Arrhythmias

Question 1

______ arrhythmias result from disturbances in impulse discharge and impulse _______ from the sinus node

Answer 1

Sinus; conduction

Question 2

List the 5 sinus arrhythmias

Answer 2

Sinus bradycardia
Sinus tachycardia
Sinus arrhythmia
Sinus arrest
Sinus exit block

Question 3

Answer 3

Normal sinus rhythm

Question 4

Answer 4

Sinus tachycardia

Question 5

Can be caused by anything that stimulates the sympathetic nervous system or inhibits the parasympathetic nervous system

Answer 5

Sinus tachycardia

Question 6

Drugs such as epinephrine, norepinephrine, dopamine, dobutamine, tricyclic antidepressants, isuprel, cocaine, and nitroprusside _______ sympathetic tone causing ______ HR

Answer 6

Increased, increased

Question 7

Drugs such as atropine _____ parasympathetic tone resulting in _____ HR

Answer 7

Decrease, decreased

Question 8

Answer 8

Sinus bradycardia

Question 9

The sympathetic nervous system works as a cardiac ______

Answer 9

Accelerator

Question 10

The autonomic nervous system works as a cardiac ______

Answer 10

Inhibitor

Question 11

Sinus tachycardia begins and ends ______ in contrast to other tachycardias that begin and end ______

Answer 11

Gradually; suddenly

Question 12

Marked bradyarrhythmias alternating with episodes of tachyarrhythmias that is accompanied by symptoms of hemodynamic compromise (dizziness, syncope, CP, HF)

Answer 12

Tachy-Brady syndrome

Question 13

Treatment of choice for persistent sinus bradycardia

Answer 13

Atropine
Max dose: 3 mg

Question 14

Answer 14

Sinus arrhythmia

Question 15

Answer 15

Sinus pause (arrest and exit block)

Question 16

Differentiator for sinus pauses

Answer 16

Sinus block on time
Sinus arrest not on time

Question 17

A pacemaker other than the sinus node

Answer 17

Ectopic pacemaker
Can be atrial junctional or ventricular

Question 18

Abnormal condition in which myocardial cells may depolarize more than once after stimulation by a single electrical impulse

Answer 18

Triggered automaticity

Question 19

Common causes of triggered automaticity

Answer 19

MI
hypoxia
hypomagnesemia
Long QT
Slow HR
meds that prolong repolarization

Question 20

Circular movement of an impulse commonly resulting in rapid heart rates

Answer 20

Reentry

Question 21

Answer 21

Wandering atrial pacemaker

Question 22

Common causes of reentry

Answer 22

MI
Hyperkalemia
Accessory pathway

Question 23

The pacemaker site shifts back and forth between the sinus node, other atrial sites, and sometimes the AV node

Answer 23

Wandering atrial pacemaker

Question 24

Common cause of WAP

Answer 24

Increased vagal effect on the SA node
(Altered automaticity)

Question 25

Variant of WAP with rates > 100 bpm Common in persons with COPD

Answer 25

MAT multifocal atrial tachycardia

Question 26

Answer 26

PACs

Question 27

PACs associated with a wide QRS complex

Answer 27

Aberrantly conducted PACs Due to impulse reaching the bundle branches before repolarization is complete. Causes sequential depolarization of ventricles

Question 28

T/F The pause associated with PACs is usually non compensatory

Answer 28

True Measurement from r wave before PAC to r wave after PAC is less than the sum of two R-R intervals of underlying rhythm

Question 29

Common causes of PACs

Answer 29

Stress Alcohol, caffeine, nicotine Hypoxia MI Chronic lung disease

Question 30

When PACs occurs in consecutive runs of three or more (at a rate of 140-250 bpm) ______ is considered to be present

Answer 30

Atrial tachycardia

Question 31

Answer 31

Nonconducted PAC

Question 32

Most common cause of unexpected pauses in a regular sinus rhythm

Answer 32

Nonconducted PACs

Question 33

How to differentiate between Nonconducted PAC and sinus pauses

Answer 33

Compare T wave contours PAC will alter T wave

Question 34

Answer 34

Atrial Tachycardia

Question 35

Paroxysmal atrial tachycardia is commonly initiated by a ____

Answer 35

PAC

Question 36

Initial treatment of choice in patients with PAT who are hemodynamically *unstable*

Answer 36

Cardioversion

Question 37

Treatment options for patients with PAT who are hemodynamically *stable*

Answer 37

1st: Sedation Next: vagal maneuvers Adenosine 6mg Rate control drugs (CCB, BB) Ablation

Question 38

Answer 38

Atrial flutter

Question 39

Consists of a negative component followed by a positive component producing v shaped waveforms Sawtooth appearance

Answer 39

Flutter waves in atrial flutter

Question 40

In atrial flutter _____ ratios are more common than _____ ratios

Answer 40

Even; odd

Question 41

If the conduction ratio varies, the ventricular rhythm will be irregular and the rhythm described as atrial flutter with ______\\\

Answer 41

Variable AV conduction

Question 42

Clots in the atria

Answer 42

Mural thrombi

Question 43

If atrial flutter has been present less than ______ it is safe to convert the rhythm with cardioversion or amiodarone

Answer 43

48 hours

Question 44

Answer 44

atrial fibrillation

Question 45

_____ is the most common rhythm next to sinus rhythm

Answer 45

Atrial fibrillation

Question 46

AF with a V rate <100 bpm

Answer 46

Controlled atrial fibrillation

Question 47

AF with a V rate >100 bpm

Answer 47

Uncontrolled AF or AF with rapid ventricular response (RVR)

Question 48

Commonly caused by valvular heart disease, particularly mitral valve disease

Answer 48

Chronic AF

Question 49

List the 6 atrial arrhythmias

Answer 49

Wandering atrial pacemaker Premature atrial contraction Nonconducted PAC Paroxysmal atrial tachycardia Atrial flutter Atrial fibrillation