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EOR Family med > Arrhythmias > Flashcards

Arrhythmias Flashcards

1
Q

Normal heart rate

A

60-100 bpm

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2
Q

where do electrical impulses originate

A

Sinoatrial node (SA)

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3
Q

sinus tachycardia

A

NSR > 100 bpm

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4
Q

What med can be used for sinus tachycardia in the setting of acute coronary artery syndrome

A

beta blockers

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5
Q

sinus bradycardia

A

NSR < 60 bpm

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6
Q

first line for sx or unstable sinus bradycardia – and what does it do

A

atropine (anticholinergic drug that decreases vagal tone)

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7
Q

second line for sx or unstable sinus bradycardia if unresponsive to atropine

A

epinephrine or transcutaneous pacing

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8
Q

definitive management of sinus bradycardia

A

permanent pacemaker

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9
Q

what is the most common cause of narrow QRS complex tachycardia in paroxysmal supra ventricular tachycardia

A

reentry - AV nodal reentry MC

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10
Q

paroxysmal A-fib

A

self-terminating within 7 days (usually < 24 hours) +/- recurrent

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11
Q

persistent A-fib

A

fails to self-terminate, lasts > 7 days. requires termination (medical or electrical)

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12
Q

permanent A-fib

A

persistent A-fib > 1 year (refractory to cardio version or cardio version never tried)

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13
Q

lone a-fib

A

paroxysmal, persistent or permanent without evidence of heart disease

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14
Q

risk factors for Afib

A

HTN
valvular heart disease
heart failure ischemia
advanced age
obstructive sleep apnea
pulmonary embolism
obesity
chronic kidney disease
electrolyte imbalance (hypomagnesemia, hypokalemia)
diabetes
hyperthyroidism
pheochromocytoma
alcohol consumption
omega-3 fatty acid use
inflammation

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15
Q

what percent of Afib episodes are asx

A

90%

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16
Q

sx Afib

A

palpitations
dizziness
fatigue
generalized weakness
poor exercise tolerance
mild dyspnea
presyncope

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17
Q

unstable afib

A

sx are due to hypo perfusion and can include significant hypotension (systolic BP in double digits)
altered mental status
refractory chest pain (uncontrolled angina or ischemia)
decompensated congestive heart failure

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18
Q

what can be used to diagnose afib

A

EKG
cardiac monitoring

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19
Q

what will EKG show for Afib

A

irregularly irregular rhythm w fibrillary waves
no discrete P waves
often atrial rate > 250 bpm
the AV nodal refractory period determines the ventricular rate

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20
Q

cardiac monitoring for afib

A

a holter monitor or telemetry can be used if afib is not seen on an EKG but is suspected

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21
Q

tx for stable afib

A

rate control - Beta blockers (metoprolol, Atenolol, esmolol) OR non-dihydropyridine calcium channel blockers (Diltiazem, Verapamil) to slow AV node conduction

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22
Q

when is digoxin used in Afib

A

this is another option for rate control but is usually reserved for patients in whole beta blockers or CCBs are contraindicated (severe heart failure [NYHA class III or IV], hypotension)

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23
Q

tx for unstable afib

A

direct current (synchronized) cardioversion

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24
Q

is rate control or rhythm control preferred for long-term management of afib

A

rate control

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25
Q

long term therapy for afib

A

rate control
direct current (synchronized cardio version) or pharmacologic cardio version
radio frequency catheter ablation or surgical ‘MAZE’ procedure
CHA2DS2-VASc criteria for nonvalvular Afib to determine patients yearly thromboembolic risk in order to select appropriate anticoagulation regimen

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26
Q

in patients w AFib, what CHA2DS2-VASc score for oral anticoagulation

A

2 or more

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27
Q

when is cardio version most successful in afib

A

performed within 7 days after onset of Afib

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28
Q

what is done prior to cardio version in patients w Afib

A

transesophageal echocardiogram

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29
Q

If Afib > 48 hours — anticoagulation therapy

A

initiate anticoagulation therapy for at least 3 weeks before and at least 4 weeks after cardio version

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30
Q

If Afib < 48 hours — anticoagulation therapy

A

cardio version may be attempted as soon as possible often without coagulation

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31
Q

how long must anticoagulation be continued after cardio version in Afib

A

for 4 weeks after cardio version

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32
Q

CHA2DS2-VASc criteria

A

Congestive heart failure (1)
HTN (1)
Age >/= 75 (2)
DM (1)
Stroke, TIA, thrombus (2)
Vascular disease (prior MI, aortic plaque, peripheral arterial disease) (1)
Age 65-74 (1)
Sex (female) 1

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33
Q

recommended therapy for CHA2DS2-VASc 2 or more

A

moderate to high risk
chronic oral anticoagulation therapy recommended

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34
Q

recommended therapy for CHA2DS2-VASc 1

A

low risk
anticoagulation may be recommended in some cases

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35
Q

recommended therapy for CHA2DS2-VASc 0

A

no anticoagulation needed

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36
Q

tx for afib in stable patient

A

anticoagulation - warfarin, apixaban, rivaroxaban, edoxaban, heparin, dabigatran

37
Q

tx for afib in the presence of heart failure

A

digoxin
amiodarone
dronedarone

38
Q

tx for afib for RATE control

A

BB or CCB
metoprolol
esmolol
diltiazem
verapamil

39
Q

atrial flutter

A

rapid, regular atrial depolarizations at a characteristic rate around 300 bpm due to 1 single irritable atrial focus firing at a fast rate w some degree of AV node conduction block

40
Q

what percent of pts w atrial flutter have coronary artery disease or hypertensive heart disease

A

60%

41
Q

what is the range for bpm in atrial flutter

A

240 - 400 bpm
characteristically around 300 bpm

42
Q

sx atrial flutter

A

palpitations
dizziness
fatigue
poor exercise tolerance
mild dyspnea
pre syncope

43
Q

unstable atrial flutter

A

sx are due to HYPOPERFUSION
systolic BP in double digits
altered mental status
refractory chest pain

44
Q

diagnosis of atrial flutter

A

EKG
transthoracic echocardiography

45
Q

what will EKG show for atrial flutter

A

flutter “sawtooth” atrial waves usually ~300 bpm (atrial rate usually 240-400 bpm) but no discernible P waves

46
Q

what is the preferred initial imaging modality for evaluating atrial flutter

A

transthoracic echocardiography

47
Q

what will transthoracic echocardiography show for aflutter

A

can evaluate right and left atrial size, size and fin of right and left ventricles, assess for valvular heart disease, LVH, pericardial disease

48
Q

tx for stable aflutter

A

vagal maneuvers
rate control w beta blockers (metoprolol, atenolol, esmolol) or non-dihydropyridine calcium channel blockers (Verapamil, Diltiazem)

49
Q

when is Digoxin used for aflutter

A

another option for rate control but usually reserved for pts in whole beta blockers or CCBs are contraindicated (severe heart failure class III or IV,) hypotension – due to ADE and toxicity

50
Q

tx for unstable aflutter

A

direct current (synchronized) cardio version

51
Q

definitive management for aflutter

A

radiofrequency catheter ablation

52
Q

PVC

A

premature beat originating in the ventricle –> wide, bizarre QRS occurring earlier than expected
With a PVC, the T wave is in the opposite direction of the QRS usually
Associated w a compensatory pause = overall rhythm is unchanged (AV node prevents retrograde conduction)

53
Q

tx for PVC

A

asx –> no tx
sx –> beta blockers (MC) or non-dihydropyridime CCB
radio frequency catheter ablation if refractory

54
Q

ventricular tachycardia

A

3 or more consecutive PVCs (Wide complex QRS duration > 120 ms) at a rate > 100 BPM (usually between 120 and 300 bpm)

55
Q

what can sustained vtach lead to

A

Vfib

56
Q

what is sustained vtach

A

duration at least 30 seconds or cause hemodynamic collapse in < 30 seconds

57
Q

causes of vtach

A

underlying heart dz: ischemic heart dz MC (post MI 70%), structural heart defects, cardiomyopathies

Prolonged QT interval
Electrolyte abnormalities (hypomagnesemia, hypokalemia, hypocalcemia)

Digoxin toxicity

58
Q

sx vtach

A

palpitations
dizziness
fatigue
dyspnea
chest pain

59
Q

unstable vtach

A

hypo perfusion can cause hypotension (systolic BP in double digits), altered mental status, refractory chest pain, acute pulmonary edema

60
Q

what will EKG show for vtach

A

regular, wide complex tachycardia w no discernible P waves

61
Q

tx for stable vtach

A

Amiodarone
Procainamide

62
Q

tx for unstable vtach

A

direct current (synchronized) cardio version

63
Q

tx for pulseless vtach

A

unsynchronized cardio version (defibrillation) + CPR

64
Q

chronic therapy for Vtach

A

beta blockers

65
Q

torsades de pointes and what will EKG show

A

variant of polymorphic Vtach
polymorphic Vtach (cyclic alterations of the QRS amplitude around the isoelectric line) aka sinusoidal waveform

66
Q

what labs should you do when someone has torsades

A

rule out hypomagnesemia and hypokalemia

67
Q

tx for recurrent TdP

A

IV magnesium sulfate
Isoproterenol or Transvenous overdrive pacing if refractory

68
Q

Tx for congenital TdP

A

beta blockers
Avoid Isoproterenol

69
Q

Tx for hemodynamically unstable TdP

A

synchronized cardio version

70
Q

tx for pulseless TdP

A

prompt defibrillation (unsynchronized) cardio version

71
Q

Vfib

A

a type of sudden cardiac arrest or sudden cardiac death with ineffective ventricular contraction

72
Q

RF for Vfib

A

Ischemic heart disease (MC)
structural heart defects
Sustained Vtah
electrolyte abnormalities - hypokalemia, hyperkalemia, hypomagnesemia, acidosis, hypoxia

73
Q

what will EKG show for vfib

A

disorganized high frequency undulations w erratic pattern of electrical impulses, fibrillation waves of varying amplitude, shape, and periodicity, occurring at a rate above 320 bpm
No identifiable P waves, QRS complexes, or T waves

74
Q

tx for vfib

A

Unsynchronized cardioversion (defibrillation) + CPR
Epi and Amiodarone per ACLS protocol

75
Q

prevention for Vfib

A

secondary prevention - implantable cardioverter-defibrillator placement in people w prior VF and sustained VT
primary prevention - ICD placement (pts w left ventricular ejection fraction < 35%)

76
Q

First degree AV block

A

PR internal > 0.2

77
Q

second degree AV block MOBITZ 1

A

progressive PRI lengthening until occasionally non-conducted atrial beats (one or more P waves without corresponding QRS)

78
Q

second degree AV block MOBITZ 2

A

constant PRI length occasionally non-conducted atrial beats

79
Q

third degree AV block

A

AV dissociation - normal P-P and R-R - atrial beats are not related to ventricular beats

80
Q

aortic dissection

A

hx of uncontrolled HTN
sudden onset severe chest pain that radiates to back

81
Q

pericarditis

A

hx of viral infection
retrosternal stabbing, chest pain that improves when leaning forward, worsens w deep inspiration

82
Q

congestive heart failure

A

sx - cough exacerbated by lying down at night and improved by propping with pillows, exertion dyspnea

83
Q

costochondritis

A

hx of viral infeciton
sx - stabbing chest pain that worsens w deep inspiration, relieved by aspirin
chest wall tenderness

84
Q

pulmonary embolism

A

hx of recent immobilization
sx - acute onset SOB at rest and pleuritic chest pain, tachycardia, hypotension, tachypnea, fever

85
Q

pulmonary edema

A

sx worsening dyspnea of 6 hours + cough w pink, frothy sputum

86
Q

GERD

A

retrosternal burning sensation that occurs after heavy meals and when lying down; relieved by antacids

87
Q

sickle cell disease - acute chest syndrome

A

sx - acute onset severe chest pain w hx of sickle cell disease

88
Q

what murmur might people w Afib have

A

mitral stenosis

EOR Family med (25 decks)

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