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Flashcards in Clinical Treatment of Arrhythmias Deck (14)
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1. Recognize clinical arrhythmia syndromes in relation to underlying etiologies.
2. Describe acute treatment of arrhythmias when encountered in clinical practice.
3. Discuss long-term options for arrhythmia treatment especially as it relates to individualization of patient care.
4. Discuss the advantages and limitations of different arrhythmia treatment strategies.



Where in the conduction system do bradyarrhythmias develops?

- SA node
- AV node
- Below AV node


Which types of bradyarrhythmias are due to SA node dysfunction?

1) Sinus bradycardia
2) Sinus arrest/puase
3) Tachy-brady syndrome
4) Chronotropic incompetence


Describe sinus bradycardia

- Persistent slow rate from SA node
- HR = 55
- PR interval = 180ms


Describe sinus arrest

- failure of SA node to discharge => absence of atrial depolarization and periods of ventricular asystole (flat line)
- HR = 75
- PR interval = 180ms
- 2.8 second arrest


Describe brady-tachy syndrome

- Intermittent episodes of slow and fast rates from SA node or atria
- HR during brady = 43
- HR during tachy = 130


Describe chronotropic incompetence

- Inability to mount age-appropriate HR w/ exercise
- Remember the graph? Can barely reach and can't stabilize appropriate HR


Which types of bradyarrhythmias are due to AV node dysfunction?

1) First degree AV block
2) Mobitz I 2nd degree AV block (Wenkebach)


Describe first-degree AV block

- AV conduction is delayed
- PR interval is prolonged (>200ms)
- HR = 79


Describe Mobitz I 2nd degree AV block (Wenkebach)

- Progressive prolongation of PR interval until ventricular beat is dropped
- Ventricular rate = irregular
- Atrial rate = 90


Which types of bradyarrhythmias are due to dysfunction below the AV node (infranodal/His Purkinje system)

1) Mobitz II 3rd degree AV block (Wenkebach)
2) Complete heart block


Describe Mobitz II 3rd degree AV block (Wenkebach)

- No impulse conduction from atria to ventricles
- Atrial rate > Ventricular rate
- Vent rate = 37
- Atrial rate = 130
- PR interval is variable


At what point should you be concerned about bradyarrhythmias?

1) When the pt is symptomatic (doesn't matter which part of conduction system is affected)
2) When rhythm is intranodal


Describe the treatment methods of bradyarrhythmias

- Treat reversible causes (ischemia, hypothyroidism, lyme disease)
- Stop offending meds if possible
- Acute tx in unstable pt: beta-agonists, temporary transvenous pacing
- Long term: pacemaker (only option)