic murmur best heard at second and third left intercostal space
*radiates to left shoulder
*early systolic sound precedes the murmur during expiration

Pulmonic stenosis