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exam 2 Flashcards

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1
Q

arrhythmia

A
  • any electrical disturbance that changes rate, regulatity, site of origin or conduction pathway in pathologic way
  • single beat or sustained
  • benign to life threatening
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2
Q

causes of arrhythmias

A
  • hypoxia
  • ischemia and irritability
  • sympathetic stimulation
  • drugs
  • electrolyte disturbances
  • enlargement and hypertrophy
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3
Q

types of arrhythmias

A
  • form SA node
  • ectopic rhythm
  • recurrent arrhythmia
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4
Q

ectopic rhythms

A
  • originate form focus other than SA node
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5
Q

recurrent arrhythmias

A

electrical activity trapped in a continuous circuit

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6
Q

sinus tachycardia

A
  • rhythm > 100 bpm
  • normal or pathologic
  • pathologic due to hyperthyroidism or PE**
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7
Q

sinus bradycardia

A
  • rhythm < 60 bpm
  • normal or pathologic
  • normal happens in well conditioned athletes
  • pathologic- vasovagal syncope
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8
Q

sinus arrest

A
  • sinus node stops firing
  • causes flat line
  • length of line depends on if and when rescue beat occurs
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9
Q

asystole

A

prolonged sinus arrest

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10
Q

rescue beat

A
  • aka escape beat

- originate from atria, AV node, or ventricles

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11
Q

sick sinus syndrome

A
  • dysfunction of SA node

- inability to generate heart rate that meets physiological needs

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12
Q

possible results of sick sinus syndrome

A
  • bradycardia
  • sinus pauses
  • sinus arrest
  • paroxysmal supraventricular tachycardia
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13
Q

supraventricular arrhythmias

A
  • originate in atria or AV node

- single beat or sustained rhythm

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14
Q

ectopic rhythms

A
  • arises elsewhere not sinus node
  • sustained rhythms
  • enhanced automaticity of non-sinus site
  • abnormal acceleration of depolarization
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15
Q

what is a common cause of ectopic rhythms

A

medication

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16
Q

what does AVNRT stand for

A
  • AV node reciprocating tachycardia

- type of reentry loop

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17
Q

characteristics of AVNRT

A
  • sudden onset and offset*
  • can vary in size
  • if no P wave then it originated below atria
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18
Q

what reentry loop involves entire heart

A

AV reentry tachycardia- AVRT

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19
Q

characteristics of AVRT

A
  • accessory pathway between atrium and ventricle bypasses AV node
  • connects directly to his bundle, ventricular myocardium or one of fascicles
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20
Q

4 questions to ask about rhyhm

A
  • is it regular or irregular
  • P waves present?
  • do P waves precede each QRS?
  • are QRS narrow or wide?
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21
Q

premature atrial contractinon

A
  • usually due to ectopic focus
  • isolated beat that comes early
  • P wave morphology sometimes looks different
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22
Q

types of supraventricular arrhythmias

A
  • paroxysmal supraventriclar tachy
  • a flutter
  • a fib
  • multifocal atrial tachycardia
  • paroxysmal atrial tachycardia
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23
Q

supraventricular tachycardia (SVT)

Study These Flashcards
A
  • usually initiated by premature supraventricular beat
  • driven by recurrent loop in AV node
  • regular rhythm, very rapid
24
Q

causes of SVT

Study These Flashcards
A
  • very common
  • can occur in normal heart
  • alcohol
  • coffee
  • excitement
25
mechanisms to break SVT
- valsalva maneuver first - if valsalva doesnt work give adenosine - carotid massage
26
atrial flutter
- common - regular but very rapid rate - rapid fire atrium - have "flutter" p waves - saw tooth appearance
27
common conditions associated with a flutter
- HTN - electrolyte abnormalities - alcohol - drug abuse (Stimulants) - thryotoxicosis - cardiac conditions
28
atrial fibrillation
- atria activity is completely chaotic - AV node can be bombarded with > 500 impluses/ min - multiple reentrant circuits - no true P waves - irregularly irregular ventricular rate
29
conditions associated with a fib
- HTN - mitral valve disease - PE - thyrotoxicosis - pericarditis
30
multifocal atrial tachycardia
- irregular rhythm at 100-200 bpm - random firing of several different ectopic atrial foci - common in lung disease - p waves vary in morphology
31
what is multifocal atrial tachycardia called if its less than 100 bpm
wandering atrial pacemakers
32
premature ventricular contraction
- most common ventricular arrhythmia - QRS wide and bizarre - happens before next beat should occur - isolated PVC is normal
33
ventricular bigeminy
- for every sinus beat you get a ventricular ectopic beat/ PVC
34
ventricular trigeminy
two normal beats to one PVC
35
when are PVCs dangrous?
- when frequent - when runs of more than 3 in a row (called v tach) - when variable in morphology - when pt is having MI
36
ventricular tachycardia classifications
- non-sustained v tach (NSVT) | - sustained v tach (SVT)
37
non-sustained v tach
- common - usually asymptomatic - potential marker for sustained v tach but usually benign if no heart disease - usually < 30 sec
38
sustained v tach
- pulse present vs. pulseless - conscious vs unconcious - leads to v fib -> death - lasts greater than 30 sec
39
ventricular fibrilation
- v tach degenerates into v fib - no discernible QRS complexes - no cardiac output - immediate CPR and defibrillation required
40
causes of v fib
- MI (most common) - myocardial ischemia - HF - hypoxemia or hypercapnia - hypotension/ shock - electrolyte imbalances - stimulants - often preceded by v tach
41
torsades de pointe
- unique form of v tach - usually seen with prolonged QT intervals - QRS complexes spiral around baseline, change amplitude and axis
42
conduction block
- obstruction or delay of flow of electricity along normal electrical pathway
43
types of conduction blocks
- sinus node block - AV block - BBB
44
sinus node block
- sinus node fires but wave of depol is immediately blocked - atria doesnt contract - causes sinus pause/arrest
45
AV block
- any conduction block between sinuse node and purkinje fibers
46
types of AV block
- first degree AVB - second degree- mobitz I or II - third degree ABV
47
bundle branch block
- conduction block in one or both ventricular BB - can occur in main BB or within one of fascicles - wide QRS
48
what is LBB associated with
- coronary artery disease | - very concerning in setting of MI
49
first degree AV block
- prolonged delay in AV node conduction - normal depol of atria - prolonged PR - every atrial impulse makes it through
50
second degree AV block
- not every atrial impulse makes it through - P to QRS >1:1 - either mobitz I or mobitz II
51
mobitz type I
- aka wenchebach - each atrial impulse gets has longer delay - usually 3rd of 4th impulse fails to make it through - not indication for pacemaker
52
mobitz type II
- block below AV node in his - some but not at atrial impulses transmitted - two or more beats with normal PR then dropped beat - cycle is repeated - indication for pacemaker
53
third degree heart block
- aka complete heart block - no atrial impulses make it to ventricles - site can be at AV node or lower - escape rhythm generated below block - atria and ventricles become dissociated - pacemaker indicated
54
RBBB
- R ventricular depolarization is delayed - wide QRS - r-R' bunny ear pattern - wide S in V6 - can be in normal or sick hearts
55
LBBB
- delayed ventricular depolarization - prolongation in rise of R waves in leads over left ventricle - broad and notched QRS - leads over R ventricle will show broad S wave
56
what does LBBB usually suggest
coronary artery disease

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