tachyarrhythmias, afib and aflutter Flashcards
1
Q
common causes of sinus tachycardia
A
- exercise
- anxiety
- pain
- stimulants
- volume depletion
- anemia
- hypoxia
- PE
- pericarditis
2
Q
treatment for tachycardia
A
- treat underlying cause
3
Q
AVNRT
A
- AV nodal reentry tachycardia
- electrical conduction gets trapped in a loop around AV node
4
Q
AVRT
A
- av reciprocating tachycardia
- wider circuit
- accessory pathway through AV node into atria and ventricles
5
Q
junctional tachycardia
A
- originates in AV node
6
Q
main symptom of SVT
A
- sudden onset and offset
7
Q
management of stable SVT
A
- first line= vagal maneuvers* or carotid massage
- adenosine 6 mg IVP, 12 mg IVP, 12 mg IVP
- BB or CCB
- frequent attacks require ablation
8
Q
management of unstable SVT
A
- vagal maneuvers first line
- DC cardioversion if unsuccessful
9
Q
sx of vtach
A
- heart palpitations
- near syncope or syncope
- chest pain, SOB, diaphoresis
- sustained LOC
- death
10
Q
treatment for vtach with pulse
A
- stable- amiodarone IV bolus then cont infusion, ICD
- unstable- DC cardioversion
11
Q
treatment vtach without pulse
A
- CPR
- defibrillation
- epi
12
Q
torsades de pointes triggers
A
- hypoK
- hypoMg
- drugs that prolong QTc:
- antiarrhythmic drugs
- antipsychotics
- abx
- antidepressants
13
Q
antiarrhythmics that prolong QTc
A
- amiodarone
- flecainide
- sotalol
14
Q
antipsychotics that prolong QTc
A
- chlorpromazine
- haloperidol
- olanzapine
- quetiapine
- risperidone
15
Q
abx that prolong QTc
A
- azithromycin
- levofloxacin
- ciprofloxacin
16
Q
antidepressants that prolong QTc
A
- citalopram
- TCAs
17
Q
treatment for torsades
A
- IV mg firstline
- temp transvenous overdrive pacing if no response to Mg
- if unstable requires defibrillation
18
Q
causes of vfib
A
- MI most common
- HF
- hypoxemia or hypercapnia
- hypotension/ shock
- electrolyte abnormalities
- stimulates
- often preceded by vtach
19
Q
assoc conditions with vfib
A
- LVH
- HOCM
- CHF
- aortic stenosis
- brugada syndrome
20
Q
treatment for vfib
A
- CPR
- defibrillation
- if pulse regained consider cardiac cath and ICD
21
Q
afib
A
- rapid irregular atrial contraction
- no p waves
- usually assoc with HR of 120-160
- high stroke risk
- more common in elderly, males, and whites
22
Q
etiology of afib
A
- hyperthyroidism*
- acute vagotonic episode
- alcohol
- post op
- atrial enlargement
- disruption of electrical conduction sys
23
Q
where does ablation occur for afib
A
- ostial portion of pulmonary veins
24
Q
risk factors for afib
A
- age > 64
- male
- HTN
- obese
- prolonged PR interval
- valve disease*
- CHF
25
paroxysmal afib
- intermittent
26
persistent afib
- fails to terminate within 7 days
| - requires intervention
27
permanent afib
- lasts > 12 mo
| - no longer pursue rhythm control
28
sx of afib
- may be asymptomatic
- heart palpitations
- presyncope or syncope
- SOB and exs intolerance
- chest pain
- fatigue
29
triggers of afib
- sleep deprivation
- physical illness
- post op
- stress
- hyperthryoidism
- physical exertion
- stimulant meds
- alcohol, caffeine
- dehydration
30
what should every person with afib have during work up>
- TTE to assess for valve disease
| - TSH levels
31
what is the best method for detecting atrial thrombus
- TEE
| - very invasive
32
goals of afib tx
- rhythm control- always tried first
- rate control to prevent tachy CMP or ischemia
- decrease stroke risk with anticoags
- alleviate sx
33
who requires urgent DC cardioversion for afib
- unstable hemodynamics
- evidence of hypoperfusion
- severe manifestations of HF
- WPW
34
non-urgent DC cardioversion
- new onset/ dx afib
- persistent afib who are limited by sx
- before cardiversion control ventricular rate and provide IV heparin
35
tx prior to DC cardioversion for afib
- anticoag tx X 3 weeks OR TEE to determine if thrombus present
36
c/i to cardioversion for afib
- known afib with minimal sx
- multiple comorbidities
- unlikely to maintain NSR
- benefits decrease after 80
- paroxysmal afib
- known clot or sx > 48 hours without anticoag tx X 3 weeks
37
complications of afib
- ischemia
- pulmonary edema
- tachycardia induced CMP
- stroke
38
treatment for rate control in afib
- BB or CCB first line (IV then PO)
- digoxin added to BB or CCB
- amiodarone last line
39
side effects of amiodarone
- abnormal LFTs
| - pulmonary toxicity- chronic interstitial pneumonitis
40
how do you determine stroke risk for afib pts
- CHADS2 score
| - CHADS2-VASc score which is more specific if pt falls into intermed risk
41
anticoag tx options for afib
- warfarin
- dabigatran
- rivaroxaban
- apixaban
42
warfarin
- competitively depletes vit K
- 5-7 days for full therapeutic effect
- goal INR of 2-3
- CYP2C9 interactions
- no bridging for afib
43
indications for hospitalizations with afib
- ablation of accessory- WPW
- treat assoc medical problems that are trigger
- manage rate or sick sinus syndrome
44
treatment of aflutter
- rate control more difficult than afib
- usually respond well to ablation
- anticoag tx prior to abalation X 1 month or if recurrent
45
where does ablation occur for aflutter
- large macroreentrant pathway of RA
