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ECG > Arrhythmias > Flashcards

Arrhythmias Flashcards

1
Q

What is the classification of tachycardia based on QRS complex?

A

Supraventricular
* Sinus tachycardia
* Focal atrial tachycardia
* Multifocal atrial tachycardia
* Atrial fibrillation
* Atrial flutter
* AVNRT and AVRT = PSVT

Ventricular
* Ventricular tachycardia has 2 types: monomorphic and polymorphic VT (more than 1 irritable area) with normal QT
* Polymorphic VT wth prolonged QT interval: Torsades de Pointes
* Ventricualr fibrillation

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1
Q

What is the classification of tachycardia based on origin of depolarization?

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2
Q

What is the ECG changes in atrial flutter?

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3
Q

What is the ECG changes in atrial tachycardia?

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4
Q

What is the ECG changes in junctional (nodal) tachycardia?

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5
Q

What is the ECG changes in atrial fibrillation?

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6
Q

What is the ECG changes in ventricular tachycardia?

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7
Q

What is the ECG changes in Wolff-Parkinson-White syndrome?

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8
Q

What is the diagnostic algorithm for narrow QRS tachycardia?

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9
Q

What is the algorithm for wide complex tachycardia?

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brugada algorithm

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10
Q

What is treatment algorithm for tachycardia?

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11
Q

What are the different classes of antiarrhythmics and when are they used?

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12
Q

What is treatment algorithm for stable regular narrow complex tachycardia?

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13
Q

What is treatment algorithm for stable wide complex tachycardia?

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14
Q

What is the moa of vagal manouevres (carotid sinus massage) and ATP?

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15
Q

What is the management of AF and atrial flutter?

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16
Q

What is the management of regular narrow complex tachycardias?

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17
Q

What is the management of irregular narrow complex tachycardias?

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18
Q

What is the management of wide complex tachycardias?

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19
Q

What is the classification of bradycardia?

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20
Q

What are the ECG changes and causes for 1st, 2nd and 3rd degree heart block?

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21
Q

What are the ECG changes and causes for RBBB?

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22
Q

What are the ECG changes and causes for LBBB?

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23
Q

What are the ECG changes and causes for left anterior fascicular block, bifascicular block?

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24
What are the ECG changes and causes for sick sinus syndrome?
SAN dysfunctional (fibrosis/myocardial scarring/ idiopathic) causing sinus bradycardia Due to SAN dysfunction --> develops SVT --> AFl, AF, PAC which produces tachycardia Sometimes known as tachybrady syndrome
25
What is the treatment algorithm for bradycardia?
26
What is management protocol for VF or pulseless ventricular tachycardia?
27
List the 6H and 6Ts of pulseless electrical activity
28
What is management of pulseless electrical activity?
29
A patient presented with irregularly irregular pulse. What are the 6 main differential diagnosis?
 Atrial fibrillation  Atrial flutter with variable AV block  Atrial tachycardia with variable AV block  Multi-focal atrial tachycardia (MAT) * Atrial rate > 100 bpm * Absence of one dominant pacemaker * P waves of at least 3 morphologies  Multi-focal atrial rhythm (MAR) * Atrial rate ≤ 100 bpm * Absence of one dominant pacemaker * P waves of at least 3 morphologies  Very frequent ectopic beats
30
What is physiological cause of tachyarryhthmias?
* Increased automaticity * Triggered activity * Reentrant circuit
31
What is physiological cause of bradyarryhthmias?
* Decreased automaticity * Conduction block
32
What controls the automaticity of the heart?
33
What causes decreased automaticity of heart?
ICP causes brain herniation and compression on CN10 stimulating PSNS --> bradycardia
34
What are the causes for increased automaticity in heart?
Increased SNS tone * Hypovolemia * Hypoxia: anemia, lung ddx, pulmonary embolism * Sympathomimetics * Pain/anxiety * Increased metabolic activity: fever (sepsis), hyperthyroidism
35
What are the causes of early after depolarization? Associated with what condition?
Associated with: Polymorphic VT + prolonged QTi --> torsades de Pointes
36
What are the causes of delayed after depolarization? Associated with what condition?
* Ischemia (MI, CAD) * Hypoxia (lung disease) * Inflammation (myocarditis) * Stretch (DCM, MR) * Increased SNS tone * Digoxin toxicity DADs * MAT * FAT (focal atrial tachycardia) * VT
37
What are the 2 types of AVRT and QRS morphology?
Orthodromic AVRT: goes through normal conduction pathway (SAN --> AVN --> bundle of His --> bundle branches --> purkinje fibers --> Bundle of Kent) Antidromic AVRT (less common): down B.Kent --> purkinje fibers --> bundle branch --> bundle of His --> AVN
38
What is the mechanism of AVNRT?
Scars or fibrosis in the AVN: which prolongs conduction pathway 1st step goes down both alpha and beta pathway 2nd step: B pathway is refractory, sends signal down slow alpha pathway. By the time it reaches the bottom B pathway is no longer refractory and gets depolarized 3rd step: becomes a self containing reentrant cycle sending signals back up to the atrium and down to the ventricle Most common is slow-fast pathway
39
What are the reentry circuit causes?
* AVNRT, AVRT --> PSVT * AFl: cavotricuspid isthmus --> reentry * AF * VT/VF
40
What are causes of conduction block in AVN?
* Inferior wall MI (RCA) * Fibrosis * HyperK * Drugs: BB/CCB/digoxin (AVN blockers) * Infiltration: sarcoidosis, amyloidosis * Lymes disease (borellia burgdorferi)
41
How to classify tachycarrhythmias?
Wide or narrow QRS complex Regular/irregular rhythm
42
How to determine in ECG if sinus tachycardia? Treatment?
P waves present in all QRS * Go up in lead II * Go down in lead aVR P --> QRS --> T Treat underlying cause * If hypovolemic: give fluids * If fever: antipyretics * If hypoxia: oxygen * If pulmonary embolism: heparin, tPA
43
How to determine in ECG if focal atrial tachycardia? Treatment?
P waves present: goes down in lead II (depolarization is away from positive electrode lead II), goes up in lead aVR P --> QRS --> T Ensure that electrodes are placed on correct side Treatment for all SVTs Vagal manouvre: hold breath (increased intrathoracic pressure --> increase vagal tone --> bradycardia) Adenosine BB/CCB (depend on contraindications) Cardioversion (if hypotensive, altered mental status, chest pain, pulmonary edema must do instantly as they are unstable) Long term treatment: radiofrequency ablation of ectopic foci
44
How to determine in ECG if atrial flutter? Treatment?
* Saw tooth waves most common in lead II, III, aVF * Lead V1 * 2/3/4: 1 ratio Treatment for all SVTs Vagal manouvre: hold breath (increased intrathoracic pressure --> increase vagal tone --> bradycardia) Adenosine BB/CCB (depend on contraindications) Cardioversion (if hypotensive, altered mental status, chest pain, pulmonary edema must do instantly as they are unstable) Long term treatment: radiofrequency ablation of cavotricuspid isthmus
45
How to determine in ECG if AVRT/AVNRT? Treatment?
Narrow QRS, regular rhythm tachycardia No p waves present --> most likely AVRT/AVNRT (SVT) * No visible P waves (hidden within the QRS complex) * Retrograde P waves: leads II, III, aVF (AVN produces depolarization into atrium) Treatment for all SVTs Vagal manouvre: hold breath (increased intrathoracic pressure --> increase vagal tone --> bradycardia) Adenosine BB/CCB (depend on contraindications) Cardioversion (if hypotensive, altered mental status, chest pain, pulmonary edema must do instantly as they are unstable) Long term treatment: radiofrequency ablation
46
How to determine in ECG if AFib? Treatment?
* Fibrillization in lead V1 * Irregular irregular rhythm narrow QRS complex Treatment * Try adenosine (doesn't really work) * BB/CCB * Cardioversion (if at any point unstable --> do cardioversion immediately) Long term treatment: RFA + AFIB --> CHADVAS (>2 --> requires anticoag)
47
How to determine in ECG if AFlutter with variable block? Treatment?
* Saw tooth waves in lead II, III, AVF. Also lead V1. * 2:1 + 1:1 ratio * Irregular rhythm narrow QRS complex Treatment * Try adenosine (doesn't really work) * BB/CCB * Cardioversion (if at any point unstable --> do cardioversion immediately) Long term treatment: RFA (cavotricuspid isthmus) If + AFIB --> CHADVAS (>2 --> requires anticoag)
48
How to determine in ECG if MAT? What is causes? Treatment?
* 3 or more morphologically different p waves * Underlying disease is the cause (COPD/PE/underlying heart failure) Treatment * Try adenosine (doesn't really work) * BB/CCB * Cardioversion (if at any point unstable --> do cardioversion immediately) Long term treatment: RFA of ectopic foci If + AFIB --> CHADVAS (>2 --> requires anticoag)
49
How to determine in ECG if Vtach? What is causes? Treatment?
* Wide QRS regular rhythm: >0.14s * AV dissociation * Extreme right axis deviation * History of CVD (>35 years old) If wide regular QRS complex always think V tach (if SVT w BBB and treated wrongly will kill patient --> if V tach but actually SVT w BBB --> condition will improve) If hard to differentiate between PMVT +normal QT and AF +WPW (treat as PVMT + normal QT as same treatment --> dont give AVN blockers) Treatment * Amiodarone * Procainamide * Synchronized cardioversion (pads should be ready as VT can quickly go into VFib) Long term treatment * RFA * V tach: look for MI * AICD
50
How to determine in ECG if SVT with BBB? What is causes? Treatment?
* <0.14s QRS complex * No AV dissociation * No extreme right axis deviation * No significant past medical history of CVD If hard to differentiate between PMVT +normal QT and AF +WPW (treat as PVMT + normal QT as same treatment --> dont give AVN blockers) Treatment * Adenosine (cautious) Long term treatment * RFA * AICD
51
What is AF + WPW on ECG? What drugs can you not give? What Tx?
Wide QRS complex irregular rhythm WPW is likely antidromic going through the Bundle of Kent first Cannot give AVN blockers (ABCD: adenosine, B blockers, CCB, digoxin) --> will induce VF if given Treatment is same is pmVT (polymorphic VT with normal QT): Amiodarone, procainamide Synchronized cardioversion (may be difficult to sync with R waves) --> Defibrillation
52
What is PMVT with increased QT interval (requires checking ECG rhythm strip prior to TdP) on ECG? Treatment?
Varried ventricular morphology and qtc >500ms Give MgSO4 if low (hypoMg is cause) Replete K+ (if hypoK) Discontinue offending drugs: antiarrhythmics, antibiotics, antipyschotics, antidepressants, antiemetics Prevent going into TdP again Overdrive pacing/isoproterenol: increases HR which decreases QT interval (decreases chance of TdP)
53
What is treatment of PMVT (polymorphic Vtach) with normal QT?
Amiodarone Procainamide Synchronized cardioversion/defibrillation (when cannot sync with R waves)
54
What is most common wide irregular QRS complex rhythm? Treatment?
AF + BBB Treatment QRS morphology --> same * BB/CCB --> cardioversion Long term treatment * RFA * AICD
55
How to determine in ECG is sinus bradycardia?
Every P wave has QRS complex
56
How to determine in ECG is 1st degree HB?
when PR >200ms
57
How to determine in ECG is 2nd degree HB Mobitz 1?
Increased in PR interval than drop in QRS complex (wenkebach drop)
58
How to determine in ECG is 2nd degree HB Mobitz 2?
Normal PR interval and dropped QRS
59
How to determine in ECG is 2:1 block?
Normal PR interval and drop QRS 2:1 2nd HB
60
How to determine in ECG is 3rd degree HB?
PR interval normal + drop QRS + wide QRS (AV dissociation)
61
What HB requires treatment? What is treatment?
2nd degree HB Mobitz 2 2nd degree HB 2:1 block 3rd degree HB Decreased HR (bradycardia) --> decreased cardiac output --> decreased BP --> hypotension/altered mental status/chest pain/pulmonary edema (unstable --> requires treatment) Treatment (in this order) Atropine (decreased PSNS: block acetylcholine --> nothing inhibiting excitation) Epinephrine (increased SNS) Pacing: transcutaneous pacing, transvenous, permanent pacemaker Treat underlying cause of block * Inferior wall MI (RCA): STEMI/NSTEMI (cTnT, cTnI) --> cath lab --> PCI * HyperK (give calcium gluconate, insulin (shunt K+ into cell) +D50 (prevent hypoglycemia), albuterol, HCO3-, lasix (excrete K+ through urine) * Overdose of BB/CCB/digoxin. If BB overdose --> glucagon. If CCB overdose --> calcium. If digoxin overdose --> digibind. * Lymes disease (borrelia burgdorferi) --> give IV ceftriaxone * Hypothermia: warm them up * Hypothyroidism: levothyroxine (myxoedema coma)

ECG (15 decks)

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