arrhythmias 2

Question 1

atrial flutter

Answer 1

P wave rate 240-320/min -

often P:QRS ratio 2:1 or 3:1 or 4:1

Question 2

Atrial tachycardia

Answer 2

abnormal P waves before each QRS

rate 160-220/min

Question 3

No P waves but QRS complexes present

Answer 3

1. atrial fibrillation
2. junctional rhythm
3. ventricular tachycardia

Question 4

atrial fibrillation

Answer 4

1. irregular QRS beats often with
   undulating baseline.
2. QRS may be narrow or wide

Question 5

junctional rhythm

Answer 5

1. regular rhythm with flat baseline

2. often no P

Question 6

ventricular tachycardia

Answer 6

wide, regular, usually fast QRS

Question 7

No P wave and no QRS

Answer 7

1. ventricular fibrillation

2. asystole

Question 8

ventricular fibrillation

Answer 8

wavy, irregular baseline

Question 9

asystole

Answer 9

flat baseline

Question 10

sinus tachycardia in pt with coronary artery disease,

Answer 10

the increased cardiac oxygen demand may precipitate angina

also a feature of hyperthyroidism

Question 11

sinus tachycardia typical rate

Answer 11

101-150

Question 12

sinus bradycardia may produce

Answer 12

1. syncope during intense vagal activation as in fainting (‘Vaso- Vagal event’) for which atropine is effective.
2. Often occurs with small inferior wall infarctions which increase vagal tone.

Question 13

sinus bradycardia can cause

Answer 13

1. syncope
2. lightheadedness
3. fatique in elderly patients with age-related dysfunction
   (the ‘sick sinus syndrome’)

Question 14

First degree AV block is a

Answer 14

benign condition but can proceed to more serious types of block

Question 15

3rd degree AV block is due to

Answer 15

1. AV node or “junctional” failure with aging

2. infarct or disruption during cardiac surgery.

Question 16

3rd degree AV block may result in

Answer 16

syncope or sudden death

Question 17

in 3rd degree AV block, you see

Answer 17

1. both P and QRS display regular rhythm
2. but they are at different rates
3. P rate> QRS rate

Question 18

Atrial flutter has some risk of

Answer 18

1. embolic stroke due to clot in the left atrium

2. may result in rapid ventricular rates that are poorly tolerated.

Question 19

Because of the increased risk of embolic stroke, nearly all Atrial fibrillation patients are treated with _____

Answer 19

anticoagulation, usually with coumadin (warfarin)

Aspirin is less effective but can be used in low risk cases.

Question 20

Atrial fibrillation rate control can be treated with

Answer 20

1. beta blockers
2. calcium channel blockers (diltiazem or verapamil)
3. digoxin

either alone or in combination.

Question 21

Because atrial fibrillation has a very high recurrence rate, most patients are managed with

Answer 21

anticoagulation and rate control.

Question 22

Atrial fibrillation: conversion to sinus rhythm can be achieved with:

Answer 22

electrical cardioversion drugs or with drugs.

However, maintenance of sinus rhythm often requires drugs with high toxic potential.

Question 23

Arrhythmias can rarely arise from a

Answer 23

single ectopic pacemaker

Question 24

most ectopic rhythms arise from ____.

Answer 24

reentry

Question 25

major mechanism of arrhythmias is

Answer 25

reentry

Question 26

Abnormal reentry pathways can be present in the

Answer 26

atria, ventricles, or the junctional tissue

Question 27

In a normal heart, arrhythmias are:

Answer 27

self- terminating because depolarization at a junction usually meets tissue which has already been depolarized and is therefore refractory to reentry.

Question 28

If chamber dilation and/or islands of fibrosis create a long and circuitous path,

Answer 28

the depolarization can continue to find non-refractory myocardium and be sustained.

Question 29

atrial tachycardia are

Answer 29

1. Quite uncomfortable and disturbing.
2. easily terminated by adenosine infusion.
3. frequently a recurrent problem.

Question 30

atrial tachycardia recurrence is prevented by

Answer 30

ablation of the reentry pathway.