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Arrhythmias Flashcards

1
Q

class 1a anti-arrhythmic meds

3

A
  1. Quinidine
  2. Procainamide
  3. Disopyramide
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2
Q

class 1b anti-arrhythmic meds

4

A
  1. Lidocaine
  2. Phenytoin
  3. Mexiletine
  4. Tocainide
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3
Q

class 1c anti-arrhythmic meds

4

A
  1. Propafenone
  2. Flecainide
  3. Encainide
  4. Moricizine
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4
Q

class 3 anti-arrhythmic meds

5

A
  1. Amiodarone
  2. Sotalol
  3. Ibutilide
  4. Dofetilide
  5. Dronedarone
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5
Q

side effects of amiodarone

5

A
  • hypotension
  • corneal micro-deposits
  • thyroid dysfuntion (hypo > hyper)
  • pulmonary fibrosis
  • blue-gray skin discoloration
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6
Q

where do impulses originate at for normal sinus rhythms?

A

SA node

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7
Q

what BPM does the SA node produce?

A

60-100bpm

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8
Q

6 atrial arrhythmias

A
  1. sinus tachy
  2. sinus brady
  3. sinus arrhythmia
  4. PAB/multi-focal atrial tachy
  5. a fib
  6. a flutter
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9
Q

Sinus Tachycardia

EKG findings

A
  • upright P wave in lead II preceding every QRS complex
  • rate greater than 100 bpm
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10
Q

Sinus Tachycardia

causes

11

A
  1. exercise
  2. anemia
  3. dehydration/shock
  4. fever
  5. sepsis/infection
  6. hypoxia
  7. pulm diseases
  8. hyperthyroidism
  9. pheochromocytoma
  10. meds/stims
  11. heart failure
  12. PE
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11
Q

Sinus Bradycardia

EKG findings

A
  • upright P wave in lead II preceding each QRS complex
  • rate less than 60 bpm
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12
Q

Sinus Bradycardia

causes

7

A
  1. AV blocking meds
  2. heightened vagal tone
  3. sick sinus syndrome
  4. hypothyroidism
  5. hypothermia
  6. obstructive sleep apnea
  7. hypoglycemia
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13
Q

Sinus Bradycardia

work up

A
  1. TSH
  2. holter
  3. echo
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14
Q

Sinus Bradycardia

tx

3

A
  1. discontinue AV node slowing agents
  2. rule out underlying diseases
  3. atropine/external pacing/perm pacemaker
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15
Q

Sinus Arrhythmia

what is it?

A
  • changing sinus note rate with respiratory cycle
  • rate increases with inspiration and decreases with expiration
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16
Q

Sinus Arrhythmia

common in who?

A

young, healthy individuals

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17
Q

Premature Atrial Beats (PAB)

when do these occur?

A

when a focus in the atrium other than the SA node generates an AP prior to the next scheduled SA node AP

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18
Q

Premature Atrial Beats (PAB)

EKG characteristics

4

A
  1. premature
  2. ectopic
  3. narrow complexes
  4. compensatory pause
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19
Q

multi-focal atrial tachycardia (MAT)

rate/rhythm?

aka hallmarks

A
  1. less than 100 bpm
  2. irregularly irregular
  3. 3+ p waves on EKG
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20
Q

multi-focal atrial tachycardia (MAT)

associated with which disorder?

A

COPD

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21
Q

Atrial Fibrillation

how does this occur?

A

occurs when action potentials fire very rapidly within the pulm veins or atrium in a chaotic manner

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22
Q

Atrial Fibrillation

atrial vs ventricular rate?

A
  1. 300 + bpm
  2. 100-200 bpm
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23
Q

Atrial Fibrillation

what is seen on EKG?

A
  • no P waves
  • varying RR intervals (irreg. irreg.)
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24
Q

Atrial Fibrillation

rate of a fib with RVR

A

100 + bpm

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25
# Atrial Fibrillation rate of a fib with regular ventricular rate
60-100 bpm
26
# Atrial Fibrillation rate of a fib with slow ventricular rate
60 or fewer bpm
27
# Atrial Fibrillation risk factors | 10
1. HTN 2. valvular heart disease 3. CAD 4. cardiomyopathy 5. COPD 6. obesity 7. sleep apnea 8. excessive EtOH 9. DM 10. thyrotoxicosis
28
# Atrial Fibrillation signs and sx | 6
1. can be asx 2. palpitations 3. fainting 4. SOB 5. chest pain 6. stroke
29
# Atrial Fibrillation work up | 7
1. CMP 2. CBC 3. TSH 4. Mg 5. Echo 6. EKG 7. AEM
30
# Atrial Fibrillation Classifications | 4
* paroxysmal * persistent * longstanding/persistant * permanent
31
# Atrial Fibrillation describe paroxysmal a fib
recurrent episodes < 7 days
32
# Atrial Fibrillation describe persistent a fib
recurrent episodes > 7 days
33
# Atrial Fibrillation describe longstanding/persistent a fib
> 12 mo
34
# Atrial Fibrillation goal with permanent a fib
cease efforts to maintain NSR
35
# Atrial Fibrillation define CHA2DS2VASC
* CHF (+1) * HTN (+1) * Age 75+ (+2) * DM (+1) * Stroke, TIA, or TE (+2) * Vascular Disease (+1) * Age 65 to 74 (+1) * Sex = Female (+1)
36
# Atrial Fibrillation what does each score mean: * greater than 2 * greater than 1 * less than 1
* rec for full OACTx * MDM needed for OACTx * no OACTx needed
37
# Atrial Fibrillation OACTx meaning
oral anti-coag tx
38
# Atrial Fibrillation most common place to clot in a fib?
atrial appendage
39
# Atrial Fibrillation what does HAS-BLED mean?
* HTN * Abnormal liver/real function * Stroke * Bleeding tendency/disposition * Labile INR * Age (> 65) * Drugs (ASA, NSAIDS, EtOH)
40
# Atrial Fibrillation components of rate control | 3
1. old, asx, preserved EF 2. OAC Tx 3. Rx: BB, CCB
41
# Atrial Fibrillation components of rhythm control | 5
1. young, sx, EF < 45%, new onset 2. OAC Tx 3. Anti-Arrhythmias (class 1c-3) 4. Cardioversion 5. Ablation
42
# Atrial Fibrillation management
* replace K+ and Mg++ * rate control: BB, CCB, digoxin * rhythm control: amiodarone * OAC: dabigatran, rivaroxaban * cardioversion * ablation * pulm vein isolation/MAZE procedure
43
# Atrial Flutter how does this occur
occurs when a re-entrant circuit is present causing a repeated loop of electrical activity to depolarize the atrial at a fast rate of ~300 bpm
44
# Atrial Flutter Clinical Pearl w/ EKG | PPP
* narrow complex tachy w/ ventricular rate of 150 bpm = a flutter
45
# Atrial Flutter EKG findings
* classic "sawtooth" pattern of atrial activity * no p waves
46
# Supraventricular Tachycardia (SVT) overview
rapid rhythm disturbances originating from the atria or the AV node
47
# Supraventricular Tachycardia (SVT) mechanisms
* re-entry: follow a revolving pathway * automaticity: spont and repetitive firing from a single focus
48
# Supraventricular Tachycardia (SVT) signs & sx | 7
1. palpiataions 2. SOB 3. diaphoresis 4. chest pain 5. rapid breathing 6. dizziness 7. LOC
49
# Supraventricular Tachycardia (SVT) EKG findings | 3
1. narrow QRS 2. rate 160-220 bpm & does not vary 3. cannot separate T waves from P waves
50
# Supraventricular Tachycardia (SVT) tx options | just categories
1. Physical Maneuvers 2. meds 3. synchronized cardioversion
51
# Supraventricular Tachycardia (SVT) components of physical maneuvers | 7
1. valsalva 2. breath holding 3. coughing 4. carotid massage 5. putting head between knees 6. drinking ice water 7. plunging face into cold water
52
# Supraventricular Tachycardia (SVT) which meds to use? | 3
1. IV adenosine (6mg then 12 mg) 2. IV CCB 3. IV BB
53
# Supraventricular Tachycardia (SVT) prevention
radiofrequency catheter ablation * preferred approach in pts with recurrant sx PSVT
54
# First Degree AV Block EKG findings
fixed prolonged PR interval
55
# First Degree AV Block causes | 3
* meds * ischemia * lyme disease
56
# Wenckeback Type I Second Degree AV Block EKG Findings
* progressive PR interval prolongation with each beat until QRS complex is dropped * causes irregular R-R interval, but follows a pattern
57
# Mobitz Type II Second Degree AV Block EKG findings
* extra P waves with a dropped QRS * PR interval elongated * usually associated with bradycardia
58
# Mobitz Type II Second Degree AV Block tx
pacemaker or atropine
59
# Mobitz Type II Second Degree AV Block can progress to?
Third Degree AV Block
60
Qualifiers for Perm Pacemaker | 6
1. pauses > 3s 2. sinus brady < 35 bpm 3. sinus brady 36-40 bpm w/ sx 4. chronotropic incompetence 5. Mobitz Type II Second Degree AV Block 6. Third Degree AV Block
61
5 ventricular arrhythmias
1. PVC 2. Ventricular tachy 3. idioventricular rhythms 4. ventricular fibrillation 5. asystole
62
# Premature Ventricular Contractions (PVC) when do these occur?
occurs when a focus in the ventricle generates an AP before the next scheduled SA nodal AP
63
# Premature Ventricular Contractions (PVC) EKG findings
1. premature beat 2. ectopic 3. wide QRS 4. compensatory pause
64
# Premature Ventricular Contractions (PVC) associated with? | 3
1. energy drinks 2. electrolyte abnormalities 3. hyperthyroidism
65
# Premature Ventricular Contractions (PVC) when should an echo be sought?
1. more than 10,000 per day per ambulatory EKG monitoring 2. 30% of total heart beats
66
# Premature Ventricular Contractions (PVC) sx
asx
67
# Premature Ventricular Contractions (PVC) if sx, what is first line therapy?
1. BB 2. non-dihydropyridine CCB
68
# Ventricular Tachycardia EKG Findings
* wide QRS complex * rate greater than 100 bpm
69
# Ventricular Tachycardia can be associated with? | 3
1. degenerating into v fib 2. presenting as syncope 3. hemodynamical stability
70
# Ventricular Tachycardia what must occur for vtach? sustained vtach?
* 3+ PVCs in a row * sustained = 30+ sec
71
# Ventricular Tachycardia initial tx
* determined by degree of hemodynamic stability * urgent direct current cardioversion * IV amiodarone * can add short-acting BB or verapamil
72
# Ventricular Tachycardia long-term management
* reverse precipitating causes * BB for pts with structural heart disease * catheter ablation * implantable cardioveter-defibrillator
73
# Ventricular Tachycardia polymorphic ventricular tachycardia AKA
torsades de pointes
74
# Ventricular Tachycardia Torsades de Pointes EKG findings
* like a ribbon
75
# Ventricular Tachycardia tx for torsades?
magnesium
76
# Ventricular Tachycardia who has higher risk of developing torsades? | PPP
pts with a prolonged QT interval
77
# Ventricular Fibrillation what is happening?
quivering of the ventricles with virtually no forward cardiac output
78
# Ventricular Fibrillation treatment
ACLS * defibrillation * epinephrine * anti-arrhythmics
79
# Ventricular Fibrillation improved long term outcomes if what occurs?
hypothermia protocol is initiated rapidly and maintaine for 24-36 hrs post cardiac arrest
80
# Asystole what is it?
flat line- no electrical activity in the heart
81
# Asystole tx
* CPR * epinephrine
82
# Misc Rhythms what rhythm is seen with hypokalemia?
u waves between T and next P
83
# Misc Rhythms what is seen with hyperkalemia? | 4
* peaked T waves * widening of QRS * increase in PR * bradycardia
84
# Misc Rhythms what is seen with hypocalcemia?
prolonged QT interval
85
# Misc Rhythms what is seen with hypercalcemia?
shortened QT interval
86
# Misc Rhythms- Long QT Syndrome what can long QT syndrome lead to?
potentially fatal torsades de pointes
87
# Misc Rhythms- Long QT Syndrome Signs/sx of Long QT Syndrome
* palpitations * fainting * sudden death
88
# Misc Rhythms- Long QT Syndrome causes of QT prolongation | 4
* congenital * meds * disease states * electrolyte imbalances
89
# Misc Rhythms- Long QT Syndrome tx
* treat underlying cause * ICD
90
# Misc Rhythms- Brugada Syndrome most commonly from what?
a mutation in the sodium channel gene
91
# Misc Rhythms- Brugada Syndrome causes what?
sudden cardiac death from torsades or v fib even though the heart is structurally normal. also has normal QT interval
92
# Misc Rhythms- Brugada Syndrome tx
ICD
93
# Misc Rhythms- Wolff-Parkinson-White (WPW) describe
accessory pathway that connects the electrical system of the atria directly to the ventricles allowing conduction to avoid passing through the AV node
94
# Misc Rhythms- Wolff-Parkinson-White (WPW) EKG findings
* short PR interval * slurred R wave (delta)
95
# Misc Rhythms- Wolff-Parkinson-White (WPW) tx
ablation

CMT (78 decks)

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