Rate & Rhythm Disturbances

Question 1

Sinus arrhythmia-

Answer 1

• Cyclic increase in normal HR with inspiration, decrease with expiration
• Reflex changes in vagal influence on pacemaker
• Young & elderly

Question 2

Sinus arrhythmia- Sx

Answer 2

• Disappears with breath holding, increased HR

Question 3

Sinus arrhythmia- Dx/ Tx

Answer 3

No clinical significance

Question 4

Sinus Bradycardia- Eti

Answer 4

< 60 BPM- increased vagal influence in pacemaker, SA node disease

Question 5

Sinus Bradycardia-Sx

Answer 5

• weakness, confusion, syncope

- may cause article, junctional or ventricular ectopic rhythms

Question 6

Sinus Bradycardia- Dx

Answer 6

Rate increases with exercise or atropine

Question 7

Sinus Bradycardia- Tx

Answer 7

Atropine & pacing

Question 8

Sinus Tachycardia- Eti

Answer 8

> 100 BPM

- Rapid impulse formation of SA node

Question 9

Sinus Tachycardia- Sx

Answer 9

• Fever, exercise, emotion, pain, anemia, HF, shock, drugs

- Alchohol withdrawal

Question 10

Sinus Tachycardia- Dx

Answer 10

• Gradual onset & termination
• infrequently exceeds 160 BPM
• Regular rhythm, may change with position, breaths, sedation

Question 11

Sinus Tachycardia- Tx

Answer 11

• Beta blockers

- Modification of SA node

Question 12

Paroxysmal supraventricular tachycardia- Eti

Answer 12

• AV nodal reentry tachycardia
• AV accessory pathway
• No structural heart disease

Question 13

Paroxysmal supraventricular tachycardia- Sx

Answer 13

• 140-240 BPM, regular
• Episodes begin & end abruptly- seconds to hours
• Angina, dizzy, SOB,

Question 14

Paroxysmal supraventricular tachycardia- Dx

Answer 14

• ECG: regular rhythm, increased rate

- P-wave differs in contour

Question 15

Paroxysmal supraventricular tachycardia- Tx

Answer 15

• Terminate episode
• valsalva, carotid sinus massage
• Adenosine to block conduction of AV node

Question 16

Wolffe-Parkinson-White syndrome- Eti

Answer 16

Superventricular tachycardia due to accessory connection between atrium & ventricle through Kent Bundles

Question 17

Wolffe-Parkinson-White syndrome- Sx

Answer 17

• Syncope
• Rapid, regular rhythm
• Palpations
• Loss of pre excitation during exercise

Question 18

Wolffe-Parkinson-White syndrome- Tx

Answer 18

• Catheter ablation

Question 19

Atrial fibrillation- Eti

Answer 19

• Most common
• Increases in 7th decade
• 60% revert to sinus rhythm within 24 hrs
• HTN, MI, stroke

Question 20

Atrial fibrillation- Sx

Answer 20

• Irregularly irregular pulse

- palpitations or fatigue

Question 21

Atrial fibrillation- Dx

Answer 21

• ECG- ambulatory

Question 22

Atrial fibrillation- Tx

Answer 22

> 1 wk = anticoagulants & rate control with beta blockers, CCB

Question 23

Atrial premature contraction- Eti

Answer 23

• Ectopic focus of atria fires before SA node

- Common

Question 24

Atrial premature contraction- Sx

Answer 24

• Premature heart beat, abolished by increase in HR
• Asymptomatic & benign
• Varied p wave morphology

Question 25

Atrial premature contraction- Tx

Answer 25

None- discontinue coffee, tobacco

Question 26

Atrial flutter- Eti

Answer 26

- Assoc with COPD | - Less common that fibrillation

Question 27

Atrial flutter- Sx

Answer 27

- Regular pulse with atrial rate btw 250-350 - Palpitations, fatigue, tachycardia - COPD or HF

Question 28

Atrial flutter- Dx

Answer 28

Sawtooth ECG

Question 29

Atrial flutter- Tx

Answer 29

- Beta blocker or CCB- rate control | - Electrical cardioversion

Question 30

Premature ventricular contraction- Eti

Answer 30

- Isolated beats originating from ventricular tissue

Question 31

Premature ventricular contraction- Sx

Answer 31

- Pts may not sense - Exercise abolishes - No p-wave - Arrhythmia- every 2nd/3rd beat premature

Question 32

Premature ventricular contraction- Dx

Answer 32

Ambulatory ECG

Question 33

Premature ventricular contraction- Tx

Answer 33

- Asymptomatic= no tx - Freq- lytes, tsh, HD - Beta blockers - Catheter ablation

Question 34

V-tach- Eti

Answer 34

- 3+ premature beats | - Sudden death with sig. LV dysfunction

Question 35

V-tach- Sx

Answer 35

- Syncope, impaired cerebral fxn | - Structural heart defects/ disease, myopathy

Question 36

V-tach- Dx

Answer 36

ECG- Torasades de pointes

Question 37

V-tach- Tx

Answer 37

- Mg sulfate | - beta blockers

Question 38

V-fib- Eti

Answer 38

- Proceeded by V-fib | - Severe CAD

Question 39

V-fib- Sx

Answer 39

- Sudden death | - Prior MI

Question 40

V-fib- Tx

Answer 40

- Cardioverter- defibrilatoer

Question 41

Long QT syndrome- Eti

Answer 41

Congenital or acquired

Question 42

Long QT syndrome- Sx

Answer 42

- Congenital: Primary elec. disorder, no evidence of HD, deafness - Acquired: secondary to MI, abn lytes, antiarrythmics

Question 43

Long QT syndrome- Tx

Answer 43

Beta blockers