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