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MS2 Unit 4 Pharm > Antiarrhythmics I > Flashcards

Antiarrhythmics I Flashcards

1
Q

what are the PQRST waves in an ECG?

A 
P: atrial activation
Q: his, BB, septum activation
R: ventricular (left) activation
S: late ventricular (right) activation
T: ventricular repolarization
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2
Q

what is a U wave?

A

purkinje repolarization. caused by ypokalemia. hyperkalemia will shorten the QT interval and sharpen the T wave

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3
Q

what is a J wave?

A

occurs during ST segment. Caused by hypothermia and hypocalcemia (decreases QT interval). Hypercalcemia will Increase QT interval.

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4
Q

what causes ST segment elevation?

A

caused by transmural infarct or coronary vasospasm. (prinzmetal angina)

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5
Q

what causes ST segment depression?

A

subendocardial ischemia (exertional/stable angina)

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6
Q

enhanced normal automaticity

A

increased If, reduced Ik1, cytosolic Ca overload

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7
Q

triggered activity aka abnormal automaticity

A

can be an EAD or DAD (early afterdepolarizations, or delayed afterdepolarizations).

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8
Q

EADs

A

develop during phases 2-3. Decreased K currents in Phase 3. Increased late sodium current, increased Ica currrent in phase 2

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9
Q

DADs

A

develop during phase 4 (resting, diastole). Decreased K current. Increased diastolic Na and Ca influx.

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10
Q

prerequisite conditions for Reentry (re-excitation)

A

unidirectional block. slow conduction. Conduction time > refractory period.

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11
Q

where does reentry prefer?

A

tissue heterogeneity. gap junction coupling. fibrosis. extrasystoles.

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12
Q

major determinants of conduction velocity

A

cardiac sodium current. length constant. fibrosis. cell size. cell membrane capacitance

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13
Q

bradycardia

A

abnormally slow heart rate. may be caused by depressed impulse formation, impaired impulse conduction, excessive vagal tone, hyperkalemia, hypothyroidism, medications.

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14
Q

sick sinus syndrome

A

disease of the SA node. occurs in elderly people. sometimes due to occulsion of the SA artery. may be caused by meds. may require pacemaker.

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15
Q

1st degree atrio-ventricular block

A

prolonged PR interval. 1:1 P wave:QRS complex association

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16
Q

2nd degree AV block

A

not every P wave is followed by a QRS complex. Mobitz type I: PR interval progressively prolongs until a beat is dropped. Mobitz type II: PR interval is constant. (need pacemaker)

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17
Q

3rd degree AV block

A

complete AV block. no consistent PR interval, ventricular pacemaker evident. Need pacemaker to live.

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18
Q

mechanisms for tachycardia

A

accelerated automaticity. triggered activity. abnormal conduction. action potential inhomogeneity. Abnormal conduction structures. accessory pathways. dual AV node pathways.

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19
Q

P wave, PR interval, and onset/termination in sinus tachycardia

A

P wave normal. PR interval normal or prolonged. Onset/termination gradual.

20
Q

P wave, PR interval, and onset/termination in atrial tachycardia

A

P wave abnormal. PR interval normal or prolonged. Onset/termination paroxysmal.

21
Q

P wave, PR interval, and onset/termination in junctional tachycardia

A

P wave retrograde. PR interval short or absent. Onset and termination paroxysmal.

22
Q

AV node reentry mechanism

A

dual AV node conduction pathways. 2/3 of all SVTs.

23
Q

Bypass tract reentry mechanism

A

AVN and bypass tract reentry. 1/5 of all SVTs.

24
Q

automatic atrial tachycardia

A

non-paroxysmal, ectopic foci. may precede flutter or fibrillation.

25
Q

automatic AV junctional tachycardia

A

non-paroxysmal, ectopic foci (usually His bundle). variable rate. no or retrograde P waves, short PR interval. vagal stimulation, adenosine will slow the rate. commonly caused by cardiac glycoside toxicity.

26
Q

tachycardia

A

abnormally rapid heart rate. caused by excessive sympathetic tone, pheochromocytoma, sinus node reentry, hypotension, anemia, sepsis, shock, hyperthyroidism, anxiety, fever, stimulants, cardiac ischemia, heart failure, PE or COPD. treat with carotid massage, beta blockers, AVN blocking agents, catheter ablation, ivabradine

27
Q

reentrant supraventricular tachycardias

A 
sinus node reentry (paroxysmal, terminate with electrical stimulus)
atrial reentry (paroxysmal, extrasystole trigger)
AV node reentry (dual conduction pathways, paroxysmal, extrasystole trigger, depends on Ica)
28
Q

wolff-parkinson-white syndrome

A

fast AV accessory pathway. typically atrial origin, bundle of kent. initiated by extrasystole or ventricular pre-excitation. short PR interval. d-wave, wide QRS. not responsive to vagal tone. AVN blockers contraindicated. higher risk for sudden death. treat with cardioversion or ablation

29
Q

monomorphic and polymorphic ventricular tachycardias

A

mono are uniform, life threatening, treat with antiarrhythmic drugs.
polymorphic are nonuniform, life threatening, treat with antiarrhythmics

30
Q

torsades de pointes

A

polymorphic, long QT syndrome. can be congenital, acquired, drug induced. EADs.

31
Q

LQT1, 2, and 3

A

1: tirggered by exercise or emotion. treat with beta blockers.
2: triggered by sleep, auditory stimulation, post partum. treated by K therapy or ICD.
3: triggered by rest, sleep, bradycardia. beta blockers less effective. ICD. need to block late Na window current

32
Q

catecholamine induced PVT

A

polymorphic. DAD mechanism. deficient Ca cycling. Exercise induced. Treat with beta blockers, CID, sympathectomy.

33
Q

atrial flutter

A

rapid atrial rate. normal QRS, AV dissociation. sawtooth pattern (f wave). vagal stimulation needed. CCBs not effective. no ventricular transmission, no danger.

34
Q

atrial fibrillation

A

irregular F waves, QRS complexes, and RR interval. if cannot terminate, need to maintain ventricular rate control. leading cause of stroke. need anticoagulants, rate control, and anti-arrhythmics for rest of life.

35
Q

ventricular flutter

A

lethal if not terminated. regular, rapid reentrant rhythm. no QRS or T wave. cardioversion required, ICD. antiarrhythmic drugs may make it worse

36
Q

ventricular fibrillation

A

same as ventricular flutter except irregular, rapid rhythm.

37
Q

atrial extrasystole

A

early occurrence of a P wave. followed by a normal QRS or not (block)

38
Q

junctional extrasystole

A

early, inverted, or no P wave. normal QRS. AVN, His origin

39
Q

ventricular extrasystole

A

distal to His bundle. abnormal, prolonged QRS. compensatory pause may occur.

40
Q

RBBB ecg pattern

A

broad QRS > 120ms

41
Q

LBBB ecg pattern

A

broad QRS > 120ms, left axis deviation

42
Q

ecg pattern in LAFB or LPFB

A

LAFB: QRS 80-110ms. Left axis deviation. Small Q waves with tall R waves in leads I and aVL. small R waves with deep S waves in II, III, and aVF.

LPFB: QRS 80-110ms. Right axis deviation. Small R waves with deep S waves in I and aVL. Small Q waves with tall R waves in leads II, III, and aVF

43
Q

parasystole

A

slow automatic ventricular rhythm, ectopic ventricular pacemaker origin. abnormal QRS

44
Q

bigeminy, trigeminy

A

PVC after every sinus beat, PVC after every 2nd sinus beat

45
Q

overdrive suppression

A

rapid stimulation suppression of normal pacemaker activity

MS2 Unit 4 Pharm (9 decks)

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