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Cardio Module > 10. Petersen - Arrhythmia Identification > Flashcards

10. Petersen - Arrhythmia Identification Flashcards

1
Q

What is the rate, rhythm, symptoms, and treatment for premature atrial contraction?

A

Rate: normal
Rhythm: abnormal, atrial contractions occur prematurely
Symptoms: asymptomatic
Treatment: none required, minimal risk

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2
Q

What is the rate, rhythm, causes, symptoms and treatment of Supraventricular Tachycardia (SVT)?

A

Rate: fast, 150-250bpm
Rhythm: regular
Causes: reentry pathway
Symptoms: angina, dyspnea, fatigue, palpitations, CHF
Treatment: if unstable, Direct cardio version

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3
Q

What is the treatment goal of Supraventricular tachycardia (STV)?

A

Protect the ventricles!

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4
Q

What is the treatment for stable and unstable SVT?

A

Stable: carotid massage, vagal maneuver
Unstable: direct cardio version, 50-100 joules

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5
Q

What is the rate, rhythm, causes, symptoms of Wolff-Parkinson-White (WPW) syndrome?

A

Rate: variable
Rhythm: variable
Causes: accessory pathway, the bundle of Kent which passes AV node stimulation
Symptoms: chest pain, vertigo, syncope, SOB

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6
Q

What is the treatment for WPW syndrome?

A

Cure: catheter ablation
Chronic treatment: adenosine (normal QRS)
- PO class III –> increase AP refractory phase
- Class 1a and Ic –> decrease AP conduction

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7
Q

What should not be used in the treatment of WPW syndrome and why?

A

Beta blockers, Non-DHP CCBs, digoxin (if Afib)

  • decreases AV node conductions
  • increases accessory pathway conduction
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8
Q

What is the unique wave seen on an EKG from WPW syndrome?

A

Delta wave, at the start of QRS

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9
Q

What is the rate, rhythm, causes, symptoms of Afib/ Atrial flutter?

A

Rate: very fast, 400-600bpm
Rhythm: irregularly
Causes: 1) Afib - multiple reentry pathways 2) A flutter - single reentry loop
Symptoms: asymptomatic, SOB/DOE, palpitations

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10
Q

What are the treatment goals of Afib/A flutter?

A

Rate control, rhythm control, prevent thromboembolism, symptom management

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11
Q

When should rate control be used in Afib/A flutter pts?

A

All pts, maintaining a HR

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12
Q

When should rhythm control be used in Afib/A flutter pts?

A

Most effective in younger pts, maintains NSR, for symptomatic/unstable pts, but no morbidity/mortality advantage over rate control

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13
Q

What are the rate controlling meds in Afib?

A

LVEF 40%: beta blockers, non-DHP CCBs, digoxin to decrease HR

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14
Q

What are the rhythm control meds in Afib?

A

Direct Current Cardioversion (DCC)
Class 1c AAD: flecainide, propafenone
Class III AAD: Amiodarone, ibutilide (DCC only), dofetalide, sotalol

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15
Q

What was the finding of the AFIRM trial?

A

No difference was found in mortality in rate vs. rhythm control

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16
Q

When is pharmacological converse to NSR most effective? What medications are used?

A

Most effective within the first 7 days of arrhythmia

Drugs: flecainide, propafenone, dofetalide, amiodarone, ibutilide

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17
Q

What three meds are are rhythm control in a pt w/o heart disease or HTN and without LVH

A

Flecainide
Propafenone
Sotalol

18
Q

What 2 meds are for rhythm control in a pt who has CHF?

A

Amiodarone

Dofetalide

19
Q

What 3 medications are for rhythm control in pts who have CAD?

A

Dofetilide
Sotalol
Dronedarone

20
Q

What medication is for rhythm control in a pt who have HTN with LVH?

A

Amiodarone

21
Q

What is the rate, rhythm, causes, and treatment of junctional tachycardia?

A

Rate: normal (but AV node is slow)
Rhythm: normal
Causes: digitalis toxicity, hypokalemia, MI
Treatment: correct underlying cause

22
Q

What is the rate, rhythm, causes, symptoms of premature ventricular contractions?

A

Rate: regular
Rhythm: abnormal, occasional contraction w/o P wave
Causes: usually post-MI
Symptoms: asymptomatic, mild palpitations

23
Q

What is the treatment of premature ventricular contractions? What should not be used?

A 
Asymptomatic: no treatment 
Symptomatic: beta blockers - slow down the extra contraction
Do not use class 1c if post-MI
24
Q

What is the rate, rhythm, causes, symptoms of ventricular tachycardia?

A

Rate: fast, > 3 PVCs in a row
Rhythm: normal or abnormal
Causes: hypokalemia, hypoxia, digitoxin toxicity
Symptoms: asymptomatic, palpitations, pulmonary edema, pulseless

25
Q

What is the treatment for ventricular tachycardia?

A

Depends on if the pt has a pulse or not
Pulse - use adult tachycardia algorithm
Pulseless - use vfib/pulseless Vtach ACLS algorithm

26
Q

What is the rate, rhythm, causes, and treatment of Torsades de Pointes (TdP)?

A

Rate: fast
Rhythm: irregular
Causes: multiple QTc prolonging meds
Treatment: Magnesium 1-2g IV over 10 mins

27
Q

What are meds that prolong QTc?

A

Class 1a and III AAD, chlorpromazine, fluroquinolones, macrolides, fluconazole, haloperidol, tricyclic antidepressants, SSRI, methadone

28
Q

What is the rate, rhythm, symptoms and treatment of ventricular fibrillation?

A

Rate: rapid, >300bpm
Rhythm: highly irregular
Symptoms: pulseless, unconscious, unresponsive
Treatment: vfib ACLS algorithm; long term: implantable cardioverter defibrillator

29
Q

What are the steps of vfib/pulseless Vtach ACLS algorithm?

A
  1. Begin CPR (30compressions + 2 breaths)
  2. Defibrillate (shock)
  3. Recheck rhythm/shock again
  4. Epi 1mg (every 3-5 min)
  5. 2 min CPR, shock
  6. Antiarrhythmic - 300mg Amiodarone, then 150 mg
  7. Repeat steps 3-6
30
Q

What are 3 features of an implantable cardioverter defibrillator?

A

Decreases sudden cardiac death risk
Delivers an electrical shock to covert to NSR
May be used when waiting for heart transplant

31
Q

What is the rate, rhythm, causes, and symptoms of sinus bradycardia?

A

Rate: slow

32
Q

What is the treatment for symptomatic sinus bradycardia?

A

Atropine 0.5mg or pacemaker implant

33
Q

What causes AV node blocks and what treats them?

A

Causes: MI, CV surgery, congenital heart disease
Treatment: beta blockers, non-DHP CCBs, digoxin

34
Q

What if first degree AV node block? What’s the treatment?

A

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)

35
Q

What is mobitz I second degree AV node block? What’s the treatment?

A

Progressively lengthening PR interval until QRS is dropped

Treatment: atropine 0.5mg q3-5min (max 3mg), permanent pacemaker if symptoms

36
Q

What is mobitz II second degree AV node block? What’s the treatment?

A

Prolong PR interval with random QRS complexes missing

Treatment: ACLS algorithm, transcutaneous pacing if symptoms, if chronic permanent pacemaker needed

37
Q

What is third degree AV node block? What is the treatment?

A

Complete heart block, no link between P wave and QRS complex

Treatment: d/c ADD meds, transcutaneous pacing, permanent pacemaker

38
Q

What is pulseless electrical activity (PEA)? What is the treatment?

A

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

39
Q

What is asystole? What is the treatment?

A

No pulse or electrical activity

Treatment: adult cardiac arrest ACLS algorithm, CPR (very low likelihood pt will come out of asystole)

40
Q

What are the steps of ACLS algorithm for PEA/asystole?

A
  1. 2 minutes CPR (30 compressions + 2 breaths)
  2. Assess for shockable rhythm (yes, treat. No, continue CPR)
  3. If not shockable - epi 1mg q3-5 min. At this point atropine and shocking are no longer reccomended
  4. Continue CPR and epi for X amount of time
41
Q

What is the rate, rhythm, symptoms, causes and treatment of sinus tachycardia?

A 
Rhythm is normal
Rate is fast, > 100bmp
Symptoms: asymptomatic, fatigue
Causes: caffeine, hyperthyroidism, hypotension
Treatment: treat underlying cause

Cardio Module (12 decks)

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