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CABS2: Cardiology > Arrhythmias > Flashcards

Arrhythmias Flashcards

1
Q

What are arrhythmias and the problems with them

A

abnormal rhythm of the heart
rate: too fast, too slow (out of normal 60-100bpm)
rhythm: how regular is the heart beat
origin

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2
Q

what are the types of arrhythmias

A

Supraventricular (atrial origin, AV junction)
Ventricular

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3
Q

What is premature atrial contraction

A

PACs
supra-ventricular premature beats
not from the SA node
may originate within other areas of the atria or the AV node
more common in pts with mitral valve pathology or ventricular pathology

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4
Q

what are the causes of PACs

A

idiopathic
Toxins (smoking, ETOH, coffee)
ACS
COPD
Atrial myopathy (changes associated with aging process)

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5
Q

What are premature ventricular contractions

A

premature ventricular beats
abnormal beat coming from ventricular myocardium
leads to premature depolarization of the ventricles

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6
Q

what are the causes of PVCs

A

reentry associated with cardiac scaring
abnormal automaticity (electrolyte abnormality, ischemia, catecholamine surge)
other unique trigger

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7
Q

what are the subtypes of PVCs

A

Bigeminy (2)
Trigeminy (3)
quadrigiminy (4)
all regularly irregular

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8
Q

how can PVCs be classified

A

based on:
morphology
Frequency
symptomatic vs asymptomatic
exertional or not
if underlying cause can be identified

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9
Q

what is a block

A

delay in conduction along the ventricular pathway

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10
Q

what is first degree AV block

A

delay in transmission from atria to ventricles
PR interval prolonged >200ms

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11
Q

what is the causes of first degree AV block

A

increased vagal tone
fibrosis/scaring
idiopathic
familial disease (associated with prolonged QT syndrome)

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12
Q

what is the clinical presentation of first degree AV block

A

asymptomatic

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13
Q

what is second degree AV block

A

intermittent AV conduction
typically in a regular pattern
Mobitz type 1 (Wenckebach)
Mobitz type 2

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14
Q

what is Mobitz type 1

A

Wenckebach: Second degree AV block
progressive prolongation until beat drop
first PR segment normal

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15
Q

what is Mobitz type 2

A

second degree AV block
PR is maintained but will occasionally wont conduct through the ventricles
more dangerous than Wenckebach

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16
Q

What can cause second degree AV block

A

MI involving/near the conduction system
cardiomyopathy
myocarditis
endocarditis (abscess)
iatrogenic: medication that are AV nodal blocking

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17
Q

what is third degree AV block

A

complete heart block, no atrial impulses reach the ventricle
atria and ventricles are not communicating, firing in silos
the ventricular rhythm will maintain cardiac circulation - typically < 45bpm

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18
Q

what are the causes of third degree AV block

A

myocardial ischemia
cardiomyopathy
myocarditis
iatrogenic
lyme disease

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19
Q

what is the clinical presentation of 3rd degree AV block

A

lightheadedness
palpitations
syncope
weakness
fatigue
chest pain

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20
Q

what are bundle branch blocks

A

disruption of electrical conduction down one of the bundle branches coming off the bundle of His

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21
Q

what is Right BBB

A

branching off the bundle of His, RBB made up of fast response Purkinje fibers
blood supply from RCA
associated with:
increased right ventricular hypertrophy
increase ventricular pressure (PE)
Mi, infraction
inflammation
iatrogenic

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22
Q

what is Left BBB

A

branching off of the bundle of His, LBB made up of fast response Purkinje fibers
blood supply from RCA
pathophysiology endocarditis (abscess), post surgical changes

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23
Q

what is “bunny ears” on EKG indicative of

A

Right Bundle Branch Block

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24
Q

what is the presentation of LBBB

A

results in slower QRS complex (wide)

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25
Q

what is sinus tachycardia

A

the most common tachycardia
narrow, regular tachy >100bpm
reactive rhythm associated with increased sympathetic tone
BENIGN DYSRHYTHMIA - NORMAL RESPONSE

26
Q

what are the causes of sinus tachycardia

A

increased automaticity: increased SA node firing for physiologic reasons
-increased sympathetic tone (catecholamines)
- associated with: hypovolemia, hypoxia, meds, pain/anxiety, increased metabolic demand
increased triggering: problem with the myocardium
-meds
-ischemic area
- cardiomyopathy

27
Q

what is the treatment for sinus tachycardia

A

Treat the underlying condition! (i.e. lower anxiety)

28
Q

what is PSVT

A

Paroxysmal supraventricular tachycardia AKA SVT
sustained reentry loop within the AV node - may be associated with ectopic atrial source
tachy, regular, narrow QRS complexes
P waves typically not visualized

29
Q

who is PSVT/SVT most common in

A

women, early 20s and no CV disease

30
Q

what is the average HR for SVT

A

150-250 bpm

31
Q

What is afib

A

irregularly irregular rhythm with narrow QRS complex
due to multiple areas of automaticity that are desynchronized within the atria - SA node is not in control

32
Q

what is RVR

A

rapid ventricular response

33
Q

what is afib with RVR

A

tachyarhythmia; rapid heart rate

34
Q

what are the causes of afib

A

typically a secondary disease process
ischemic heart disease
valvular heart disease
congestive cardiomyopathy
HTN
myocardidits
holiday heart
thyrotoxicosis
blunt chest trauma
genetic link
in younger pts, associated with ANS (exercise induce- sympathetic, parasympathetic source)

35
Q

what is paroxysmal afib

A

lasts less then 7 days with spontaneous conversion

36
Q

what is persistent afib

A

over 7 days or needs cardioversion

37
Q

what is seen on ECG with afib

A

no clear P wave or isoelectic baseline
QRS narrow
irregularly irregular QRS complexes
seen best in V1

38
Q

what are the different types of afib

A

paroxysmal
persistent
permanent

39
Q

what is Atrial flutter

A

atrial tachycardia with single reentrant circuit
fixed degree of AV conduction resulting in a regular rhythm
atrial rate typically 250-250 bpm
regular ventricular rate 150bpm

40
Q

what is a sawtooth on ECG

A

pathopneumonic for atrial flutter

41
Q

what are the ECG findings for atrial flutter

A

regular rate
narrow QRS
Single morphology P waves in sawtooth pattern
typically tachycardic rhythm around 150bpm

42
Q

what is the most common wide complex regular tachycardia

A

ventricular tachycardia (VTAC)
impulse originates in the myocardium of the ventricles
sustained or nonsustained

43
Q

what is vtac usually associated wtih

A

underlying etiology that causes pathologic myocardium
reentrant circuit associated with scar formation(often associated with previous MI)
Young people: myocarditis, hypertrophic cardiomyopathy, long QT, congenital causes, drugs

44
Q

what causes Vtac

A

channelopathies
cardiomyopathy
myocarditis
substance use
CAD
valvular disease

45
Q

what is the number one cause of VTAC

A

QT PROLONGATION

46
Q

what are the symptoms of VTAC

A

may range from asymptomatic to sudden cardiac death
anxiety, feelings of fluttering in chest, dizziness, pain or pressures in chest, heart palpitations, fatigue, SOB, fainting

47
Q

what is the presentation of VTAC on ECG

A

wide complex >120ms
HR >100bpm
consecutive beats uniform
lasts > 30 seconds

48
Q

What is Torsades de points

A

polymorphic VTAC
associated with electrolyte abnormality
leads to prolonged QT
increased automaticity

49
Q

what electrolyte is associated with torsades de points

A

magnesium*

50
Q

What is vfib

A

chaotic depolarization of the ventricular myocardium
no true mechanical activation
no cardiac output

51
Q

what is Vfib most commonly associated with

A

ischemic disease
may be acute or chronic - occurs suddenly, without warning
secondary disease cause more of a long progressive of LV failure

52
Q

what needs to be assessed with any concern of Vfib

A

check a pulse

53
Q

what is seen on ECG with Ventricular fib

A

may be course or fine
no P waves, defined WRS, T waves
unable to determine real rate

54
Q

what happens with bradyarrhythmias

A

may be associated with decreased automaticity
vagus nerve stimulation via parasympathetic NS decreasing HR
Decreases conduction of the SA node

55
Q

what causes sinus bradycardia

A

increased vagal tone (parasympathetic)
Medications that slow AV conduction: BB, CCB, digoxin
Metabolic changes (hypothermia, hypothyroidism)
Electrolyte abnormality (potassium)
Brain herniation

56
Q

What is sick sinus dysfunction

A

also called tachybrady syndrome
dysfunction with the SA node
- often associated with aging process
- dose not generate impulse to keep up with the demand

57
Q

what may be seen with sick sinus dysfunction

A

bradycardia
pause
arrest
inadequate HR based on physiologic demands

58
Q

what is the pathophysiology of Sick sinus dysfunction

A

fibrosis of the SA node
medications
familial disease - cardiac sodium channel SCN5A, HCN4

59
Q

what is the treatment of sick sinus syndrome

A

exercise intolerance
fatigue
dizziness
HA
Nausea
palpitations
Chest pain
SOB

60
Q

what is the treatment of sick sinus syndrome

A

observation
possible need for artificial pacemaker
medications: atropine, warfarin

CABS2: Cardiology (11 decks)

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