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3. Cat & Dog 3 > Arrhythmias > Flashcards

Arrhythmias Flashcards

1
Q

HR for normal dog and cat

A

Normal:
Dog ~ 60 – 160/min
Cat ~ 120 – 240/min

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2
Q

Arrhythmia - when to suspect arrythmia from auscultation? then, what can we find out from ECG?

A

Auscultation
* Irregular
* Too fast, too slow
* Pulse deficits
→ ECG
* Supraventricular
* Ventricular
* Block

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3
Q

what are the components of the P, QRS, T ECG wave? why is it that shape?

A
  1. Initiates at SA node
  2. Depolarizes atria (P wave)
  3. Delay through AV node (PQ
    interval)
  4. Depolarizes ventricles via His-
    Purkinje system (QRS complex)
  5. Ventricles repolarize (T wave)
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4
Q

what is a sinus rhythm? sinus arrhythmia? sinus brady and tachycardia?

A
  • Sinus rhythm: regular, expected heart rate
  • Sinus arrhythmia: irregular, expected heart rate
  • Sinus bradycardia: regular, too slow
  • Sinus tachycardia: regular, too fast
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5
Q

what is a conduction block? types? how do they look on our ECG?

A
  • Sinus rhythm with conduction abnormality:
  • Left bundle branch block (LBBB)
  • Right bundle branch block (RBBB)
  • ventricular depolarization will be affected on ECG
    > eg. With left bundle branch block, depolarization will take extra time on the left side. Nothing really changes with orientation as the left is always more dominant vs right. QRS will be slightly wider than what we normally expect. Still sinus, not worried about rhythm.
    > with right bundle branch block, things change more. Right side is still depolarizing after left is done. The ECG leads, instead of being positive as normal in lead III, aVF, and II, are now negative. The lead aVR which is usually negative, is now positive. Right bundle branch block will shift how our ECG looks. Still sinus.
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6
Q

normal lead orientation with respect to heart. Start at aorta (~1o clock) and go clockwise:

A
  • aVL (1 o’clock) (augmented Vector Left)
  • I (3 o’clock)
  • II (5 o’clock)
  • aVF (6 o’clock) (aVFoot)
  • III (7 o’clock)
  • aVR (10 o’clock) (aVRight)
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7
Q

Supraventricular arrhythmia types, and what we observe, generally

A
  • Supraventricular premature complexes: irregular, expected heart rate
  • Supraventricular tachycardia: regular, too fast
  • Atrial fibrillation: irregular, too fast
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8
Q

Supraventricular premature complexes - what they look like on ECG

A

premature activation of the atria from a site other than the sinus node and can originate from the atria or the atrioventricular node, though most are of atrial origin
<><><><>
- we are missing a P, if it is merged with the previous T wave
- if they were all sinus and come from the SA node, the P-R interval should be the same
- QRS looks the same as normal sinus complex
- can see ‘pauses’ between complexes (activation of SA node, reset)

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9
Q

Supraventricular tachycardia
- what it looks like on ECG

A
  • one place producing arrhythmia, so regular rhythm
  • no P waves, as it does not start in the normal SA node (depolarization occurs differently to normal)
  • normal QRS
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10
Q

atrial fibrillation
- usual presentation?
- what we see on ECG

A
  • decompensated heart disease
  • super fast
  • usually present in heart failure
  • Fast, no P-waves, irregular rhythm
    (wobbly waves)
  • atria are depolarizing all the time
  • AV node is confused about what information to let through from atria (irregular)
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11
Q

Ventricular arrhythmia types, what they look like, generally

A
  • Ventricular premature complexes: irregular, expected heart rate
  • Ventricular couplets, triplets, runs: irregular, too fast
  • Ventricular tachycardia: regular, too fast
    <><><><>
  • abnormal QRS complexes
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12
Q

Ventricular premature complexes
- ECG appearance

A
  • some normal P-QRS-T, and then we see an early complex
  • early QRS will look very different from normal, because the ventricle is depolarizing in a completely different way vs our normal complexes
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13
Q

Ventricular couplets, runs
- ECG appearance

A
  • probably sounded irregular
  • abnormal complexes, QRS much taller and wider, look completely different > several in a row make couplets, triplets, runs…
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14
Q

Ventricular premature complexes vs LBBB ECG appearance

A
  • ventricular origin will look abnormal, and will not have a P-wave in front of it
  • LBBB will have a P-wave (though the complex may look strange). We are not really worried about this.
    <><><><>
  • both look wider and upright, but the P-wave is a give away (P-wave in front of each of them regularly means it is sinus origin for LBBB)
  • conduction abnormality is consistent beat to beat
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15
Q

Ventricular premature complexes vs RBBB

A
  • do look similar, but RBBB all will have P-waves in front of them at a consistent, regular distance
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16
Q

Ventricular tachycardia ECG appearance

A
  • tall zig-zag, fast, super regular
  • one area which is depolarizing and repolarizing all the time
17
Q

Tachyarrhythmia - approach

A
  1. ECG
  2. Calculate heart rate
  3. Identify sinus complex
  4. Compare abnormal complexes to sinus complex
    i. Similar to sinus complex: supraventricular arrhythmia
    ii. Different to sinus complex: ventricular arrhythmia
18
Q

Atrioventricular block (AVB) types, what we observe with each

A
  • takes longer to go from atria to ventricles
    <><><><>
  • First degree AVB: prolongation PR; Regular, expected heart rate
  • Second degree AVB: occasional non-conducted Ps;
    Irregular, too slow, (expected heart rate)
  • Third degree AVB: complete block, no P-QRS association;
    Regular, too slow
19
Q

Second degree AVB ECG appearance

A
  • see P-waves but no QRS following
  • QRS looks normal
  • see several normal complexes in a row, but then a non-conducted P wave, with nothing following (ie. occasional non-conducted Ps)
    <><><><>
  • if you are observant you can notice prolonged P-R intervals too
20
Q

Third degree AVB ECG appearance

A
  • Complete block: P own rhythm, ventricular escape
    <><><><><>
  • sinus node is trying to hold a normal heart rate, but there is a lack of communication with the AV node
  • so we see P-waves, but there are no associated QRS complexes
  • ventricles are not hearing anything from above, but there will be ventricular beats every once in a while due to ventricular escape, which is meant to keep you alive
    > may be wider than you expect
21
Q

Ventricular escape complexes/rhythm
- what is this?

A
  • Rescue from the ventricles; ensure heart is beating despite lack of input / communications from atria
  • After sinus pauses, with AVB
  • Same as ventricular premature complex: complexes from the ventricles
    > Difference: Not early (comes after a pause)
22
Q

Sick sinus syndrome: brady-tachycardia
- what is this?

A
  • episodes of bradycardia and tachycardia
  • a complete mess of the conduction system
  • May see all this stuff in the same ECG:
  • Sinus rhythm, sinus arrest, AVB, supraventricular tachycardia
23
Q

Bradyarrhythmia - approach

A
  1. ECG
  2. Calculate heart rate
  3. Identify P and QRS: PR time, association P-QRS
    i. Prolonged PR: first degree AVB
    ii. Occasional non-conducted P: second degree AVB
    iii. No Association between P and QRS: third degree AVB
    iv. Normal P-QRS, long pauses: marked sinus arrhythmia, sick sinus syndrome
24
Q

Supraventricular arrhythmias
- which ones need treatment?

A
  • Supraventricular premature complexes: might not need treatment > > if we choose the wrong treatment, we might make things worse! Often better to just monitor, and treat underlying disease
  • Supraventricular tachycardia: Yes * Atrial fibrillation: Yes
25
Q

Supraventricular arrhythmia treatment options? considerations?

A

-Goal: slow down conduction through the AV node
<><><><>
1. Diltiazem (Ca channel blocker): PO (IV) > first choice
<><>
2. Sotalol (K channel blocker): PO > if you tried Diltiazem and weren’t fully happy
<><>
3. Atenolol (beta blocker): PO
i. Not in heart failure: reduces heart rate, negative inotrope
ii. Careful if respiratory disease
iii. Do not stop suddenly
> if in doubt, don’t use this!

26
Q

Ventricular arrhythmias
- which need treatment?

A
  • Ventricular premature complexes: might not need treatment
  • Ventricular couplets, triplets, runs: Yes
  • Ventricular tachycardia: Yes
27
Q

Ventricular arrhythmia
- treatment options

A
  • Lidocaine (Na channel blocker): IV
    <><>
  • Sotalol (K channel blocker): PO
    <><>
  • Atenolol (beta blocker): PO
    i. Not in heart failure
    ii. Careful if respiratory disease
    iii. Do not stop suddenly
28
Q

Bradyarrhythmia
- when to treat?
- what to do?

A

Clinical signs:
* Third degree AVB
* Second degree AVB
* Sick sinus syndrome
> Pacemaker
<><><><>
* Theophylline, terbutaline
> might not work

29
Q

Summary:
supraventricular tachyarrhythmia treatments for:
- emergency
- if cardiac disease
- no cardiac disease

A

Treat disease that causes arrhythmia!
<><><><>
- Emergency: Diltiazem IV
<><>
Oral:
* If cardiac disease: Diltiazem
* No cardiac disease: Sotalol, atenolol

30
Q

Summary:
ventricular tachyarrhythmia treatments for:
- emergency
- if cardiac disease
- no cardiac disease

A

Treat disease that causes arrhythmia!
<><><><>
- Emergency (IV): Lidocain
<><>
Oral:
* If cardiac disease: Sotalol
* No cardiac disease: Atenolol

3. Cat & Dog 3 (26 decks)

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