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Flashcards in Clinical Treatment of arrhythmias Deck (38):
1

QRS will show when

The QRS complex on the ECG represents the depolarization of the ventricular muscle mass.

2

A small portion of the last part of the _________ is represented by the conduction time through the Purkinje system.

PR interval

3

Arrhythmias can be?

Too fast or too slow

4

TOO SLOW

Bradyarrhythmias

5

TOO FAST

Tachyarrhythmias

6

Where in the conduction system can problems develop?

Sinus node
AV node
Below the AV node

7

When should you be concerned about arrhythmia?


1. When the patient is symptomatic, no matter which part of the conduction system is affected.


2. When the rhythm is infranodal (below the AV node).

8

Find and treat reversible causes arrhythmia?

ischemia/infarction
hypothyroidism
neurologic causes
Lyme disease

9

Stop offending medications, if possible causes arrhythmia?

antiarrhythmics, clonidine, lithium, among others.

10

Acute treatment for unstable patient w/ arrhythmia?

beta-agonists (dopamine or isoproterenol)
transcutaneous pacing
temporary transvenous pacing

11

Bradyarrhythmia Take Home Points

Determine block responsible: SA, AV, infranodal

s/s and infranodal disease (which can progress to unreliable heart rhythms) should dictate rx

Treat potential reversible causes.

Acutely stabilize patients.

long-term rx is a permanent pacemaker.

12

___________ describes slow heart rate, typically defined as a rate of less than 60 beats per minute.

Bradyarrhythmia

13

Tachyarrhythmias Above Ventricle

Supraventricular Tachycardias (SVT)

14

Tachyarrhythmias Ventricle

Ventricular Tachycardia
Ventricular Fibrillation

15

Tachyarrhythmias: Rx of Atrial Fibrillation- 5 C’s

Cause: Reverse

Control Rate

antiCoagulation

Control Rhythm

? Cure: Ablation

16

Common Causes of AF

Hypertension 14%
IHD
Mitral valve Disease
Alcohol
Cardiomyopathies
Hyperthyroidism
Lone AF 14%

17

Immediate Treatment

Cardiovert in unstable
Hemodynamic collapse

Control the Rate in stable
Assess symptoms

18

RHYTHM CONTROL (CARDIOVERSION) works with

1- electrical

2- pharmacological (less successful but no sedation) via class Ic and 3

19

Patients with recurrent AF may require long term maintenance medications to control rhythm, especially if they are symptomatic in AF.

Class IC agents – contraindicated in CAD and structural heart disease

Class III agents – ex amiodarone

**anticoags (stroke risk)

20

Rate Control Medications

Betablockers
Digoxin
Verapamil
Diltiazem
Amiodarone can be used as a rate-controlling agent, especially in setting of decompensated heart failure.

21

Increased stroke risk in patients with certain risk factors (AF) often treated by

aspirin

(sometimes warfarin)

22

Atrial Flutter rx

Catheter ablation more successful than medications (and compared to AF ablation), with 95% cure rate.

23

abnormal heart rhythm, similar to AF. Both conditions are types of supraventricular (above the ventricles) tachycardia (rapid heart beat).

upper chambers (atria) of the heart beat too fast, which results in atrial muscle contractions that are faster than and out of sync with the lower chambers (ventricles).

Atrial Flutter

24

Atrial flutter ablation is a straightforward, low risk procedure targeting a known critical ________ in the right atrium between the tricuspid valve and the inferior vena cava, thus blocking the circuit that causes atrial flutter.

isthmus

25

Atrial flutter ablation is a straightforward, low risk procedure targeting a known critical isthmus in the right atrium between the tricuspid valve and the inferior vena cava, thus _________________

blocking the circuit that causes atrial flutter.

26

Three main categories of "other" SVTs

AV nodal reentrant tachycardia

Accessory pathway-mediated tachycardias

Focal atrial tachycardias

27

least common, abnormal focus of atrial tissue with enhanced automaticity– a “hotspot”.

Focal atrial tachycardias:

28

Ventricular Tachyarrhythmias
ACUTE
TREATMENT
Unstable

SHOCK

Treat underlying causes

Medications

29

Ventricular Tachyarrhythmias
ACUTE
TREATMENT
Stable

Medications:
Amiodarone
Lidocaine
Procainamide

Treat underlying causes

30

abnormal connection between atrium and ventricle.

Accessory pathway-mediated tachycardias:

31

(circuit within the AV node): most common, accounts for ~65% of regular SVTs (not including AF/flutters).

AV nodal reentrant tachycardia

32

Ventricular Tachyarrhythmias
NO
STRUCTURAL
HEART DISEASE

Idiopathic: focal
arrhythmogenic
trigger
Usually “benign”
Medications or ablation
Rarely defibrillator is necessary

33

Ventricular Tachyarrhythmias
WITH
STRUCTURAL
HEART DISEASE

Treat underlying causes
Risk stratify for defibrillator
Medications/ ablation adjunct to defibrillator- NO CURE W/ THIS

34

Tachyarrhythmia Take Home Points

Tachyarrhythmias are divided into supraventricular arrhythmias and those coming from the ventricle.

Any unstable tachyarrhythmia--> SHOCK.

Treat and reverse the underlying causes.

35

SVT: treatment is individualized according to the specific mechanism so MAKE THE DIAGNOSIS (Adenosine to see p waves).

There are a variety of treatment options for SVTs

36

Decisions regarding implantable defibrillators

structural heart disease
what is risk of sudden death with the arrhythmia

37

Most sudden deaths from ventricular arrhythmias occur in general population before_____________

they can be risk stratified.

38

Only available treatments for sudden cardiac death: _____________ YOU- as a potential bystander- can make a difference

basic life support and early defibrillation.