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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
Q

Atrial Fibrillation

rate of a fib with regular ventricular rate

A

60-100 bpm

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26
Q

Atrial Fibrillation

rate of a fib with slow ventricular rate

A

60 or fewer bpm

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27
Q

Atrial Fibrillation

risk factors

10

A
  1. HTN
  2. valvular heart disease
  3. CAD
  4. cardiomyopathy
  5. COPD
  6. obesity
  7. sleep apnea
  8. excessive EtOH
  9. DM
  10. thyrotoxicosis
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28
Q

Atrial Fibrillation

signs and sx

6

A
  1. can be asx
  2. palpitations
  3. fainting
  4. SOB
  5. chest pain
  6. stroke
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29
Q

Atrial Fibrillation

work up

7

A
  1. CMP
  2. CBC
  3. TSH
  4. Mg
  5. Echo
  6. EKG
  7. AEM
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30
Q

Atrial Fibrillation

Classifications

4

A
  • paroxysmal
  • persistent
  • longstanding/persistant
  • permanent
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31
Q

Atrial Fibrillation

describe paroxysmal a fib

A

recurrent episodes < 7 days

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32
Q

Atrial Fibrillation

describe persistent a fib

A

recurrent episodes > 7 days

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33
Q

Atrial Fibrillation

describe longstanding/persistent a fib

A

> 12 mo

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34
Q

Atrial Fibrillation

goal with permanent a fib

A

cease efforts to maintain NSR

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35
Q

Atrial Fibrillation

define CHA2DS2VASC

A
  • 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)
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36
Q

Atrial Fibrillation

what does each score mean:
* greater than 2
* greater than 1
* less than 1

A
  • rec for full OACTx
  • MDM needed for OACTx
  • no OACTx needed
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37
Q

Atrial Fibrillation

OACTx meaning

A

oral anti-coag tx

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38
Q

Atrial Fibrillation

most common place to clot in a fib?

A

atrial appendage

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39
Q

Atrial Fibrillation

what does HAS-BLED mean?

A
  • HTN
  • Abnormal liver/real function
  • Stroke
  • Bleeding tendency/disposition
  • Labile INR
  • Age (> 65)
  • Drugs (ASA, NSAIDS, EtOH)
40
Q

Atrial Fibrillation

components of rate control

3

A
  1. old, asx, preserved EF
  2. OAC Tx
  3. Rx: BB, CCB
41
Q

Atrial Fibrillation

components of rhythm control

5

A
  1. young, sx, EF < 45%, new onset
  2. OAC Tx
  3. Anti-Arrhythmias (class 1c-3)
  4. Cardioversion
  5. Ablation
42
Q

Atrial Fibrillation

management

A
  • replace K+ and Mg++
  • rate control: BB, CCB, digoxin
  • rhythm control: amiodarone
  • OAC: dabigatran, rivaroxaban
  • cardioversion
  • ablation
  • pulm vein isolation/MAZE procedure
43
Q

Atrial Flutter

how does this occur

A

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
Q

Atrial Flutter

Clinical Pearl w/ EKG

PPP

A
  • narrow complex tachy w/ ventricular rate of 150 bpm = a flutter
45
Q

Atrial Flutter

EKG findings

A
  • classic “sawtooth” pattern of atrial activity
  • no p waves
46
Q

Supraventricular Tachycardia (SVT)

overview

A

rapid rhythm disturbances originating from the atria or the AV node

47
Q

Supraventricular Tachycardia (SVT)

mechanisms

A
  • re-entry: follow a revolving pathway
  • automaticity: spont and repetitive firing from a single focus
48
Q

Supraventricular Tachycardia (SVT)

signs & sx

7

A
  1. palpiataions
  2. SOB
  3. diaphoresis
  4. chest pain
  5. rapid breathing
  6. dizziness
  7. LOC
49
Q

Supraventricular Tachycardia (SVT)

EKG findings

3

A
  1. narrow QRS
  2. rate 160-220 bpm & does not vary
  3. cannot separate T waves from P waves
50
Q

Supraventricular Tachycardia (SVT)

tx options

just categories

A
  1. Physical Maneuvers
  2. meds
  3. synchronized cardioversion
51
Q

Supraventricular Tachycardia (SVT)

components of physical maneuvers

7

A
  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
Q

Supraventricular Tachycardia (SVT)

which meds to use?

3

A
  1. IV adenosine (6mg then 12 mg)
  2. IV CCB
  3. IV BB
53
Q

Supraventricular Tachycardia (SVT)

prevention

A

radiofrequency catheter ablation
* preferred approach in pts with recurrant sx PSVT

54
Q

First Degree AV Block

EKG findings

A

fixed prolonged PR interval

55
Q

First Degree AV Block

causes

3

A
  • meds
  • ischemia
  • lyme disease
56
Q

Wenckeback Type I Second Degree AV Block

EKG Findings

A
  • progressive PR interval prolongation with each beat until QRS complex is dropped
  • causes irregular R-R interval, but follows a pattern
57
Q

Mobitz Type II Second Degree AV Block

EKG findings

A
  • extra P waves with a dropped QRS
  • PR interval elongated
  • usually associated with bradycardia
58
Q

Mobitz Type II Second Degree AV Block

tx

A

pacemaker or atropine

59
Q

Mobitz Type II Second Degree AV Block

can progress to?

A

Third Degree AV Block

60
Q

Qualifiers for Perm Pacemaker

6

A
  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
Q

5 ventricular arrhythmias

A
  1. PVC
  2. Ventricular tachy
  3. idioventricular rhythms
  4. ventricular fibrillation
  5. asystole
62
Q

Premature Ventricular Contractions (PVC)

when do these occur?

A

occurs when a focus in the ventricle generates an AP before the next scheduled SA nodal AP

63
Q

Premature Ventricular Contractions (PVC)

EKG findings

A
  1. premature beat
  2. ectopic
  3. wide QRS
  4. compensatory pause
64
Q

Premature Ventricular Contractions (PVC)

associated with?

3

A
  1. energy drinks
  2. electrolyte abnormalities
  3. hyperthyroidism
65
Q

Premature Ventricular Contractions (PVC)

when should an echo be sought?

A
  1. more than 10,000 per day per ambulatory EKG monitoring
  2. 30% of total heart beats
66
Q

Premature Ventricular Contractions (PVC)

sx

67
Q

Premature Ventricular Contractions (PVC)

if sx, what is first line therapy?

A
  1. BB
  2. non-dihydropyridine CCB
68
Q

Ventricular Tachycardia

EKG Findings

A
  • wide QRS complex
  • rate greater than 100 bpm
69
Q

Ventricular Tachycardia

can be associated with?

3

A
  1. degenerating into v fib
  2. presenting as syncope
  3. hemodynamical stability
70
Q

Ventricular Tachycardia

what must occur for vtach? sustained vtach?

A
  • 3+ PVCs in a row
  • sustained = 30+ sec
71
Q

Ventricular Tachycardia

initial tx

A
  • determined by degree of hemodynamic stability
  • urgent direct current cardioversion
  • IV amiodarone
  • can add short-acting BB or verapamil
72
Q

Ventricular Tachycardia

long-term management

A
  • reverse precipitating causes
  • BB for pts with structural heart disease
  • catheter ablation
  • implantable cardioveter-defibrillator
73
Q

Ventricular Tachycardia

polymorphic ventricular tachycardia AKA

A

torsades de pointes

74
Q

Ventricular Tachycardia

Torsades de Pointes EKG findings

A
  • like a ribbon
75
Q

Ventricular Tachycardia

tx for torsades?

76
Q

Ventricular Tachycardia

who has higher risk of developing torsades?

PPP

A

pts with a prolonged QT interval

77
Q

Ventricular Fibrillation

what is happening?

A

quivering of the ventricles with virtually no forward cardiac output

78
Q

Ventricular Fibrillation

treatment

A

ACLS
* defibrillation
* epinephrine
* anti-arrhythmics

79
Q

Ventricular Fibrillation

improved long term outcomes if what occurs?

A

hypothermia protocol is initiated rapidly and maintaine for 24-36 hrs post cardiac arrest

80
Q

Asystole

what is it?

A

flat line- no electrical activity in the heart

81
Q

Asystole

tx

A
  • CPR
  • epinephrine
82
Q

Misc Rhythms

what rhythm is seen with hypokalemia?

A

u waves between T and next P

83
Q

Misc Rhythms

what is seen with hyperkalemia?

4

A
  • peaked T waves
  • widening of QRS
  • increase in PR
  • bradycardia
84
Q

Misc Rhythms

what is seen with hypocalcemia?

A

prolonged QT interval

85
Q

Misc Rhythms

what is seen with hypercalcemia?

A

shortened QT interval

86
Q

Misc Rhythms- Long QT Syndrome

what can long QT syndrome lead to?

A

potentially fatal torsades de pointes

87
Q

Misc Rhythms- Long QT Syndrome

Signs/sx of Long QT Syndrome

A
  • palpitations
  • fainting
  • sudden death
88
Q

Misc Rhythms- Long QT Syndrome

causes of QT prolongation

4

A
  • congenital
  • meds
  • disease states
  • electrolyte imbalances
89
Q

Misc Rhythms- Long QT Syndrome

tx

A
  • treat underlying cause
  • ICD
90
Q

Misc Rhythms- Brugada Syndrome

most commonly from what?

A

a mutation in the sodium channel gene

91
Q

Misc Rhythms- Brugada Syndrome

causes what?

A

sudden cardiac death from torsades or v fib even though the heart is structurally normal. also has normal QT interval

92
Q

Misc Rhythms- Brugada Syndrome

tx

93
Q

Misc Rhythms- Wolff-Parkinson-White (WPW)

describe

A

accessory pathway that connects the electrical system of the atria directly to the ventricles allowing conduction to avoid passing through the AV node

94
Q

Misc Rhythms- Wolff-Parkinson-White (WPW)

EKG findings

A
  • short PR interval
  • slurred R wave (delta)
95
Q

Misc Rhythms- Wolff-Parkinson-White (WPW)

tx

CMT (78 decks)

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