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Methods of Anesthesia I > Preexcitation and SVT > Flashcards

Preexcitation and SVT Flashcards

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1
Q

what are the two possible electrical pathways to the ventricles?

A

normal AV node pathway

abnormal accessory pathways (in the AV node or myocardium)

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2
Q

most common electrical pathway to ventricles

A

normal AV node pathway

alpha pathway

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3
Q

beta pathway

A

abnormal conduction pathways

av node or myocardium

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4
Q

other names for beta pathways

A

accessory pathways
bypass tracts
preexcitation pathway
aberrant pathway

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5
Q

do pts just have alpha or beta pathways?

A

they have both but beta pathways are normally dormant

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6
Q

when the beta pathways are activated what is the pt at risk for?

A

developing arrhythmias

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7
Q

triggers to activate beta pathways

A

stress, catecholamine surge
caffeine, tobacco, street drugs
electrolyte abnormalities
acid base imbalance

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8
Q

electrical properties of alpha pathway

A

slow conduction

short refractory period (fast reset)

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9
Q

electrical properties of beta pathway

A

rapid conduction

long refractory period (slow reset)

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10
Q

when a current travels the beta pathway would we expect that the ventricles would depolarize earlier or later than normal

A

earlier because of the rapid conduction

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11
Q

preexcitation

A

anytime the ventricles depolarize earlier than they were supposed to

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12
Q

preexcitation + tachycardia =?

A

form reentrant loops that lead to SVT (supraventricular tachycardia)

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13
Q

What will the PR interval look like if an accessory pathway in the AV node is activated? (normal, short, or prolonged?)

A

short

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14
Q

What will the QRS complex look like if an accessory pathway in the AV node is activated? (normal or wide?)

A

normal

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15
Q

What will the PR interval look like if an accessory pathway in the myocardium is activated? (normal, short, or prolonged?)

A

short

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16
Q

What will the QRS complex look like if an accessory pathway in the myocardium is activated? (normal or wide?)

A

wide

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17
Q

three types of preexcitation

A

wolff parkinson white
lgl syndrome
mahaim preexcitation

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18
Q

what is the accessory pathway for WPW called?

A

kent bundle

direct connection between atria and ventricle

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19
Q

what are the two things that will be on an ECG for WPW

A 
short pr interval
delta wave (upward slurring of Q wave)
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20
Q

why does the delta wave occur?

A

upper ventricle is depolarized by myocardium and the rest of ventricle is depolarized by purkinje system

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21
Q

symptoms of WPW without tachycardia

A

preexcitation

asymtomatic

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22
Q

why is WPW with tachycardia a problem?

A

turns symptomatic

need to avoid ketamine, pain, hypovolemia, anxiety

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23
Q

What can WPW tachycardia be confused with on ECG?

A

ventricular tachycardia bc QRS are wide

look for delta wave

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24
Q

what are the 3 treatments for WPW

A

transvenous catheter ablation
antiarrhythmic drugs
synchronized cardioversion (if unstable)

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25
what is the most effective and permanent solution for WPW?
transvenous catheter ablation
26
what antiarrhythmic drugs should be avoided in WPW?
drugs that block conduction through AV node | adenosine, calcium channel blockers, digoxin
27
what antiarrhythmic drugs can be given to pts with WPW?
beta blockers | amiodarone
28
why do we not want to fully block the AV node?
then the entire conduction is going through the beta pathway and that can lead to serious arrhythmias
29
Lown Ganong Levine (LGL) syndrome accessory pathway
james bundle | direct connection between atria and bundle of His (bypass AV node)
30
activation of LGL pathway on ECG
short PR interval | no delta wave
31
LGL syndrome symptoms
usually asymptomatic and no treatment required
32
mahaim preexcitation accessory pathway
mahaim fibers connects AV node to RV bypass bundle of His
33
ECG for mahaim preexcitation
normal pr interval widened QRS could have or not have delta wave
34
technically what does SVT refer to?
tachycardia originating above ventricles (sinus tach, afib, aflutter)
35
clincally what does SVT refer to?
tachycardia greater than 150bpm caused by reentry
36
ECG of SVT
HR >150 QRS normal difficult to differentiate between sinus and junctional tachycardia (p wave may not be present)
37
symptoms of SVT
ventricular filling decreased | CO decreased
38
paroxysmal SVT
SVT when it begins and ends abruptly "occuring in spasms"
39
what can paroxymal SVT look like on ECG?
afib
40
Suppose a patient has an active accessory pathway in the myocardium. When the SA node depolarizes, which pathway will the current travel to get to the ventricles?
travels antegrade down both alpha and beta pathways | preexcitation occurs
41
Suppose that in this same patient with an active accessory pathway in the myocardium, a premature atrial contraction (PAC) occurs. From this PAC, which path will the current travel through to get to the ventricles? 4
1- travels antegrade down the alpha pathway (because it has a short refractory period) 2- accessory pathway repolarizes when impulse is traveling down av node 3- travels retrograde through accessory pathway 4- travels antegrade through the alpha pathway again REENTRANT LOOP
42
what does the reentrant loop in the myocardium look like on ECG?
delta wave | wide QRS
43
what does the reentrant loop in the av node look like on ECG?
normal QRS complex
44
what is the most common type of reentry?
SVT in AV node | AV Nodal Reentrant Tachycardia (AVNRT)
45
ECG for AVNRT
narrow QRS | may or may not have p wave
46
treatments for SVT in AV node (AVNRT) that slow conduction of AV node
vagal maneuvers adenosine calcium channel blockers digoxin
47
vagal maneuver
valsalva- ask pt to blow through a straw carotid massage cold stimulus
48
when should you avoid a carotid massage? why?
could dislodge plaque | avoid in geriatric, high cholesterol, previous stroke
49
pharmacology of adenosine
5-10 sec acting | uncomfortable for pt (can stop heart)
50
dose of adenosine
inital 6mg bolus | up to 2 more doses of 12mg
51
what does sotalol do?
beta blocker | increases refractory period in AV node
52
dose for sotalol to treat SVT?
100mg or 1.5mg/kg
53
when should sotalol be avoided?
pts with prolonged QT syndrome
54
full list of treatment for SVT within the AV node
``` slow conduction through AV node antiarrhythmics beta blocker synchronized cardioversion transvenous catheter ablation ```
55
what is SVT in the myocardium referred to as?
atrioventricular reentrant tachycardia (AVRT)
56
ECG for AVRT
p waves | possible delta waves
57
Is AVRT the same thing as Wolff Parkinson White?
WPW can become AVRT if has tachycardia
58
treatment for SVT within myocardium
antiarrhythmics beta blockers synchonized cardioversion transvenous catheter ablation
59
should you avoid av node blockers in AVRT?
yes
60
what is the treatment option for people who have arrhythmias (usually afib) that are unrespinsive to medications
doctors map area that is causing the disturbance and ablate the abnormal conduction pathways
61
what does the maze procedure treat?
afib
62
maze procedure
surgeon inflicts scar tissue by many means to disrupt abnormal conduction pathways
63
is the maze usually done alone?
no it is usually combined with another heart operation and is performed while sternotomy or thoracotomy
64
left atrial appendage closure
prevent clot release from LA in pts with afib
65
options for left atrial appendage closure 2
1 ligation of left atrial appendage (open heart) | 2 intertion of watchman device (endovascular)

Methods of Anesthesia I (10 decks)

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