10. Petersen - Arrhythmia Identification Flashcards
What is the rate, rhythm, symptoms, and treatment for premature atrial contraction?
Rate: normal
Rhythm: abnormal, atrial contractions occur prematurely
Symptoms: asymptomatic
Treatment: none required, minimal risk
What is the rate, rhythm, causes, symptoms and treatment of Supraventricular Tachycardia (SVT)?
Rate: fast, 150-250bpm
Rhythm: regular
Causes: reentry pathway
Symptoms: angina, dyspnea, fatigue, palpitations, CHF
Treatment: if unstable, Direct cardio version
What is the treatment goal of Supraventricular tachycardia (STV)?
Protect the ventricles!
What is the treatment for stable and unstable SVT?
Stable: carotid massage, vagal maneuver
Unstable: direct cardio version, 50-100 joules
What is the rate, rhythm, causes, symptoms of Wolff-Parkinson-White (WPW) syndrome?
Rate: variable
Rhythm: variable
Causes: accessory pathway, the bundle of Kent which passes AV node stimulation
Symptoms: chest pain, vertigo, syncope, SOB
What is the treatment for WPW syndrome?
Cure: catheter ablation
Chronic treatment: adenosine (normal QRS)
- PO class III –> increase AP refractory phase
- Class 1a and Ic –> decrease AP conduction
What should not be used in the treatment of WPW syndrome and why?
Beta blockers, Non-DHP CCBs, digoxin (if Afib)
- decreases AV node conductions
- increases accessory pathway conduction
What is the unique wave seen on an EKG from WPW syndrome?
Delta wave, at the start of QRS
What is the rate, rhythm, causes, symptoms of Afib/ Atrial flutter?
Rate: very fast, 400-600bpm
Rhythm: irregularly
Causes: 1) Afib - multiple reentry pathways 2) A flutter - single reentry loop
Symptoms: asymptomatic, SOB/DOE, palpitations
What are the treatment goals of Afib/A flutter?
Rate control, rhythm control, prevent thromboembolism, symptom management
When should rate control be used in Afib/A flutter pts?
All pts, maintaining a HR
When should rhythm control be used in Afib/A flutter pts?
Most effective in younger pts, maintains NSR, for symptomatic/unstable pts, but no morbidity/mortality advantage over rate control
What are the rate controlling meds in Afib?
LVEF 40%: beta blockers, non-DHP CCBs, digoxin to decrease HR
What are the rhythm control meds in Afib?
Direct Current Cardioversion (DCC)
Class 1c AAD: flecainide, propafenone
Class III AAD: Amiodarone, ibutilide (DCC only), dofetalide, sotalol
What was the finding of the AFIRM trial?
No difference was found in mortality in rate vs. rhythm control
When is pharmacological converse to NSR most effective? What medications are used?
Most effective within the first 7 days of arrhythmia
Drugs: flecainide, propafenone, dofetalide, amiodarone, ibutilide
What three meds are are rhythm control in a pt w/o heart disease or HTN and without LVH
Flecainide
Propafenone
Sotalol
What 2 meds are for rhythm control in a pt who has CHF?
Amiodarone
Dofetalide
What 3 medications are for rhythm control in pts who have CAD?
Dofetilide
Sotalol
Dronedarone
What medication is for rhythm control in a pt who have HTN with LVH?
Amiodarone
What is the rate, rhythm, causes, and treatment of junctional tachycardia?
Rate: normal (but AV node is slow)
Rhythm: normal
Causes: digitalis toxicity, hypokalemia, MI
Treatment: correct underlying cause
What is the rate, rhythm, causes, symptoms of premature ventricular contractions?
Rate: regular
Rhythm: abnormal, occasional contraction w/o P wave
Causes: usually post-MI
Symptoms: asymptomatic, mild palpitations
What is the treatment of premature ventricular contractions? What should not be used?
Asymptomatic: no treatment Symptomatic: beta blockers - slow down the extra contraction Do not use class 1c if post-MI
What is the rate, rhythm, causes, symptoms of ventricular tachycardia?
Rate: fast, > 3 PVCs in a row
Rhythm: normal or abnormal
Causes: hypokalemia, hypoxia, digitoxin toxicity
Symptoms: asymptomatic, palpitations, pulmonary edema, pulseless
What is the treatment for ventricular tachycardia?
Depends on if the pt has a pulse or not
Pulse - use adult tachycardia algorithm
Pulseless - use vfib/pulseless Vtach ACLS algorithm
What is the rate, rhythm, causes, and treatment of Torsades de Pointes (TdP)?
Rate: fast
Rhythm: irregular
Causes: multiple QTc prolonging meds
Treatment: Magnesium 1-2g IV over 10 mins
What are meds that prolong QTc?
Class 1a and III AAD, chlorpromazine, fluroquinolones, macrolides, fluconazole, haloperidol, tricyclic antidepressants, SSRI, methadone
What is the rate, rhythm, symptoms and treatment of ventricular fibrillation?
Rate: rapid, >300bpm
Rhythm: highly irregular
Symptoms: pulseless, unconscious, unresponsive
Treatment: vfib ACLS algorithm; long term: implantable cardioverter defibrillator
What are the steps of vfib/pulseless Vtach ACLS algorithm?
- Begin CPR (30compressions + 2 breaths)
- Defibrillate (shock)
- Recheck rhythm/shock again
- Epi 1mg (every 3-5 min)
- 2 min CPR, shock
- Antiarrhythmic - 300mg Amiodarone, then 150 mg
- Repeat steps 3-6
What are 3 features of an implantable cardioverter defibrillator?
Decreases sudden cardiac death risk
Delivers an electrical shock to covert to NSR
May be used when waiting for heart transplant
What is the rate, rhythm, causes, and symptoms of sinus bradycardia?
Rate: slow
What is the treatment for symptomatic sinus bradycardia?
Atropine 0.5mg or pacemaker implant
What causes AV node blocks and what treats them?
Causes: MI, CV surgery, congenital heart disease
Treatment: beta blockers, non-DHP CCBs, digoxin
What if first degree AV node block? What’s the treatment?
P, QRS and T are present at each beat, but PR interval is >200ms
Treatment: treat underlying cause, adenosine 0.5 mg q3-5 min (max 3mg)
What is mobitz I second degree AV node block? What’s the treatment?
Progressively lengthening PR interval until QRS is dropped
Treatment: atropine 0.5mg q3-5min (max 3mg), permanent pacemaker if symptoms
What is mobitz II second degree AV node block? What’s the treatment?
Prolong PR interval with random QRS complexes missing
Treatment: ACLS algorithm, transcutaneous pacing if symptoms, if chronic permanent pacemaker needed
What is third degree AV node block? What is the treatment?
Complete heart block, no link between P wave and QRS complex
Treatment: d/c ADD meds, transcutaneous pacing, permanent pacemaker
What is pulseless electrical activity (PEA)? What is the treatment?
No pulse felt, but P, QRS and T waves present. Heart still has electrical activity, but no mechanical activity.
Treatment: adult cardiac arrest ACLS algorithm, CPR
What is asystole? What is the treatment?
No pulse or electrical activity
Treatment: adult cardiac arrest ACLS algorithm, CPR (very low likelihood pt will come out of asystole)
What are the steps of ACLS algorithm for PEA/asystole?
- 2 minutes CPR (30 compressions + 2 breaths)
- Assess for shockable rhythm (yes, treat. No, continue CPR)
- If not shockable - epi 1mg q3-5 min. At this point atropine and shocking are no longer reccomended
- Continue CPR and epi for X amount of time
What is the rate, rhythm, symptoms, causes and treatment of sinus tachycardia?
Rhythm is normal Rate is fast, > 100bmp Symptoms: asymptomatic, fatigue Causes: caffeine, hyperthyroidism, hypotension Treatment: treat underlying cause
