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CLINICAL METHODS MIDTERM > ARRHYTHMIAS > Flashcards

ARRHYTHMIAS Flashcards

1
Q

refers to any disturbance in the rate, regularity, site of origin, or conduction of the cardiac electrical impulse; can be a single aberrant beat or a sustained rhythm disturbance

A

arrythmia

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2
Q

awareness of one’s own heartbeat

A

palpitations

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3
Q

a sudden fainting spell - can indicate a decrease in cardiac output/function

A

syncope

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4
Q

caused by rapid arrhythmias that increase the oxygen demands of the myocardium

A

angina

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5
Q

why arrhythmias happen

A 
(HISDEBS)
Hypoxia
Ischemia and Irritability
Sympathetic stimulation
Drugs
Electrolyte disturbances
Bradycardia
Stretch
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6
Q

ambulatory, portable EKG machine with memory; patient wears for 24-48hrs; 1 or more often 2 leads (1 limb, 1 precordial lead)

A

holter monitor

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7
Q

better for rhythm disturbances that happen so infrequently that a holter monitor is likely to miss it; records 3-5min of data, but is initiated by the patient when he/she experiences symptoms (palpitations)

A

event monitor

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8
Q

5 steps of rhythm analysis

A
  1. calculate rate
  2. determine regularity
  3. assess P waves
  4. determine PR interval
  5. determine QRS duration
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9
Q

sequence for calculating heart rate

A

300 - 150 - 100 - 75 - 60 - 50

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10
Q

calculating rate in 6 second strip

A

count # of waves, multiply by 10

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11
Q

if there are p waves in an arrhythmia strip, where is the origin of the arrhythmia?

A

in the atria

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12
Q

if there are inverted p waves, what is likely happening?

A

current flowing backwards from AV node - atria

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13
Q

if p waves and qrs complexes are independent of each other, what is the cause of the arrhythmia?

A

AV dissociation

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14
Q

how long is a normal PR interval?

A

0.12-2.0sec (3-5 small boxes)

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15
Q

how long is a normal QRS interval?

A

0.04-0.12sec (1-3 small boxes)

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16
Q

name the 5 types of arrhythmias

A
  1. arrhythmias of sinus origin
  2. ectopic rhythms
  3. reentrant arrhythmias
  4. conduction blocks
  5. pre-excitation syndromes
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17
Q

when electrical activity follows the usual conduction pathways, but are either too fast, too slow, or irregular

A

arrhythmias of sinus origin

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18
Q

when the electrical activity originates elsewhere than the sinus node

A

ectopic rhythms

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19
Q

when the electrical activity is trapped within an electrical racetrack whose shape and boundaries are determined by various anatomic or electrical myocardial features

A

reentrant arrhythmias

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20
Q

when the electrical activity originates in the sinus node and follows the usual pathways, but encounters unexpected blocks and delays

A

conduction blocks

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21
Q

when the electrical activity follow accessory conduction pathways that bypass the normal ones, providing an electrical shortcut, or short circuit

A

pre-excitation syndromes

22
Q

sinus tachycardia

A

rate > 100bpm; seen in CHF, severe lung disease, hyperthyroidism

23
Q

sinus bradycardia

A

rate

24
Q

how does inspiration/expiration affect HR?

A

inspiration: accelerates HR
expiration: decelerates HR

25
Q

sinus arrest

A

occurs when sinus node stops firing

26
Q

other myocardial cells spring into action when sinus node stops firing and take over pacing of the heart

A

escape beats

27
Q

prolonged electrical inactivity; no cardiac output/no blood flow

A

asystole

28
Q

treatment for asystole

A

CPR and epinephrine IV

29
Q

most common escape rhythm; depolarization originates near the AV node and usual pattern of atrial depolarization does not occur, thus NO P WAVES

A

junctional escape

30
Q

single ectopic supraventricular beats can originate in the atria (atrial premature beats/premature atrial contractions) or near the AV node (junctional premature beats)

A

atrial & junctional premature beats

31
Q

ex: paroxysmal supraventricular tachycardia (PSVT), atrial flutter, atrial fibrillation, multifocal atrial tachycardia (MAT), paroxysmal atrial tachycardia (PAT)

A

sustained supraventricular arrhythmias

32
Q

regular narrow QRS complex tachycardia; usually sudden and initiated by a premature supra ventricular beat (atrial/junctional) and termination is abrupt; P waves are retrograde if visible; rate of 150-250bpm

A

paroxysmal supraventricular tachycardia

33
Q

can help diagnose and terminate an episode of PSVT; baroreceptors sense changes in pressure which cause reflex response from brain to heart via vagus n. to slow HR

A

carotid massage

34
Q

the most common regular supraventricular tachycardia; occurs when a reentry circuit forms within or just next to the AV node. the circuit usually involves two anatomical pathways: the fast pathway and the low pathway, which are both in the right atrium

A

AV nodal reentrant tachycardia

35
Q

regular, saw-toothed waves; 2:1, 3:1, 4:1 flutter waves to QRS segment; atrial rate of 250-350bpm

A

atrial flutter

36
Q

treatment for atrial flutter

A

cardioversion/drugs

37
Q

irregularly irregular without discernible p waves; undulating baseline with an atrial rate of 350-500bpm and variable ventricular rate

A

atrial fibrillation

38
Q

treatment that may slow ventricular rate

A

carotid massage

39
Q

irregular with a rate of 100-200bpm; at least 3 different P wave morphologies from different atrial foci (P waves of variable shapes), aka wandering atrial pacemaker when rate

A

multifocal atrial tachycardia

40
Q

regular with a rate of 100-200bpm, results from enhanced automaticity of an ectopic atrial focus or reentrant circle within the atria; characteristic warm-up period in the automatic form

A

paroxysmal atrial tachycardia

41
Q

most common of the ventricular arrhythmias; QRS complex is wide and bizarre b/c ventricular depolarization does not follow normal conduction

A

premature ventricular contractions

42
Q

a run of 3 or more consecutive PVCs, with a rate of 120-200bpm; can be uniform or polymorphic (tornadoes de pointes)

A

ventricular tachycardia

43
Q

means twisting of the points; form of VT usually seen in pots with prolonged QT intervals

A

torsades de pointes

44
Q

what sustained ventricular arrhythmia is an emergency preceding cardiac arrest?

A

sustained VT

45
Q

congenital or result from electrolyte disturbance (hypocalcemia, hypomagnesemia or hypokalemia), during MI, some drugs

A

prolonged QT

46
Q

pre-terminal event, seen almost solely in dying hearts; most frequently encountered arrhythmia in adults who experience sudden death; no true QRS complexes; no cardiac output

A

ventricular fibrillation

47
Q

treatment for Vfib

A

CPR/ defibrillation immediately

48
Q

benign rhythm seen during an acute myocardial infarction (or during the early hours following reperfusion); regular rhythm occurring at 50-100bpm; represents a ventricular escape focus that has accelerated sufficiently to drive the heart; rarely sustained, does not progress to VF, and rarely requires treatment

A

accelerated idioventricular rhythm

49
Q

treatment of arrhythmias: arrhythmia is induced in lab, source of arrhythmia is mapped to determine appropriate therapy

A

programmed electrical stimulation

50
Q

treatment of arrhythmias: implantable cardioverter-defibrillators are the standard form of protection for patients with life threatening arrhythmias; surgically implanted under the skin below the shoulder, deliver a shock when a dangerous arrhythmia is detected

A

defibrillators

CLINICAL METHODS MIDTERM (5 decks)

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