Dysrhythmias

Question 1

Sinus Pause/Arrest

Answer 1

May occur from increased vagal tone, myocarditis, MI and digitalis toxicity
Typically lasts 2 seconds - 2 minutes
Atropine may be given if hemodynamically unstable

Question 2

What med should be given to a patient with symptomatic Sinus bradycardia?

Answer 2

Atropine 1mg IV

Temporary Pacemaker

Question 3

Where does SVT originate?

Answer 3

Above the His bundle.

Question 4

What might cause SVT?

Answer 4

digitalis, asthma meds, caffeine, ephedra, cocaine, meth Stimulants

Question 5

What does SVT generally start with?

Answer 5

A PAC or PVC

Question 6

S/S of SVT

Answer 6

Palpitations
Dizziness
SOB
Anxiety
CP/tightness

Question 7

SVT Tx

Answer 7

Vagal maneuvers
Carotid Massage
Adenosine 6mg IV fast push.
or of unsuccessful...
Cardioversion, IV Beta blocker/CCB

Question 8

SVT prevention

Answer 8

Beta Blockers
CCB’s
Digoxin
SVT ablation (permanent)

Question 9

Wolff-Parkinson-White Syndrome (WPW)

Answer 9

Congenital defect - any age. Men > Women
Form of SVT where an accessory pathway bypasses the AV node.
AKA AV reciprocating arrhythmia
Bypassing AV node can cause re-entry tachycardia

Question 10

WPW S/S

Answer 10

Palpitations
Tachycardia
DIzziness
Dyspnea
Anxiety
Syncope

Question 11

WPW EKG symptoms

Answer 11

PR interval < .12ms
Delta wave (slurred QRS uptake)

Question 12

WPW Long-term Tx

Answer 12

Depends on frequency and symptoms
Radiofrequency ablation
Beta blockers, CCB’s, Flecainide

Question 13

WPW Acute Tx

Answer 13

Vagal maneuvers
IV adenosine (6-12 mg fast push)
OR
IV diltiazem or verapimil

Question 14

Paroxysmal Atrial Tachycardia (PAT)

Answer 14

Atrial rate 150 - 250
P wave morphology varies
Usually requires no tx
Usually terminated with vagal maneuvers

Question 15

Premature Atrial Contractions (PAC’s)

Answer 15

Discharge from non-sinus atrial pacemaker
P’ wave marks PAC
May be precursor to Afib

Question 16

PAC Tx

Answer 16

Asymptomatic (avoid triggers (stimulants))

Symptomatic: Beta blockers

Question 17

Wandering Atrial Pacemaker

Answer 17

Seen in normal hearts and diseased hearts
Variable rate
More than 3 different P wave morphologies
Usually no tx required
May lead to multifocal atrial tachycardia

Question 18

Multifocal Atrial Tachycardia

Answer 18

Wandering atrial pacemaker with a rate over 100 bpm

Usually doesnt cause hemodynamic instability

Question 19

Causes of multifocal atrial tachycardia

Answer 19

Lung dz, COPD
AMI
Sepsis
Hypokalemia
Low magnesium
Ma be a precursor to Afib

Question 20

Multifocal atrial tachycardia tx

Answer 20

Tx underlying medical problem

Suppress rate with BB, or CCB

Question 21

Atrial Fibrillation

Answer 21

Most common arrhythmia
Micro re-entry circuit
Atrial rate is 350 - 450
No distinguishable P waves
Irregularly irregular

Question 22

Causes of Afib

Answer 22

Underlying cardiac dz
Valvular dz, Heart failure, IHD
Pericarditis
Thyrotoxicosis
PE
Pneumonia
Alcohol OD
Post-op thoracic surgery
Sleep Apnea
HTN

Question 23

Afib may result in?

Answer 23

Decreased Cardiac Output

Question 24

INR goals for Afib?

Answer 24

2.0 - 3.0

Question 25

Rate goals for Afib?

Answer 25

between 60 and 110 Diltiazem Beta Blockers Digoxin

Question 26

When is it safe to cardiovert without anticoagulation in Afib?

Answer 26

Less than 48 - 72 hours of Afib

Question 27

Atrial Flutter

Answer 27

``` Macro re-entry circuit Atrial rate 250 - 350 Ventricular rate 150 2:1 3:1 4:1 pattern regularly irregular Classic sawtooth on EKG ```

Question 28

A flutter is indicative of?

Answer 28

Diseased hearts (CHF) Precursor to Afib Tx depends on level of hemodynamic compromise

Question 29

Aflutter Tx

Answer 29

Cardioversion Class 1A antiarrhythmics BB, CCB, Digoxin

Question 30

Junctional Tachycardia

Answer 30

Junctional rhythm with a rate of 150 - 250 More common in women Usually initiated by PAC

Question 31

Junctional Tach tx

Answer 31

Vagal maneuvers Adenosine* DOC Long-term: BB, CCB

Question 32

1st degree AV block

Answer 32

PR interval > .20 Occurs in healthy and sick hearts Usually don't need tx

Question 33

2nd Degree AV Block Type 1

Answer 33

Wenchebach Occurs in the AV node, above His bundle often transient Often asymptomatic - no tx

Question 34

Wenchebach EKG

Answer 34

Variable rate | PR grows wider and wider until the QRS is blocked completely, then it resets.

Question 35

2nd Degree AB block Type 2

Answer 35

Mobitz Usually occurs below His bundle May progress into higher degree AV block

Question 36

Type 2 block EKG findings

Answer 36

Variable rate normal P wave Widened QRS associated w/ BBB PR may be normal until dropped QRS

Question 37

Type 2 block Tx

Answer 37

More serious than Type 1 Artificial pacing Usually requires permanent pacemaker

Question 38

3rd Degree Block

Answer 38

AV dissociation | Sinus impulses are completely blocked upstream of the ventricles

Question 39

3rd Degree block causes

Answer 39

digitalis toxicity Acute infxn MI Degeneration of tissue

Question 40

3rd Degree block EKG findings

Answer 40

Normal atrial rate Ventricular rate usually less than 70 QRS may be normal or widened

Question 41

3rd degree block tx

Answer 41

External pacing and atropine for acute episodes. | Permanent pacing for chronic complete block

Question 42

Premature Ventricular Contractions (PVC)

Answer 42

``` Increasing circulating catecholamines Coronary ischemia Hypokalemia Low magnesium Drug toxicities ```

Question 43

PVC EKG findings

Answer 43

Variable rate P wave usually obscured by QRS Wide QRS May occur in singles, couplets, or triplets

Question 44

Bigeminal PVC's

Answer 44

one normal beat and one PVC repeated

Question 45

Trigeminal PVC's

Answer 45

two normal beats and one PVC

Question 46

Ventricular Tachycardia causes

Answer 46

Triggered by ischemia, electrolyte abnormalities Hypokalemia is also an important trigger MI Cardiomyopathy

Question 47

Pulse Vtach Tx

Answer 47

Cardioversion | Amiodarone

Question 48

Pulseless Vtach

Answer 48

Defibrillation | Amiodarone

Question 49

Torsades de Pointes

Answer 49

Twisting about the points | Upward and downward deflection of QRS

Question 50

Torsades de Pointes causes

Answer 50

Long QT drugs electrolyte imbalances Myocardial ischemia

Question 51

Torsades de Pointes Tx

Answer 51

Synchronized cardioversion IV magnesium, potassium Overdrive pacing

Question 52

Ventricular Fibrillation

Answer 52

AKA sudden cardiac death ABsence of cardiac output Occurs with AMI

Question 53

Vfib Tx

Answer 53

ACLS protocol Immediate defib Treat underlying cause Implantation of ICD

Question 54

Idioventricular Rhythm

Answer 54

Widened WRS dying heart rhythm Pacemaker most likely needed Caused by myocardial ischemia, infarction

Question 55

Asystole

Answer 55

In the presence of AMI is almost always fatal | Complete cessation of any electrical or mechanical activity

Question 56

Asystole Tx

Answer 56

``` CPR, O2 IV, Intubate Transcutaneous pacing Epi 1mg IV push q3-5m Atropine ```

Question 57

Pulseless Electrical Activity (PEA)

Answer 57

Electromechanical dissociation There is electrical activity, but no mechanical response EKG shows sinus, but NO pulse

Question 58

PEA 6 H's

Answer 58

``` Hypoxia Hypovolemia Hypoglycemia Hydrogen Ions (Acidosis) Hypothermia Hypo/Hyperkalemia ```

Question 59

PEA 6 T's

Answer 59

``` Toxins Tamponade Trauma Tension pneumothorax Thrombosis (cardiac) Thrombosis (pulmonary) ```

Question 60

PEA Tx

Answer 60

Correct underlying cause Epi, Atropine CPR

Question 61

Which pathway do electrical impulses take in WPW?

Answer 61

Through the kent bundles | You will see delta waves and short PR