04 - Arrhythmias of Sinus Origin

Question 0

Clinical manifestations of arrhythmias

Answer 0

Palpitations - patients are aware
Decreased CO - light headed/syncope
Arrhythmias with underlying cardiac disorder - CHF, can lead to angina

Question 1

Anything other than a normal sinus rhythm

Answer 1

Dysrhythmia

Not every one is a problem

Question 2

Sometimes, the first clinical manifestation of arrhythmias is

Answer 2

Sudden death

Question 3

Why do arrhythmias happen?

Answer 3

HIS DEBS
Hypoxia
Ischemia, infarction, irritability
Sympathetic stimulation
DRUGS!!
Electrolyte disturbances
Brady - brady-tachy syndrome, sick sinus syndrome
Stretch - hypertrophy, valvular probs

Question 4

How do we find arrhythmias?

Answer 4

ECG rhythm strip
12 lead ECG
Event monitor
Holter monitors

Question 5

What triggers an event monitor?

Answer 5

The patient when symptoms of arrhythmias are felt

Question 6

Portable ECG for 24-48 hours

Answer 6

Holter monitor

Question 7

The first component when evaluating and EKG is

Answer 7

Rate

Question 8

Five types of arrhythmias?

Answer 8

Arrhythmias of sinus origin
Ectopic rhythms
Reentrant arrhythmias
Conduction blocks
Pre excitation syndromes

Question 9

Arrhythmias of sinus origin

Answer 9

Tachy
Brady
Sinus arrhythmia
Sinus arrest
Asystole
Escape beats

Question 10

Rate > 100 bpm
Normal P wave
Narrow QRS
1:1 P:QRS ratio

Answer 10

Sinus tachycardia

Question 11

If heart rate is above ____, P wave may be difficult to distinguish from previous T wave

Answer 11

140 bpm

Question 12

Causes of sinus tachycardia

Answer 12

Pain
Fear, anxiety
Exercise
Hyperthyroid
Anemia
Hypovolemia
Malignant hyperthermia
Sepsis

Question 13

What can resolve tachycardia?

Answer 13

Resolution of underlying causes
Vagal maneuvers - carotid massage, valsalva, gagging
AV blocking agents - adenosine, verapamil
Beta blockers - Esmolol, metoprolol

Question 14

Rate: 40-59 bpm
Normal P wave
Normal QRS
Regular rhythm

Answer 14

Sinus bradycardia

Question 15

Causes of sinus bradycardia?

Answer 15

Vagal maneuver
Athleticism
Sleep
Sever hypertension
Beta blockers
Hypothyroid

Question 16

Severe bradycardia can drop CO so low that the reduced blood flow causes

Answer 16

Syncope (fainting)

Question 17

Treatment of chronic bradycardia?

Answer 17

Pacemaker

Thyroid therapy

Question 18

Treatment of acute bradycardia?

Answer 18

Cease stimulation
Atropine
Glycopyrrolate

Question 19

Treatment of bradycardia is ______ unless pt in concurrently hypotensive or symptomatic

Answer 19

Not usually indicated

Question 20

Rate: 45-100 bpm (varies with RR)
Normal P wave
Normal QRS
Irregularly regular rhythm WHAT??

Answer 20

Sinus arrhythmia

Not a true arrhythmia

Question 21

Spontaneous breathing causes sinus arrhythmias due to fluctuations in

Answer 21

Parasympathetic vagal tone

Question 22

The hearts fail safe pacing mechanism proving three levels of back up pacing is known as?

Answer 22

Overdrive suppression

Question 23

What are the three levels of back up pacing in overdrive suppression?

Answer 23

Automaticity foci in atria
The ventricles
AV junction

Question 24

Conditions that increase automaticity?

Answer 24

Sympathetic nervous system stimulation

Hypoxia

Question 25

What are the automaticity foci and their rates?

Answer 25

SA node: 60-100 bpm
Atrium: 60-80 bpm
Junction: 40-60 bpm
Ventricle: 20-40 bpm

Question 26

Sinus arrest occurs when SA node and other pacemaker cells

Answer 26

Stop firing

Question 27

The rescuing beats originating from outside the sinus node are called

Answer 27

Escape beats

Question 28

Which pacemaker cells rescue the heart most frequently?

Answer 28

AV junction

Question 29

If alternative pacemaker cells beat for an extended period of time into a regular rhythm, this is

Answer 29

Junctional escape rhythm

Question 30

A junctional escape rhythm can have P waves that are not seen or appear retrograde because

Answer 30

There is an abnormal pattern of atrial depolarization