Arrhythmias 2 Flashcards
an arrhythmia in which ectopic ventricular focus fires an action potential
premature ventricular contraction
what should be considered in premature ventricular contractions?
structural heart disease
what is the threshold of significance in PVCs?
more than 10/hr
what is the present symptom, if any, of PVCs?
palpitations
how does the regularity look in PVCs?
irregular
what would the PRI look like in PVCs?
no PRI due to no P wave
what would the QRS complex and T wave look like in PVCs?
wide/bizarre QRS
discordant T wave
when every alternate beat is a PVC
bigeminy
when two normal beats precede every PVC
trigeminy
two consecutive PVCs
couplets
three consecutives PVCs
triplets
what are 4 consecutive PVCs called?
Ventricular tachycardia
what is the treatment for PVCs in otherwise healthy patients?
reassurance
beta blockers
why is a beta blocker prescribed in PVCs?
for palpitations
what is the treatment for PVCs in patients with advanced structural heart disease?
treat underlying cause
implantable cardioverter-defibrillator (ICD)
an arrhythmia that starts in the ventricle that leads to low cardiac output, slow apical pulse, and difficulty auscultating BP
idioventricular rhythm
what is the rate in idioventricular rhythm?
20-50 bpm
what does the QRS complex look like in idioventricular rhythm?
wide and bizarre
what is the treatment for idioventricular rhythm?
underlying cause
pacemaker
why should we avoid suppressing idioventricular rhythms?
they prevent asystole
what is the most common rhythm presenting post MI?
accelerated idioventricular rhythm
what is the rate in accelerated idioventricular rhythms?
50-100 bpm
what is the treatment for accelerated idioventricular rhythm?
underlying cause
pacemaker
what does the QRS complex look like in accelerated idioventricular rhythm?
wide and bizarre
a series of three or more PVCs that persists more than 30 seconds
sustained monomorphic ventricular tachycardia
a series of three or more PVCs that are self-terminating
non-sustained ventricular tachycardia
what is the treatment for a sustained monomorphic ventricular tachycardia? (2)
cardioversion
antiarrhythmic drug
what does sustained monomorphic ventricular tachycardia lead to?
ventricular fibrillation
sudden cardiac death
what are 4 symptoms of ventricular tachycardia?
low cardiac output
syncope
pulmonary edema
palpitations
what is the rate in ventricular tachycardia?
150-250 bpm
what does the P wave, QRS complex, and T wave look like in ventricular tachycardia?
no P wave
wide/bizarre
discordant T wave
what is it called when a sinus beat falls on a spot that allows some innervation of the ventricle to occur through the normal ventricular conduction system?
fusion beat
what is it called when a sinus beat transmits through the AV node and depolarizes ventricles trough normal conduction system? It occurs in the middle of ventricular tachycardia
capture beats
which ventricular tachycardia beat will look like a “normal” QRS complex?
capture beat
what is the initial management for ventricular tachycardia in a stable patient? (3)
cardioversion
procainamide or amiodarone
what is the initial management for ventricular tachycardia in an unstable patient? (2)
ACLS
torsades = defibrillation
what is the long term management for ventricular tachycardia?
implantable cardioverter-defibrillator (ICD)
what is the treatment for idiopathic ventricular tachycardia? (3)
ablation
B blockers OR calcium channel blockers
multiple ectopic foci or a continually changing reentry circuit
Polymorphic ventricular tachycardia (torsades de pointes)
what is the signature ECG presentation for torsades de pointes?
QT prolongation
which class 3 antiarrhythmic can cause torsades de pointes?
sotalol
what is the pattern associated with torsades de points?
sine wave pattern (party streamer)
if a patient presents with palpitations, syncope, nausea, cold sweats, SOB, and chest pain, what are they likely experiencing?
torsades de points
what is the treatment for torsades de points?
magnesium
what is the pharmacologic treatment for a patient with congenital prolonged QT interval?
beta blockers
what is the nonpharmacologic treatment for a patient with congenital prolonged QT interval?
pacemaker
what is the major cause of mortality in acute MI?
ventricular fibrillation
arrhythmia of disordered, rapid stimulation of the ventricles with no coordinated contractions
ventricular fibrillation
what does the QRS complex look like in ventricular fibrillation?
totally chaotic with no waves or complexes
what are the symptoms of ventricular fibrillation? (2)
pulseless
apneic
what is the short-term treatment for ventricular fibrillation?
shock
what is the long-term treatment for ventricular fibrillation?
implantable cardiovert defibrillator
flat isoelectric line on ECG
asystole
what is the treatment for asystole? (3)
CPR
ACLS
end of life
an overall term covering disorders of the sinus node
sick sinus syndrome
what is the treatment for sick sinus syndrome?
treat underlying cause
what is the treatment for sick sinus syndrome if the patient is symptomatic and has bradycardia?
pacemaker
sudden syncope related to heart rate
stokes-adams attacks
combination of supraventricular tachycardia (afib) and sick sinus syndrome (bradycardia)
bradycardia-tachycardia syndrome
what is the treatment for bradycardia-tachycardia syndrome? (2)
antiarrhythmic drugs
pacemaker
