Clinical Aspects Of Cardiac Arrhythmias

Question 1

Rate of less than 60 bpm w/ each P wave followed by a QRS and each QRS preceded by a P wave

Answer 1

Sinus Bradycardia

Question 2

Sudden cessation of sinus node activity as evidenced by loss of atrial depolarization

Answer 2

Sinus arrest

Question 3

What do we call a sudden cessation of sinus node activity if it is for

1. ) Less than 3 seconds
2. ) More than 3 seconds

Answer 3

Sinus Arrest

Question 4

Resting sinus bradycardia with periods of supraventricular tachycardia often followed by sinus pauses or sinus rest

Answer 4

Brady-Tach syndrome

Question 5

Diagnosed by a rate less than 60 bpm, w/ sinus pause or sinus arrest

Answer 5

Sick sinus syndrome

Question 6

We can treat sick sinus syndrome w/

Answer 6

Atropine (anti-cholinergic), Beta agonists, and temporary pacemaker

Question 7

Impaired conduction between the atria and ventricles

Answer 7

AV block

Question 8

What are the three types of AV block?

Answer 8

1. ) First degree
2. ) Second degree
3. ) Third degree

Question 9

Characterized by a PR interval of greater than 0.2 sec w/ 1:1 relationship between P waves and QRS

Answer 9

First degree AV block

Question 10

A 1st degree AV block can be caused by an

Answer 10

Inferior MI

Question 11

There is usually no treatment see for a

-Avoid drugs that will cause further impairment

Answer 11

First degree AV block

Question 12

Intermittent failure of AV conduction w/ some P waves not followed by QRS complex but constant P to P intervals and prolongation of PR interval before block

Answer 12

Mobitz type I 2nd degree AV block (Wenckebach)

Question 13

An inferior MI, Lyme myocarditis, an congenital AV block can all cause

Answer 13

Wenckebach Block

Question 14

For a mobitz I (Wenckebach) block, we may need to treat w/

Answer 14

Atropine or isoproterenol

Question 15

Intermittent failure of AV conduction w/ some p waves not followed by QRS complex, constant P to P intervals and NO prolongation of PR interval before block

-QRS is usually wide

Answer 15

Mobitz Type II second degree AV block

Question 16

An intermittent conduction block distal to the AV node in the bundle of His

Answer 16

Mobitz Type II

Question 17

Clinically presents w/ syncope (Stokes-Adams), dizziness, extensive anterior MI

Answer 17

Mobitz Type II second degree AV block

Question 18

Complete failure of conduction between atria and ventricle w/ NO relationship between p waves and QRS

-Sinus rate is greater than ventricular rate

Answer 18

3rd Degree Heart Block

Question 19

Treated w/ a permanent pacemaker unless their is reversible AV nodal injury

Answer 19

3rd degree heart block

Question 20

Normal, narrow QRS complexes at rates of 40-60 bpm w/ no p wave preceding the QRS

-May have retrograde p waves

Answer 20

Junctional Escape Rhythm (JESC)

Question 21

Diagnosed by wide QRS complexes at rates of 30-40 bpm w/ no p wave preceding the QRS

-May have retrograde p waves

Answer 21

Ventricular Escape Rhythms (VESC)

Question 22

Increased automaticity of the SA node by way of either increased sympathetic tone or decreased parasympathetic tone

Answer 22

Sinus Tachycardia

Question 23

Premature p wave, usually followed by normal narrow QRS but can also be followed by wide (aberrantly conducted) or by no QRS

Answer 23

Atrial premature complexes

Question 24

Can be caused by increased sympathetic tone, stretch, and fibrosis

Answer 24

Atrial Premature Complexes

Question 25

Atrial Premature Complexes (APCs) are usually followed by normally conducted

Answer 25

Narrow QRS complexes

Question 26

When the APC are very premature and fail to conduct to the ventricles or conduct w/ an aberrantly conducted complex due to block in the right or left bundle

Answer 26

APC w/ aberrancy and blocked APC

Question 27

Rate greater than 100 bpm w/ p wave morphology that is different than typical sinus p wave morphology -sudden onset and termination

Answer 27

Atrial Tachycardia

Question 28

Can be the result of abnormal automaticity, DAD, or reentry

Answer 28

Atrial Tachycardia

Question 29

Treated w/ beta blockers, Ca2+ blockers, class IC or III antiarrhythmic drugs, or ablation

Answer 29

Atrial Tachycardia

Question 30

Rapid, regular, uniform atrial activity at a rate of 240-300 bpm -Inferior leads have “Saw-tooth” appearance

Answer 30

Atrial Flutter

Question 31

Caused by reentry along the tricuspid valve annulus

Answer 31

Atrial Flutter

Question 32

An atrial flutter will often present w/ a

Answer 32

2 to 1 Block

Question 33

Irregularly irregular rate w/ no discernible p waves on the ECG but w/ low amplitude oscillations -Presenting ventricular rate is usually 140-160 bpm

Answer 33

Atrial Fibrillation

Question 34

Multiple wandering atrial reentrant circuits w/ atrial rate -Pulmonary vein triggers may initiate

Answer 34

Atrial Fibrillation

Question 35

Associated w/ hypertension, cardiomyopathy, CHF, mitral stenosis, mitral regurgitation, and ischemic heart disease

Answer 35

Atrial Fibrillation

Question 36

Acutely, we want to treat atrial fibrillation w/

Answer 36

Beta-blockers and Calcium-blockers

Question 37

For chronic treatment of atrial fibrillation, we want to give meds for which 3 purposes?

Answer 37

1. ) Anticoagulation 2. ) Rhythm control 3. ) Rate control

Question 38

The sudden onset and termination of heart rates between

Answer 38

140and 250 bpm

Question 39

Regular, rapid, usually narrow QRS complex rhythm at rated of 140-250 bpm

Answer 39

AV nodal reentrant tachycardia

Question 40

Acutely, we can treat AV nodal reentrant tachycardia w/

Answer 40

Vagal maneuvers and adenosine

Question 41

Characterized by a short PR interval (less than 0.12 sec) w/ normal sinus p waves, wide QRS, and a delta wave that slurs first portion of QRS

Answer 41

Ventricular Pre-excitation (Wolff-Parkinson-White Syndrome WPW)

Question 42

Rapid conduction across the bypass tract and down the AV node w/ varying degrees of fusion

Answer 42

Atrial fibrillation in WPW

Question 43

Premature QRS complex, which is wide, because the impulse travels from its ectopic site through the ventricles via slow cell-to-cell connections

Answer 43

Ventricular Premature Complexes

Question 44

W/ a ventricular Premature Complex, the ectopic complex is not related to a

Answer 44

Preceding P wave

Question 45

Defined as more than 3 consecutive PVC at greater than 100 bpm

Answer 45

Ventricular tachycardia

Question 46

Rapid, wide QRS complex rhythm at rats of 100 to 300 bpm w/ all QRS complexes having the same morphology

Answer 46

Sustained Ventricular Tachycardia

Question 47

Consecutive wide QRS complexes w/ continually changing shape and rate from complex to complex

Answer 47

Polymorphic Ventricular Tachycardia

Question 48

ECG shows irregular deflections of varying amplitude and contour w/ no defined P waves, QRS complexed, or T wavs can be recognized

Answer 48

Ventricular Fibrillation

Question 49

Characterized by multiple reentrant circuits and clinically presents as cardiac arrest

Answer 49

Ventricular Fibrillation

Question 50

The cause of congenital long QT syndrome is an

Answer 50

Ion Channel Mutation

Question 51

Characterized by a coved type ST elevation

Answer 51

Brugada syndrome

Question 52

Characterized by a saddle-back type ST elevation

Answer 52

Brugada Syndrome

Question 53

Characterized by a very mild saddle-back “ST elevation”

Answer 53

Type 3 Brugada Syndrome

Question 54

A genetic arrhythmogenic disorder characterized by a peculiar ECG pattern

Answer 54

Brugada Syndrome

Question 55

Predisposes to ventricular arrhythmias and sudden cardiac death -Affects males much more than females

Answer 55

Brugada Syndrome

Question 56

Caused by a mutation in genes coding for Calcium handling by proteins

Answer 56

Familial catecholaminergic polymorphic ventricular tachycardia

Question 57

Long QT 1 is triggered by

Answer 57

Exercise (swimming)

Question 58

Long QT 2 is triggered by

Answer 58

Auditory stimuli

Question 59

Long QT 3 often occurs at

Answer 59

Rest