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CVPR > CV - clinical treatment of arrhythmias > Flashcards

CV - clinical treatment of arrhythmias Flashcards

1
Q

impulse formation starts at the ____________ node.

A

sinoatrial (SA)

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2
Q

the ____________ system is the most proximal branch of the bundle branch system.

A

his-purkinje

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3
Q

arrhythmias that are too slow are called ____________.

A

bradyarrhythmias

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4
Q

where in the conduction system can bradyarrhythmias occur?

A

sinus node
atrioventricular node
below the AV node

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5
Q

define sinus bradycardia

A

persistent slow rate from SA node
rate of 55 bpm
PR interval 180 ms (0.18 s)

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6
Q

define sinus arrest

A

failure of sinus node to discharge resulting in the absence of atrial depolarization and periods of ventricular asystole
rate of 75 bpm
PR interval 180 ms (0.18 seconds)

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7
Q

what are examples of bradyarrhythmias at the level of the AV node?

A

1st degree AV block

2nd degree AV block type 1 (mobitz 1, wenckebach)

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8
Q

describe 2nd degree AV block type 1 (mobitz 1, wenckebache)

A

progressive prolongation of the PR interval until a ventricular beat is dropped

ventricular rate irregular
atrial rate 90 bpm
PR interval is progressively longer until a P wave fails to conduct

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9
Q

when should you be concerned about bradycardia?

A

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

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10
Q

what are the reversible causes of bradycardia?

A

ischemia/infarction
hypothyroidism
neurologic causes
lyme disease

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11
Q

what are the acute treatments for unstable patients?

A

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

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12
Q

what are the long term treatments for unstable patients?

A

permanent pacemaker

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13
Q

what are the steps to approach a patient presenting with bradycardia?

A

determine level of block responsible for bradycardia
symptoms dictate treatment
treat reversible causes
acutely stabilize patients
long-term treatment - permanent pacemaker

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14
Q

tachyarrhythmias can originate ____________ or ____________.

A

above the ventricle

in the ventricle

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15
Q

it is unlikely that a ventricular tachyarrhythmia has a ____________ QRS.

A

narrow

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16
Q

tachyarrhythmias originating SVT present with a ____________ QRS on ECG.

A

narrow

17
Q

if the QRS on ECG is narrow, the tachyarrhythmia must be an ____________.

A

SVT

18
Q

what are the three possible causes of an SVT with an irregular rhythm?

A

atrial fibrillation
multifocal atrial tachycardia (MAT)
atrial flutter

19
Q

typical atrial flutter courses around the ____________ valve.

A

tricuspid

20
Q

what are the six potential causes of an SVT with a regular rhythm?

A 
sinus tachycardia 
atrioventricular nodal reentrant tachycardia atrioventricular reentrant tachycardia
atrial flutter
atrial tachycardia
junctional tachycardia
21
Q

if a patient presents with a tachycardia and is hemodynamically UNSTABLE, the treatment is ____________.

A

shock - cardioversion or defibrillation

22
Q

what are the treatment for SVTs with irregular rhythms?

A

rate control
antiarrhythmics
cardioversion

23
Q

IV ____________ is the treatment for regular 1:1 SVTs.

A

adenosine

24
Q

what is an alternative treatment to adenosine?

A

vagal maneuver

25
Q

describe an atrioventricular nodal reentrant tachycardia

A

reentrant circuit within the AV node fast and slow pathways
atria and ventricles depolarized simultaneously
P wave buried within or on the tail end of the QRS complex

regular, narrow complex tachycardia
P waves not visible

26
Q

what is Wolff-Parkinson-White syndrome?

A

patient is born with an accessory electrical pathway between atria and ventricles

if accessory pathway is able to propagate in the forward direction, ventricle is depolarized prematurely - pre excitation of a ventricle

presents as delta wave (“slurred upslope”) on ECG

setup for AVRT

27
Q

if an accessory pathway is functional, ____________ is likely to develop.

A

AVRT (atrioventricular reentrant tachycardia)

28
Q

if there is no gateway to slow the conduction of signals from the atria to the ventricles as in WPW syndrome, atrial fibrillation may become ____________ and may lead to ____________.

A

ventricular fibrillation

sudden cardiac death

29
Q

what are the three main categories of SVTs?

A

AV nodal reentrant tachycardia
accessory pathway-mediated tachycardias
focal atrial tachycardias

30
Q

what is the most common of the SVTs?

A

AV nodal reentrant tachycardia

31
Q

what are the long-term medications used to treat SVTs?

A 
beta blockers
calcium channel blockers to block AV node
class I anti arrhythmics to suppress hotspots or premature beats that may trigger tachycardia
32
Q

what are the common causes of atrial fibrillation?

A 
hypertension
mitral valve disease
alcohol ("holiday heart")
cardiomyopathies
hyperthyroidism
lone atrial fibrillation
33
Q

there is an increased risk of ____________ in patients with atrial fibrillation.

A

thrombus formation

embolic stroke

34
Q

in patients with atrial fibrillation, thrombus formation most commonly occurs in the ____________.

A

left atrial appendage

35
Q

the acute treatment of ventricular tachyarrhythmias are determined by whether the patient is ____________ or ____________.

A

stable

unstable

36
Q

if a patient presents with ventricular tachyarrhythmia and is unstable, the treatment is ____________.

A

shock

37
Q

after shock, what are the treatments for unstable ventricular tachyarrhythmias?

A

treat underlying causes

medications

38
Q

what are the treatments for stable patients presenting with ventricular tachyarrhythmias?

A

medications (amiodarone, lidocaine, procainamide)

treat underlying causes

CVPR (14 decks)

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