A: CARDIAC ARRHYTHMIA Flashcards by Rashia Micawayan

Deviation from the normal heartbeat pattern

Cardiac Arrhythmia

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Cardiac Arrhythmia includes abnormalities of

Impulse formation
Heart rate
Rhythm
Site of impulse origin
Conduction disturbances
These disrupts the normal sequence of atrial and ventricular activation

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This refers to a slow heartbeat

Bradyarrhythmia

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A resting heart rate below 60 beats per minute

Bradycardia

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This refers to a fast heartbeat

Tachyarrhythmia

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A resting heart rate greater than 100 beats a minute

Tachycardia

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A transient voltage change (membrane potential) across the membranes of the heart

Myocardial Action Potential

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Myocardial Action Potential Phases

a.)Phase 0 (rapid depolarization)
b.) Phase 1 (early rapid depolarization)
c.) Phase 2 ( Plateau)
d.) Phase 3 (final rapid repolarization)
e.) Phase 4 (Slow depolarization)

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Two electrical sequences that cause heart chambers to fill with blood and contract are initiated by __ of the heart

Conduction System

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1st sequence, takes place when an electrical impulse is generated automatically

Impulse Formation

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2nd sequence, occurs once the impulse has been generated, signaling the heart to contract

Impulse Transmission

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It serves as the heart’s natural pacemaker, regulating the heartbeat by generating electrical impulses that coordinate the heart’s contractions

Sinoatrial Node

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Sinoatrial Node is initiated in

60-100 BPM (Beats Per Minute)

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Impulses are delayed briefly to permit completion of atrial contraction

Atrioventricular Node

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Atrioventricular Node

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Transmission of impulses along left to right

Bundle of His

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Composed of bundle of his and Purkinje fibers

Latent Pacemakers

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They contain cells capable of generating impulses

Latent Pacemakers

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Depolarization

P Wave

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Represents the spread of impulse from atria to the Purkinje fibers

PR Interval

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Ventricular Depolarization

QRS Complex

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Represents phase 2

ST Segment

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Ventricular Repolarization

T Wave

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An irregularly fast or erratic heartbeat (arrhythmia) that affects the heart’s upper chambers

Supraventricular Arrhythmias

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From enhances automaticity of the SA node or another pacemaker region

Supraventricular Arrhythmias

Occurs below bundle of his, when a ectopic (abnormal) pacemaker triggers a ventricular contraction

Ventricular Arrhythmias

What is the French word for twisting of points

Torsades de pointes

Prolonged QT interval

Torsades de pointes

Precipitating Causes

*Heart Disease *Myocardial Infarction *Systemic Hypertension *Hyperkalemia/Hypokalemia *COPD *Thyroid Disorders *Drug Therapy *Toxic Doses of Cardioactive Drugs *Increase Sympathetic Tone *Decrease Parasympathetic Tone *Vagal Stimulation *Increase Oxygen *Metabolic Disturbances *Cor Pulmonale

COPD stands for

Chronic Obstructive Pulmonary Disease

COPD compose of

Emphysema and Bronchitis

escape beats and bradycardia

Depressed Automaticity

Premature beats, tachycardia and extrasystole

Increased Automaticity

The only LAB test that can definitely identify arrhythmia

Electrocardiogram (ECG)

Determines the location of the ectopic foci

Electrophysiological Testing

Can locate reentry of heart block or reentry pattern

His bundle study

Electrolytes Laboratory Findings

a.) serum potassium: >5meg/L b.) serum calcium : >4.5meq/L c.) serum magnesium: <2.5 meq/L

Moderate depression on conduction, prolongation of repolarization, which results in an increase in the QRS interval and an increase in the QT interval

Class 1A

Class 1A interfere with

Sodium Channel Ion

Drugs of Class 1A

Disopyramide Procainamide Quinidine

Suppression and prevention of atrial and premature ventricular complexes

Disopyramide

Frequently given than quinidine because it can be administered in IV and in Sustained release oral preparation

Procainamide

Conversion & prevention of of relapse into atrial fibrillation and/or flutter and the suppression of ventricular arrhythmia

Quinidine

Modest depression of conduction, shortening of repolarization, which results in a decrease in the QT interval

Class 1B

Class 1B interfere with

Sodium Channel Ion

Class 1C interfere with

Sodium Channel Ion

Drugs of Class 1B

Lidocaine Mexiletine Phenytoin

Used therapeutically for ventricular arrhythmia that result from acute MI and open - heart surgery

Lidocaine

Reduced first pass liver metabolism, oral dose available

Mexiletine

Used in patients with severe ventricular arrhythmias

Mexiletine

Treatment for digitalis induced ventricular arrhythmias

Phenytoin

Strong depression of conduction w/ mild or no effect on repolarization which results in a very large increase in the QRS interval

Class 1C

Drugs of Class 1C

Flecainide Propafenone

Treatment for life threatening ventricular arrhythmias

Flecainide Propafenone

Slow sinus as well as AV nodal conduction, which results in decrease in heart rate and prolongation in the PR interval (atrial depolarization)

Class 2: Beta Blocker

Drugs of Class 2: Beta Blocker

Propranolol Esmolol Acebutolol

Control supraventricular arrhythmias

Propranolol

Suppress severe ventricular arrhythmias in prolonged QT interval

Propranolol

Treatment for digitalis induced

Propranolol

Shortest t1/2

Esmolol

Given to patients with atrial fibrillation

Acebutolol

Prolongation of repolarization, which results to prolongation of QT interval

Class 3 Inh. (-) Potassium

Class 3 inhibits

(-) Potassium

Drugs of Class 3 Inh. (-) Potassium

Amiodarone Sotalol Ibutilide Dofetilide

Given to malignant ventricular arrhythmias

Amiodarone

Treatment for supraventricular and ventricular tachyarrhythmias

Sotalol

Used in the conversion of atrial fibrillation

Ibutilide

Restricted access in USA in the treatment of atrial fibrillation

Dofetilide

Calcium channel blockade in calcium-dependent channels, which result in reduced heart rate and an increase in the PR interval

Class 4: Calcium Channel Blockers

Treatment for supraventricular arrhythmias

Verapamil

First line agents for the suppression of PSVT (Paroxysmal Supraventricular Tachycardia) stemming

Diltiazem

Drugs of Class 4: Calcium Channel Blockers

Verapamil Diltiazem

Blocks vagal effects on SA node

Atropine

Indication of Atropine

Bradycardia and junctional rhythm

Slow conduction through the AV node

Adenosine

Indication of Adenosine

Acute supraventricular tachycardia

Interrupts reentry pathway through the AV node

Adenosine

Slowing the rate of Impulse formation in myocardium

Magnesium Sulfate

Restore normal sinus rhythm in patients with PSVT

Adenosine

Indication of Magnesium Sulfate

Treatment for Drug induced long QT syndrome

Positive inotropic effect

Digoxin

Indication of Digoxin

Stable, narrow complex regular tachycardia

MOA similar to amiodarone

Dronedarone

Indication of Dronedarone

Treatment for atrial fibrillation