Arrhythmias Flashcards by A B

Sinus Tachycardia

Characteristics of EKG

Normal P and QRS,

regular, fast heart rate >100bpm

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Sinus Tachycardia

Causes

Sympathetic activation:

1) Exercise
2) emotion
3) hypotension,
4) acute lung pathology (pneumonia/cholecy)
5) thyrotoxicosis

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Sinus Tachycardia

Treatment

Usually none

B blockers in thyrotoxicosis (high thyroid hormone)

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Sinus Tachycardia symptom

symptom = angina

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Sinus Bradycardia

Characteristics of EKG

Normal P, QRS,

regular slow HR< 60bpm

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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)

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Sinus Bradycardia

Treatment

none

atropine

pacemaker if sx

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Sinus Bradycardia

symptoms

symptom = syncope, lightheadedness,

fatigue in elderly (sick sinus)

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Sinus Rhythm

Characteristics of EKG

P before QRS, P upright in 2,

down in avR, 60-100 bpm

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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

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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)

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Atrial Fibrillation

complications

Rapid HR

1) ischemia
2) heart failure

Loss of Atrial contraction
1) heart failure

Atrial thrombi
1) embolic stroke

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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)

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Atrial Fibrillation

picture

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Atrial Tachycardia

Characteristics of EKG

Abnormal P waves with narrow QRS

FAST rhythm. > 150/min

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Atrial Tachycardia

causes

Patient in a little distress (nervous/agitated),

structural heart disease

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Atrial Tachycardia

complications

not in notes

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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

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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

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Atrial Flutter

causes

Structural heart disease

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Atrial Flutter

complications

Embolic stroke,

rapid ventricular rates that are poorly tolerated

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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),

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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