Arrhythmias Flashcards
Sinus Tachycardia
Characteristics of EKG
Normal P and QRS,
regular, fast heart rate >100bpm
Sinus Tachycardia
Causes
Sympathetic activation:
1) Exercise
2) emotion
3) hypotension,
4) acute lung pathology (pneumonia/cholecy)
5) thyrotoxicosis
Sinus Tachycardia
Treatment
Usually none
B blockers in thyrotoxicosis (high thyroid hormone)
Sinus Tachycardia symptom
symptom = angina
Sinus Bradycardia
Characteristics of EKG
Normal P, QRS,
regular slow HR< 60bpm
Sinus Bradycardia
Causes
Athletics
Vagotonic state (parasympathetic) - faint (Vagovagal episodes)
- sick sinus syndrome (sinus rate slows, ventricle stiffer, low SV)
- inferior infarct (increased vagal activity)
Sinus Bradycardia
Treatment
none
atropine
pacemaker if sx
Sinus Bradycardia
symptoms
symptom = syncope, lightheadedness,
fatigue in elderly (sick sinus)
Sinus Rhythm
Characteristics of EKG
P before QRS, P upright in 2,
down in avR, 60-100 bpm
Atrial Fibrillation
Characteristics of EKG
1) No P wave but chaotic atrial depol at > 350b/min
2) irregular QRS (irregular R-R interval)
“irregularly irregular QRS”
Look for squiggles at baseline
Atrial Fibrillation
causes
1) aging (fibrosis of atria –> re-entry)
2) post operative (stress response)
3) heart disease (mitral valve disease/ DCM)
4) hyperthyroidism
5) Lone AFib = normal subjects (w/ stress)
Atrial Fibrillation
complications
Rapid HR
1) ischemia
2) heart failure
Loss of Atrial contraction
1) heart failure
Atrial thrombi
1) embolic stroke
Atrial Fibrillation
treatment
1) anticoagulation
2) rate control with drugs (B blockers, Ca 2+ channel blockers @ AV node)
3) cardioversion
4) ablation
Rhythm control (I,III,cardioversion, ablation, shock)
Atrial Fibrillation
picture
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Atrial Tachycardia
Characteristics of EKG
Abnormal P waves with narrow QRS
FAST rhythm. > 150/min
Atrial Tachycardia
causes
Patient in a little distress (nervous/agitated),
structural heart disease
Atrial Tachycardia
complications
not in notes
Atrial Tachycardia
treatment
1) adenosine (quick decr SA and AV node)
2) vagal manuever (stim vagus, slow rate via baroreceptor)
3) beta blocker
4) verapamil or diltiazem
Atrial Tachycardia
picture
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Atrial Flutter
Characteristics of EKG
1) Sawtooth pattern
2) P wave rate ↑200ish (240-320/min)
3) regular or irregular pulse
Atrial Flutter
causes
Structural heart disease
Atrial Flutter
complications
Embolic stroke,
rapid ventricular rates that are poorly tolerated
Atrial Flutter
treatments
1) Anticoagulation (to prevent risk of clot)
2) Adenosine,
3) rate control (verapamil, diltiazem)
4) cardioversion
5) ablation
(if have slow AV too - βB, Ca 2+ Blocker- so 1:1 recovery isn’t too fast = syncope),
Atrial Flutter
picture
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Premature Atrial Contraction (atrial premature beat)
Characteristics of EKG
Premature beat preceded by ABNORMAL P wave, narrow (normal) QRS
Premature Atrial Contraction
causes
Healthy young person with
occasional palpitations
Premature Atrial Contraction
treatment
none
Premature Ventricular Contraction
Characteristics of EKG
Wide/abnormal QRS, no P wave, pause before
normal rhythm restored
Premature Ventricular Contraction
causes
Common in normal healthy patients
1) Acute MI
2) HF
extra:
Caffeine, ectopic ventricular focus conducted by
slow myocardium,
Premature Ventricular Contraction
treatments
Usually nothing, B blockers (reduce symp involvement)
ablation in extreme cases (worry about HF)
Premature Ventricular Contraction
picture
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Torsades de Pointes
Characteristics of EKG
Wide complexes at very rapid rate,
no p waves, sinusoidal pattern,
twisting around a point (sub type of VT)
Torsades de Pointes
causes
Long QT interval
Torsades de Pointes
complications
Death, Vfib
Torsades de Pointes
treatment
Shock, if have time give
Mg 2+ (shortens QT)
Torsades de Pointes
picture
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Ventricular Tachycardia
Characteristics of EKG
regular, wide QRS (100-200 bpm)
no P waves
sustained v-tach = > 30 secs
85% of wide complex tachycardia is VT
Ventricular Tachycardia
causes
Ectopic ventricular focus conducted
by slow myocardium
Ventricular Tachycardia
complications
Low blood pressure- not
enough time for filling.
>30s could lead to cardiac arrest
Ventricular Tachycardia
treatments
If stable:
1) amiodaraone bolus, then IV.
2) lidocaine
if unstable:
cardioversion
Emergency defibrillation.
Automatic implantable cardiac defibrillator.
what is sustained ventricular tachycardia
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Ventricular fibrillation
Characteristics of EKG
no consistent QRS complexes/coordinated contraction
No real pattern, no P.
Irregular baseline.
RANDOM.
Ventricular fibrillation
causes
Abnormal ventricular contractions
Ventricular fibrillation
complications
No blood leaving the heart in a
coordinated manner,
sudden death
Ventricular fibrillation
treatments
Emergency defibrillation
Ventricular fibrillation
picture
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1st degree AV block
Characteristics of EKG
Prolonged PR interval, > 0.2 s
incr junctional delay
1st degree AV block
causes
Drug induced (B blockers, Ca 2+ blockers, digitalis)
conduction system disease
1st degree AV block
complications
Mostly benign
1st degree AV block
picture
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2nd degree AV block
Characteristics of EKG
Consistent PR intervals with dropped ventricular beats.
“A single dropped beat”
some P waves conduct, some don’t
2nd degree AV block
causes
conduction disease
tone drugs)
2nd degree AV block
complications
Syncope, confusion
2nd degree AV block
treatments
Pacemaker if needed Isoproterenol,
Dopaminecan be used temporarily -
but bad if infranodal block.
2nd degree AV block
Define 2 Mobitz Types
(Mobitz 1 = PR lengthen until P dosen’t conduct) = Wenckebach due to incr vagal tone
(Mobitz 2 = no change in PR)
3rd Degree AV block
Characteristics of EKG
Both P and QRS show regular rhythm, but they are at different rates.
With P rate > QRS rate.
3rd Degree AV block
causes
1) Severe conduction system disease (ischemia)
2) rarely drugs
3) sarcoidosis (interfere with conduction of AV node)
extra:
aging, infarct, cardiac surgery,
(AV node disease)
3rd Degree AV block
complications
Syncope and sudden death
3rd Degree AV block
treatments
Pacemaker if ventricular rate or BP too late
3rd Degree AV block
picture
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Junctional Rhythm
Characteristics of EKG
1) regular
2) narrow QRS
3) no antecedent P waves (can see negative P wave b/c AV node is stim ventricle and backward stim atria)
P- waves upright in aVR,
negative in II, III and aVF
Junctional Rhythm
picture
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Treatment for Mobitz 1
Atropine (decr vagal tone)
Treatment for junctional rhythm
none
