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Rosen's Cardio > 69. Disryhthmias > Flashcards

69. Disryhthmias Flashcards

1
Q

3 ions in action potential

A

K
Na
Ca

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2
Q

artery perfusing SA node

A

55% RCA

45% LCA

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3
Q

rate of AV node

A

45-60

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4
Q

rate of infranodal pacer

A

30-45

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5
Q

3 fascicles and their supply

A

 RBB – LAD supply
 LASB – LAD supply
 LPIB – RCA or LCA

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6
Q

3 mech of dysrythmias

A

1, enhance automaticity

  1. trigger actitivty
  2. re-entry circuits
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7
Q

Class 1 ion

A

Na fast

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8
Q

Class 1A medication and use

A

Procainamide

  • Most common
  • Ventricular and supraventricular
  • Give until stop rhythm, hypoT or QRS widening
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9
Q

Class 1B medication and use

A
  • Less slowing than other class 1 agents
  • Shorten repolarization
    Lidocaine
  • Only one for emergency
  • Suppresses AV and SA node function
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10
Q

Class 1C medication and use

A
  • Profoundly slow depolarization
  • Can also be prodysrtyhmic
    Flacainaide
  • Paroxysmal SVT
  • Narrow therapeutic index
    Propafenone
  • Some B and Ca action
  • Caution with structural or ischemic heart disease
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11
Q

Class 2 mechanism

A
  • BB
  • Suppress SA node automaticity and slow conduction through AV node
  • Good for ventricular rate control
  • Can also terminate AV nodal reentrant tachys
  • More B1 are more cardio selective
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12
Q

Contraindication to BB

A

o Asthma or COPD
o Advanced CHF
o 3rd trimester
o Heart block beyond first degree

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13
Q

Class 3 mechanism

A
  • Prolong refractory period by blocking K

- Variable QT effects

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14
Q

examples of class 3

A

amio

sotalol

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15
Q

short and long term SE of amio

A 
Short term
o	Hypotension
o	Brady
o	Heart failure
Long term
- Irrevereisble lung and thyroid disease
- photosensitivy
- corneal deposits
- GI intolerance
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16
Q

Class 4 mechanism

A
  • Slow Ca channel blockers
  • Slow AV conduction and suppress SA node
  • All cause peripheral vasodilation
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17
Q

2 examples of class 4

A 
Diltiazem
-	Loading IV dose then infusion PRN
-	Oral dose to sustain the response
Verapamil
-	Rare to give
-	May cause hypotension
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18
Q

SEs of digoxin

A
  • GI intolerance
  • fatigue
  • color distubances
  • HA
  • psychosis
  • ## heart block
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19
Q

Best leads to see disrhytmias

A

V1 or inferior

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20
Q

aid to unmask dysryhtmias

A

vagal maneuvers

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21
Q

Vagal causes of sinus brasy

A

o Ischmia
o Hypoxia
o Cold
o Drugs

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22
Q

def sinus dysrhytmia

A
  • Conducted p waves with variable P-P interval
  • Normal variant
  • Common in kids and young adults
23
Q

Tx of sick sinus

A
  • Acute
    o Treat specific rhythm
    o Be wary of profound brady that may need pacing
  • Long term
24
Q

define 1st degree block

A
  • Prolonged conduction
  • Long PR
  • Can be normal
  • No Tx other than avoid nodal blocking agents
25
Q

2 types of 2nd degree block

A 
Type 1
o	Progressive impairment in AV node
o	Lengthen to block
o	Generally transient 
Type 2
o	Block below the AV node
o	Sporadic and periodic conduction
o	Usually narrow QRS, but can be wide
26
Q

def and Tx 3rd degree block

A
  • Complete
  • No conduction of atrial impulses
  • AV dissociation
  • Usually due to degeneration, acute ischemia, drugs
  • Any new or symptomatic should be admitted
27
Q

def extrasystoles

A
  • Ectopic atrial or vent focus
  • May or may not have contraction
  • Can occur in geminy
28
Q

def PACs

A
  • Common and usually no sig
  • Abnormal P wave in the ECG
  • Usually conducted
    o Changes PP interval;
  • Blocked PAC can cause non-compensatory pause
  • Can lead to SVT
29
Q

things that worsen PVCs

A

pain, catechoalmines, anxiety, stims

30
Q

ECG pattern of PVCs

A
  • Wide QRS without preceding P wave
  • Compensatory pause
  • LBBB appearance if from R ventricle
31
Q

Def atrial tachy

A
  • > 100BPM with non-sinus node site
  • Abnormal P waves
    Multifocal atrial tachy
    o 3 or more distinct P waves tyeps
    o Pulmonary disease in 60%
    o Can be due to primary cardiac patho
32
Q

Tx of atrial tachy

A

o Correct precipitating factors
o Lytes
o Drugs
o Hypoxemia

33
Q

3 types of Afib

A 
o	Paroxysmal
o	Persistent (requires conversion)
o	Permanent (no longer converting)
34
Q

usual afib rate

A
  • Ventricular rate rarely above 160—170

- > 200 usually mean another reentrant pathway

35
Q

Causes of afib

A
  • HTN
  • cardiomyopathy
  • ACS
  • valves
  • CHF
  • pericarditis
  • HyperT
  • sick sinus
  • contusion
  • EtOH
  • idiopathic
  • cardiac surgery
  • catechoamine excess
  • PE
  • accessory pathway
36
Q

MGMT stable afib

A 
Nodal blocking agent to reduce < 120
	BB or CCB
	Not for accessory pathway
Rhythm vs rate control
	Not great evidence for rhythm, often fails
If < 48 hours or anticoag can trial cardioversion
	Higher success with electrical
If chemical
•	Clas 1A, 1C, and 3 best
•	Procainamide and amio most common
37
Q

CHADS2VASC

A 
CHF
HTN
Age
DM
Stroke
Gender
Age
Valves
38
Q

Def. AVNRT

A
  • AKA paroxysmal SVT
  • Regular, narrow complex tachy with vent rate of 130 or more, usually more than 160
  • Reentry circuit in AV node
  • Abrupt onset
    o Usually during exercise or stress
39
Q

Tx SVT

A 
Tx
o	Vagal
o	Adenosine
o	If refractory: BB or CCB
Can rarely do electrical cardioversion
40
Q

Classic rentrant pathway

A

WPW

41
Q

3 ECG features of WPW

A

o Short PR < 0.12
o QRS > 0.1
o Slurred upstroke

42
Q

RFs for WPW

A 
cardiomyopathy
transpostion of great vessels
MV prolapse
tricuspid atresia
ebsteins
43
Q

2 types of re-entrant and their features

A 
-	Orthodromic
o	AV anterograde
o	Pathway retrograde
o	Narrow QRS and verntricular rate constrained
-	Antidromic
o	AV node retrograde
o	Pathway anterograde
o	Wide QRS and very rapid
44
Q

Tx of orthodromic

A

 Treat like AVRNT

 Vagal and adenosine

45
Q

Tx of antidromic

A

 Rates can be >200
 Nodal blocking agents contraindicated
 Procainamide is first line
 Electrocardioversion if at all unstable

46
Q

Brugada approach to differentiate VT from SVT with abberancy

A

If any yes - VT, if all no SVT

  1. Absence of RS in all precordial leads
  2. R to S interval > 100ms in one precordial
  3. AV dissociation
  4. Criteria for VT in both precordial leads V1-2 and V6
47
Q

Tx of SVT with abberancy

A
  • If unstable, cardiovert
  • If borderline, can trial procainamide or amio
  • Possible to use adenosine if careful search does not reveal VT
48
Q

Tx V tach

A 
o	Stable
	Trial amio
	Procainamide 2nd line
o	Unstable 
	Cardiovert
49
Q

3 criteria for torsades

A

o Vent rate> 200
o Undulating QRS
o Paroxysms < 90sec

50
Q

Tx of torsades

A

o Treat underlying causes
o MgSO4
o Cardiovert

51
Q

Acquired causes of long QT and torsades

A 
Drugs
- 1A and 1C anti-arrythmics
- haldol
- TCAs
- ABx
- antihistamines
- antiseizures
- antiemetics
Lytes
Diet - starvation
Severe brady
HypoTh
Contrast
CVA
MI
52
Q

ECG for brugada

A

o Downward coved or saddleback STE in V1-3

53
Q

Tx brugada

A

implantable defib

Rosen's Cardio (6 decks)

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