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Cardiology > Arrhythmias > Flashcards

Arrhythmias Flashcards

1
Q

Cardiac Conduction System

A

SA node –> AV Node –> bundle of His –> right and left bundle branch –> Perkinje fibers

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2
Q

Which node is known as the native pacemaker

A

SA node

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3
Q

Classification of Arrhythmias

A

Location
Rate

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4
Q

<60 bpm

A

bradyarrhythmias

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5
Q

> 100 bpm

A

tachyarrhythmias

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6
Q

Type of arrhythmias that originate above the bundle of His

A

Supraventricular arrhythmias

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7
Q

Type of arrhythmias that originate below the bundle of His

A

Ventricular arrhythmias

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8
Q

Name the supraventricular arrhythmias

A

Sinus bradycardia
Sinus tachycardia
Paroxysmal supraventricular tachycardia
Atrial fibrillation
Atrial flutter

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9
Q

Name the ventricular arrhythmias

A

Premature ventricular contractions
Vtach
Vfib

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10
Q

What is a normal heart rate in an adult?

A

60-100 bpm

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11
Q

What is the order of treating bradycardias?

A

Rate
Rhythm
Blood pressure (should resolve when you fix the other two)

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12
Q

Causes of sinus bradycardia

A

Intrinsic:
Advanced age
Any disease process affecting atrium

Extrinsic:
Medications
Elevated vagal tone (athletes)
Metabolic
Transient periods of high vagal tone as reflex response (fear or pain)

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13
Q

What is the definition of sinus bradycardia?

A

HR <60 bpm originating from the SA node

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14
Q

What is the definition of sick sinus syndrome?

A

Intrinsic SA node dysfunction that causes periods of inappropriate symptomatic bradycardia

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15
Q

What is the most common indication for a pacemaker?

A

Sick Sinus Syndrome

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16
Q

What is the definition of Tachycardia-Bradycardia Syndrome?

A

Sinus bradycardia with intermittent episodes of atrial
tachyarrhythmias (Afib most common)

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17
Q

In Tachycardia-Bradycardia Syndrome, which rhythm do you treat first?

A

Bradycardia

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18
Q

What are the three types of escape rhythms?

A

Atrial escape rhythm
Junctional escape rhythm
Ventricular escape rhythm

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19
Q

Which escape rhythm has the following characteristics:
HR 60-80 bpm
P wave different shape than SA node P wave
Narrow QRS complex following P wave

A

Atrial escape rhythm

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20
Q

Which escape rhythm has the following characteristics:
HR 40-60 bpm
Extremely regular
QRS not preceded by a P wave

A

Junctional Escape rhythm

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21
Q

Which escape rhythm has the following characteristics:
HR 30-40 bpm
Widened QRS complexes

A

Ventricular escape rhythm

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22
Q

Which type of heart block is described below?
Prolongation of the normal delay between atria and ventricles
PR interval >0.2 seconds
1:1 ratio of P:QRS
Generally benign and asymptomatic

A

First Degree Heart Block

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23
Q

Causes of first degree heart block

A

Heightened vagal tone
Transient AV node ischemia
Drugs
MI
Chronic degeneration disease of conduction system

24
Q

Which type of heart block is described below?
Intermittent failure of AV conduction – results in some P waves not
followed by a QRS
PR interval gradually increases until an impulse is completely blocked and ventricular stimulation does not follow P wave
Most patients are asymptomatic
Usually caused by impaired conduction in the AV node

A

Second Degree Heart Block - Type 1
Mobitz Type I (Wenckebach)

25
Q

Which type of heart block is described below?
Intermittent failure of AV conduction – results in some P waves not
followed by QRS
Characterized by sudden, unexpected blocked P waves without variation or prolongation of the PR interval
Carries a high risk of progression to complete heart block often with associated cardiovascular collapse

A

Second Degree Heart Block - Type 2
Mobitz Type 2

26
Q

Which type of heart block is described below?
Complete failure of conduction between atria and ventricles
No relationship between P wave and QRS – Atrioventricular (AV)
dissociation

A

Third Degree Heart Block

27
Q

What is the most common cause of a second degree heart block type 2?

A

MI (anterior or inferior)

28
Q

What are some causes of third degree heart block?

A

Acute MI
Drug toxicity (especially digoxin)
Chronic degeneration of conduction pathway

29
Q

Definition of tachycardia

A

> 100 bpm for 3 consecutive beats

30
Q

Which tachycardia has the following characteristics:
SA node rate >100 bpm, typically 100-180 bpm
Normal P waves and QRS complexes

A

Sinus Tachycardia

31
Q

Which tachycardia has the following characteristics:
Normal junctional escape rhythm: 40-60 bpm
“accelerated AV junctional rhythm”
Usually seen in the setting of organic heart disease

A

Junctional Tachycardia

32
Q

What is the first line treatment for inappropriate sinus tachycardia?

A

Beta Blockers

33
Q

Which tachycardia has the following characteristics:
Irregular rhythm with multiple P wave morphologies (at least 3)
Average atrial rate >100 bpm
Easily confused with Afib!
Often seen in a setting of underlying pulmonary disease and hypoxemia

A

Multifocal Atrial Tachycardia

34
Q

Which tachycardia has the following characteristics:
Conduction from right atrium to ventricles is normally over a single
pathway (AV nodal) with no route of reentry back into atrium
Some have dual AV nodal pathways (~25% of the population)
HR 120-200 bpm (up to 250 have been recorded)

A

Atrioventricular Nodal Reentrant Tachycardia
(AVNRT)

35
Q

DOC for Atrioventricular Nodal Reentrant Tachycardia
(AVNRT)

A

IV adenosine

36
Q

Which tachycardia has the following characteristics:
one limb of reentry loop is made by an accessory pathway (bypass tract) instead of a separate fast and slow
pathway within the AV nodeShorted PR interval
Delta wave
Wide QRS complex
Ventricular rates 250-350 bpm

A

Wolf-Parkinson-White Syndrome

37
Q

Wolf-Parkinson-White Syndrome has what unique characteristic on an EKG?

A

Delta Wave

38
Q

What is the DOC in hemadynamically stable Wolf-Parkinson-White Syndrome

A

Procainamide

39
Q

What drug is contraindicated in Wolf-Parkinson-White Syndrome

A

Digoxin

40
Q

Which tachycardia has the following characteristics:
Rapid, regular atrial activity
“sawtooth” appearance
Flutter waves, no identifiable P waves
Rate 180-350 bpm (typical rate is 300 bpm)

A

Atrial Flutter

41
Q

What is the most common cardiac arrhythmia necessitating hospitalization in the US

A

Atrial Fibrillation

42
Q

Which tachycardia has the following characteristics:
Irregularly irregular 🡪 chaotic
Atrial rate >350 bpm
No discernable P wave
Multiple “wandering” reentrant circuits within atria

A

Atrial Fibrillation

43
Q

What are the risk factors for Afib?

A

Structural heart disease (Atrial enlargement, MI, Infiltration, etc)
Hypertension and CAD (most common)
Hyperthyroid
EtOH

44
Q

Afib Treatment Goals

A

Ventricular rate control
Anticoagulation
Restore sinus rhythm

45
Q

What is the most common ventricular arrhythmia?

A

Premature Ventricular Contraction

46
Q

Which tachycardia has the following characteristics:
Widened QRS
Not related to preceding P wave (commonly earlier than expected)
Palpitations = most common symptom

A

Premature Ventricular Contraction

47
Q

Which tachycardia has the following characteristics:
Series of 3 or more PVCs
QRS > 0.12 seconds (widened)
Rate 100-200 bpm
Monomorphic or Polymorphic
Commonly found in patients with structural heart disease

A

Ventricular Tachycardia

48
Q

What is the most common cause of ventricular tachycardia?

A

CAD

49
Q

Which tachycardia has the following characteristics:
A polymorphic VT
Multiple ectopic foci or continually changing reentry circuit
Prolonged QT interval

A

Torsades de Pointes

50
Q

What is the most common cause of Torsades de Pointes?

A

Acute MI

51
Q

Which tachycardia has the following characteristics:
QRS morphology same as when in sinus rhythm
Responds to vagal maneuvers
More common in women than men
HR 120-200 (up to 250 bpm)

A

SVT

52
Q

What is the first line treatment for stable Torsades de Pointes?

A

Magnesium

53
Q

Which tachycardia has the following characteristics:
Immediately life-threatening 🡪 a chaotic mess
Disordered, rapid stimulation of ventricles
No coordinated contractions = pulseless
Occurs in patients with severe underlying heart disease

A

Ventricular Fibrillation

54
Q

What is the major cause of mortality in acute MI?

A

Ventricular Fibrillation

55
Q

What is the only effective therapy in ventricular fibrillation?

A

prompt electrical defibrillation

56
Q

Which rhythm has the following characteristics:
Less than 100bpm (very similar to multifocal atria tachycardia)
Presence of more than one pacemaker within the atria (taking turns firing)
May or may not include the SA node
Attributed to pulmonary disease as well
All of the Ps vary/look different from one another

A

Wandering Pacemaker

Cardiology (13 decks)

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