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Cardiology > Arrhythmias > Flashcards

Arrhythmias Flashcards

1
Q

abnormalities of the electric rhythm

A

arrhythmias

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2
Q

why do arrhythmias happen? (7)

A

Hypoxia
Ischemia
Sympathetic stimulation
Bradycardia
Electrolyte disturbance
Drugs
Stretch

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3
Q

what does an abnormal number of P waves for every QRS complex suggest?

A

AV nodal block

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4
Q

what does it mean if P waves are not identical?

A

another pacemaker cell is firing

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5
Q

what does a narrow QRS complex mean?

A

impulse came from supraventricular rhtyhm

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6
Q

what does a wide QRS complex indicate?

A

impulses transmitted by direct cell to cell contact

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7
Q

what slows rate by stimulating the vagus nerve and can end arrhythmias?

A

carotid massage

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8
Q

arrhythmias in which electrical activity follows the usual conduction pathway

A

arrhythmias of sinus origin

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9
Q

arrhythmia in which electrical activity originates from a focus other than the sinus node

A

ectopic rhythm

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10
Q

arrhythmia in which electrical activity is trapped within an electrical racetrack whose shape and boundaries are determined by various anatomic or electrical myocardial configurations. These can occur anywhere in the heart.

A

reentrant arrhythmias

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11
Q

arrhythmia in which electrical activity originates in the sinus node and follows the usual pathways but encounters unexpected blocks and delays

A

conduction blocks

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12
Q

arrhythmia in which electrical activity follows anomalous accessory conduction pathways that bypass the normal ones

A

preexcitation syndromes

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13
Q

what speeds up and slows down the heart rate in a sinus arrhythmia, respectively?

A

inspiration
expiration

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14
Q

SA node discharge rate greater than 100 bpm that most often results from increased sympathetic and/or decreased vagal tone

A

sinus tachycardia

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15
Q

SA node discharge less than 60 bmp that can result from enhanced vagal tone and cause fainting

A

sinus bradycardia

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16
Q

what medications cause sinus bradycardia? (3)

A

beta blocker
CCBs
opioids

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17
Q

what is the most common rhythm disturbance seen in the early stages of an AMI?

A

sinus bradycardia

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18
Q

variation in heart rate that accompanies inspiration and expiration

A

sinus arrhythmia

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19
Q

a delay in the SA node that leads to delayed depolarization and contraction

A

atrial escape beat

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20
Q

how could a P wave in atrial escape beat look? (2)

A

flattened
notched

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21
Q

P wave of ectopic beat that occurs early and can be flatted or notched, and may be lost in the preceding T wave

A

premature atrial contractions

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22
Q

a contraction where the P wave could be buried in the QRS or show up after the QRS

A

junctional premature beat

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23
Q

what is frequently the inciting event to paroxysmal supraventricular tachycardia and will reset the SA node?

A

premature atrial contractions

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24
Q

pre-atrial contractions that can last a few seconds to days, in which the SA node gives up and another place in the atria picks up the slack by pacing the heart

A

ectopic atrial rhythm

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25
Q

what would be seen in an ectopic atrial rhythm?

A

P wave may be negative in 1, 2, and aVF

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26
Q

what does an upside down P wave tell us?

A

depolarization started at the bottom of the atria

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27
Q

formation of a reentry circuit, or dual electrical pathways confined to the AV node

A

atrioventricular nodal reentrant tachycardia (AVNRT)

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28
Q

what kind of depolarization / refractory period would a slow pathway in AVNRT produce?

A

slow depolarization / short refractory period

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29
Q

what kind of depolarization / refractory period would a fast pathway in AVNRT produce?

A

fast depolarization / long refractory period

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30
Q

what is the most common symptom of AVNRT?

A

palpitations

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31
Q

what is the usual rate of AVNRT?

A

120-220 bpm

32
Q

a finding on ECG of buried or upside down P wave, depressed ST segment, and T wave inversion indicates what?

A

AVNRT

33
Q

what is suspected in a patient with abrupt onset and offset of rapid sustained palpitations?

A

AVNRT

34
Q

what could terminate an episode of AVNRT?

A

carotid massage (vagal maneuver)

35
Q

what medication can be used to manage AVNRT?

A

adenosine

36
Q

a reentrant circuit that runs along the tricuspid valve at an atrial rate of 180-350 bpm

A

atrial flutter

37
Q

in atrial flutter, the atrial impulse cannot repolarize, so will not get to the ventricle to produce a QRS. what is this caused by?

A

AV block

38
Q

what kind of P waves will be seen in atrial flutter?

A

saw toothed P waves

39
Q

what is the typical relationship between P waves and QRS complexes in atrial flutter?

A

2:1

40
Q

what are 2 ways to get rhythm control in atrial flutter?

A

synchronized cardioversion
chemical cardioversion

41
Q

what is the drug of choice for atrial flutter?

A

ibutillide

42
Q

what are 3 medications to help rate control in atrial flutter?

A

CCB
beta blocker
digoxin

43
Q

what is the best treatment for rate control in atrial flutter?

A

radiofrequency catheter ablation

44
Q

why wouldn’t carotid massage terminate atrial flutter?

A

originates above the AV node

45
Q

multiple tiny reentrant circuits whirling around in totally unpredictable fashion

A

atrial fibrillation

46
Q

what are the etiologies of atrial fibrillation?

A

Pulmonary embolism
Iatrogenic
Rhematic heart disease
Acute coronary syndrome
Thyroid (hyperthyroidism)
ETOH
Sleep (obstructive sleep apnea) or Sick heart

47
Q

what causes changes in depolarization pattern in atrial fibrillation?

A

atrial remodeling / fibrosis

48
Q

in atrial fibrillation, what does chronic remodeling lead to?

A

irreversible atrial enlargement

49
Q

what are 2 symptoms of atrial fibrillation?

A

palpitations
tachycardia

50
Q

what would a patient present with when coming in for atrial fibrillation?

A

embolism

51
Q

what will be seen on JVP or monitoring of atrial fibrillation?

A

absent A waves

52
Q

how is atrial fibrillation rhythm described?

A

irregularly irregular

53
Q

what is the usual atrial rate in atrial fibrillation?

A

more than 350 bpm

54
Q

a patient with unremarkable hx, somewhat normal physical, and incidental finding of atrial fibrillation on ECG would be considered what?

A

stable

55
Q

a patient with hypotension, ongoing ischemia, severe heart failure, stroke, and atrial fibrillation on ECG would be considered what?

A

unstable

56
Q

how should a stable patient with atrial fibrillation be treated?

A

treat underlying etiology

57
Q

how should an unstable patient with atrial fibrillation be treated?

A

cardioversion

58
Q

an electrical discharge that is synchronized to occur at the time of the QRS complex to terminate supraventricular tachycardias or ventricular tachycardias

A

cardioversion

59
Q

would would cardioversion during the T wave lead to?

A

reentry leading to ventricular fibrillation

60
Q

what is used to terminate ventricular fibrillation and is not timed with QRS since there is not a QRS complex on which to synchronize it

A

defibrillation

61
Q

in a patient with atrial fibrillation, how should oral anticoagulants be initiated?

A

bridging - initially use heparin with another anticoagulant

62
Q

what management is the initial approach for most old patients in atrial fibrillation?

A

rate control with drugs

63
Q

what management is pursued in younger patients in atrial fibrillation?

A

rhythm control via cardioversion and arrhythmic drugs

64
Q

what 2 types of medications are used in atrial fibrillation for rate control?

A

beta blocker
CCB

65
Q

what medication is used in patients with atrial fibrillation and systolic heart failure?

A

digoxin

66
Q

what medication is useful in acute ischemia, MI, LV dysfunction, or atrial flutter and atrial fibrillation?

A

amiodarone

67
Q

rhythm with at least 3 different visible shapes in the P wave with a rate that is normal

A

wandering atrial pacemaker

68
Q

irregular rhythm with at least 3 different shapes in the P waves with an atrial rate over 100 bpm

A

multifocal atrial tachycardia (MAT)

69
Q

what 2 conditions is multifocal atrial tachycardia most common in?

A

severe pulmonary disease
hypoxemia

70
Q

what medication can slow the ventricular rate in multifocal atrial tachycardia?

A

CCB verapamil

71
Q

what does not work to treat multifocal atrial tachycardia?

A

carotid massage

72
Q

displayed by a warm-up period when it starts, followed by a somewhat irregular rhythm, and a cool-down period when it terminates

A

paroxysmal atrial tachycardia

73
Q

what can cause paroxysmal atrial tachycardia?

A

digitalis toxicity

74
Q

what is the typical rate in paroxysmal atrial tachycardia?

A

100-180 bpm

75
Q

paroxysmal atrial tachycardia (PAT) and AVNRT look similar. How can I tell the difference?

A

PAT will not respond to carotid massage

Cardiology (19 decks)

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