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Flashcards in Treatment of arrhythmias Deck (26):
1

Bradyarrythmias of SA node

sinus bradycardia, sinus arrest/pause, tachy-brady syndrome, chronotropic incompetence- inability to mount age-appropriate HR with exercise

2

Bradyarrhythmias of AV node

1st degree AV block, Mobitz I 2nd degree AV block (Wenkebach)

3

Bradyarrhythmias below AV node

Mobitz II 2nd degree AB block, complete heart block

4

Sinus bradycardia

SA node fires slow (<60BPM)

5

Sinus arrest

a pause in the rate at which the SA node firesdue to failure of SA node discharge

6

Bradycardia-tachycardia syndrome

SA node has alternating periods of firing too slowly (< 60 bpm) and too fast (> 100 bpm). Brady-tachy syndrome often manifests itself in periods of atrial tachycardia, flutter, or fibrillation

7

Chronotropic incompetence

HR response to activity is unstable

8

1st degreee AV block

delay in AV conduction, but each atrial signal is conducted to the ventricles

9

2nd degree AV block- mobitz I and II

failure of atrial depolarizations to reach the ventricle. Mobitz I(Wenckebach): Progressive prolongation of the PR interval until a ventricular beat is dropped due to block of AV node. Mobitz II: intermittent dropped beats preceded by constant PR intervals due to block of bundle of His

10

Mobitz I vs II

Mobitz1: difference in PR intervals before and after beat is >0.02seconds. MobitzII: difference in PR intervals before and after beat is <0.02 seconds

11

What is advanced second degree block

block of two or more consecutive P waves

12

3rd degree AV block

The QRS complexes are not caused by conduction of the P waves through the AV node to the ventricles, but rather the QRS is initiated at a site below the AV node (such as in the His bundle or the Purkinje fibers) as an escape rhythm

13

Treatment for Bradyarrhythmias

1. treat reversible causes (ischemia, infarct, hypothyroidism). 2. Stop offending meds (antiarrhythmics, clonidine, lithium). 3. Acute treatment for unstable patient: beta-agonists (dopamine or isoproterenol), transcutaneous pacing, temporary transvenous pacing. 4. Long term: Permanent pacemaker

14

Describe implantation of pacemaker

generator placed in shoulder with leads that are guided by venous system into heart (atria or ventricle) where sensing of heart rhythm occurs

15

Two general categories of tachyarrhythmias

Supraventricular tachycardia or ventricular (tachycardia or fibrillation)

16

Supraventricular tachycardia classifications

irregular: Atrial fibrillation, multifocal atrial tachycardia (3 or more p waves), atrial flutter. Regular: sinus tachycardia, AV nodal reentrant tachycardia, atrioventricular reentrant tachycardia, atrial flutter, atrial tachycardia, and junctional tachycardia

17

Acute treatment of supraventricular tachycardia

Shock/cardiovert if unstable. If stable: irregular SVT treated with rate control, antiarrhythmics or cardioversion. Regular SVT treated with adenosine (blocks AV node)

18

Treatment of Atrial fibrillation

reverse cause, control rate, anti-coag, control rhythm and possible cure with ablation

19

Causes of atrial fibrillation

hypertension, mitral valve disease, alcohol, cariomyopathies, hyperthyroidism, lone AF

20

List methods for rhythm control in Afib

drugs: class III agents, class IC agents. Electrical: DC shock has good success but requires sedation. Ablation is last resort

21

Use of anti-coags in afib

risk of thromboembolism from clot in atrium

22

Methods for rate control in Afib

meds: B blocerks, digoxin, verapamil (IV), Diltiazem (IV), amiodarone

23

CHAD2 tool

risk assessment tool that weighs the risks and benefits of taking warfarin vs having an embolus. C: CHF, H: hypertension, A: Age>75, D: diabetes, 2: prior stroke/TIA

24

Atrial flutter treatment

Catheter ablation has high success rate (better than Afib). Targets isthmus in RA btw tricuspid and IVC

25

Treatment of ventricular tachyarrhythmias

if unstable: shock, treat underlying causes and meds. If stable: Meds (amiodarone, lidocaine, procainamide), treat underlying . If structural heart disease, may require defibrillator. If idiopathic, meds include B blockers, Ca channel blockers, Class IC and Class II agents and ablation.

26

When does patient need a defibrillator

Secondary prevention: Patient has had sudden cardiac arrest without reversible cause. Primary prevention: No previous cardiac arrest by significant risk due to ischemic heart disease (low Ejection fraction<35% ), ischemic heart disease with EF 35-40% and inducible VT, or structural disease (hypertrophy, etc)