Arrhythmias Flashcards
Describe how you determine axis and the possible options?
- Look at Leads 1 and AVF
- Normal = Both positive
- Left Axis = Positive in 1 and Negative in AVF
- Right Axis = Negative in 1 and Positive in AVF
Normal axis deviation degrees
-30 – +90
Left axis deviation degrees
-30 – -90
Right axis deviation degrees
+90 – +180
For a LBBB, what is the pneumonic and what will you see in leads V1 and V6?
WiLLiaM
V1 = W pattern
V6 = M pattern
For a RBBB, what is the pneumonic and what will you see in leads V1 and V6?
MaRRoW
V1 = M pattern
V6 = W pattern
– “bunny ears” –
What are 2 physiology items that cause HF with REDUCED EF? (systolic dysfunction)
Decreased LV contractility
Increased afterload
What physiology item can cause HF with PRESERVED EF? (diastolic dysfunction)?
Impaired diastolic relaxation = decreased compliance
What condition often causes HF with Preserved EF?
HTN that results in LV hypertrophy
What is the treatment for an acute HF exacerbation?
LMNOP
- Lasix
- Morphine
- Nitrates
- O2
- Position
What are things used to treat chronic HF? (5)
- Diuretics
- Beta blockers
- ACEi/ARB
- Spironolactone
- Digoxin for symptoms
What are things used to treat chronic HF? (5)?
- Diuretics
- Beta blocker
- ACEi/ARB
- Spironolactone
- Digoxin for symptoms
What drug can actually cause an AV block arrhythmia?
Digoxin
1st degree AV block
PR interval is prolonged (>1 big box/200msec)
PR interval is > 200msec or 1 big box?
1st degree AV block
Type 1 Wenckebach 2nd degree AV block
Progressive PR interval lengthening until a QRS is dropped
Progressive PR interval lengthening until a QRS is dropped?
Type 1 Wenckebach 2nd degree AV block
Type 2 2nd degree AV block
Random dropped QRS complexes with no change in the PR interval
Random dropped QRS complexes with no changed in the PR interval?
Type 2 2nd degree AV block
3rd degree AV block
NO relationship between the P and QRS waves
No relationship between the P and QRS waves
3rd degree AV block
What is the treatment for the different types of AV block?
Pacemaker placement
What is Sick Sinus Syndrome?
Degeneration of the SA node that leads to intermittent arrhythmias
What most often causes Atrial Fibrillation?
Ectopic foci in the pulmonary veins
How does Afib look on EKG?
NO discernible P waves
Irregularly irregular QRS complexes
What is the pneumonic to remember treatment for Afib?
ABCD
- Anticoagulate
- Beta blocker to control rate
- CCB or Cardioversion if unstable
- Digoxin if refractory
What is the treatment for Afib?
ABCD
- Anticoagulate
- Beta blocker to control rate
- CCB or Cardioversion if unstable
- Digoxin if refractory
What causes Atrial Flutter?
Circular movement of electrical activity around the atrium
How will Atrial Flutter look on EKG?
LOTS of SAWTOOTH P waves with a regular QRS
How will Atrial Flutter look on EKG?
Lots of SAWTOOTH P waves with regular QRS
How do you treat Atrial Flutter?
ABCD
- Anticoagulate
- Beta blocker
- CCB or Cardioversion
- Digoxin
What causes Multifocal Atrial Tachycardia?
Multiple reentrant pathways
How will Multifocal Atrial Tachycardia look on EKG?
> 3 P wave morphologies
What causes Wolff-Parkinson White Syndrome?
Abnormal fast accessory conduction pathway (Bundle of KENT) from atria to ventricles
What causes Wolff-Parkinson White Syndrome?
Abnormal fast accessory conduction pathway (Bundle of KENT) from atria to ventricles
How will Wolff-Parkinson White Syndrome look on EKG?
Delta wave = slow upstroke of wide QRS
What medication is used to treat Wolff-Parkinson White Syndrome?
Procainamide
– Amiodarone 2nd line
What 2 medications are contraindicated in Wolff-Parkinson White syndrome?
CCBs
Digoxin
– USE PROCAINAMIDE
Ventricular Tachycardia
TOMBSTONE appearance = wide QRS
Ventricular Fibrillation
Totally erratic wide complex tracing
What is the usual treatment for Ventricular Tachycardia/Fibrillation when the patient is unstable?
Defibrillation and ACLS protocol
If there is a rhythm like Afib for example on telemetry but no pulse… what is that?
Pulseless Electrical Activity
What do you do if Pulseless Electrical Activity is present?
CPR + epinephrine
– NOT A SHOCKABLE RHYTHM/NOR IS ASYSTOLE
If Asystole is present, what do you do?
CPR + epinephrine
What are the usual shockable rhythms?
Vtach
Vfib
