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Cardiovascular > Arrhythmias > Flashcards

Arrhythmias Flashcards

1
Q

Sinus bradycardia etiology

A

Normal response to CV conditioning

Can also result from sinus node dysfunction or from B-blocker or CCB excess.

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2
Q

Signs/Symptoms of Sinus brady

A

May be Asx. May present with lightheadedness, syncope, chest pain or hypotension

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3
Q

ECG findings in sinus brady

A

Sinus rhythm

Ventricular rate less than 60bpm

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4
Q

Tx for sinus brady

A

None if ASx

Atropine may be used to increase HR

Pacemaker placement is the definitive tx in severe cases.

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5
Q

First degree AV block etiology

A

Can occur in normal individuals

Associated with increased vagal tone and with B-blocker or CCB use

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6
Q

Signs of First degree AV Block

A

Asx

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7
Q

ECG findings for First degree AV block

A

PR interval greater than 200ms

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8
Q

Tx for First degree AV block

A

None needed

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9
Q

Second degree AV block (Mobitz I/Wenckebach) etiology

A

Drug effects (Digoxin, B-blockers, CCBs) or increased vagal tone; R coronary ischemia or infarction

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10
Q

Mobitz I signs

A

Usually ASx

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11
Q

ECG findings for Mobitz I

A

Progressive PR lengthening until a dropped beat occurs; the PR interval then resets

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12
Q

Tx for Mobitz I

A

Stop offending drugs

Atropine as clinically indicated

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13
Q

Second degree AV block (Mobitz II) etiology

A

Results from fibrotic disease of the conduction system or from acute, subacute, or prior MI

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14
Q

Signs of Mobitz II

A

Occasionally syncope

Frequent progression to third-degree block

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15
Q

ECG findings of Mobitz II

A

Unexpected dropped beats without a change in PR

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16
Q

Tx for Mobitz II

A

Pacemaker placement

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17
Q

Third degree AV block (complete) etiology

A

No electrical communication between the atria and ventricles

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18
Q

Signs of complete heart block

A

Syncope, dizziness, acute heart failure, hypotension, cannon A waves

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19
Q

ECG for complete heart block

A

No relationship between P waves and QRS complexes

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20
Q

Tx for complete heart block

A

Pacemaker placement

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21
Q

Sick sinus syndrome/tachycardia-bradycardia syndrome etiology

A

A heterogeneous disorder that leads to intermittent SVT and bradyarrhythmias

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22
Q

Signs and symptoms of SSS

A

Secondary to tachycardia or bradycardia; may include syncope, palpitations, dyspnea, chest pain, TIA, and stroke

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23
Q

Sinus tachycardia etiology

A

Normal physiologic response to fear, pain, and exercise

Can be secondary to hyperthyroid, volume contraction, infection, or Pulm Embolus

This is supraventricular at Atria

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24
Q

Sinus tachycardia signs

A

Palpitations, SOB

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25
Q

ECG sinus tachy

A

Sinus rhythm, ventricular rate above 100bpm

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26
Q

Tx of sinus tachy

A

treat underlying cause

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27
Q

AFib etiology

A

Acute = PIRATES.

1) Pulmonary disease
2) Ischemia
3) Rheumatic heart disease
4) Anemia/Atrial myxoma
4) Thyrotoxicosis
5) Ethanol
6) Sepsis

Chronic - HTN and CHF

This is supraventricular at the atria

28
Q

Signs of AFib

A

Often ASx, but may present with SOB, CP or palpitations

Physical exam reveals an irregularly irregular pulse

29
Q

ECG AFib

A

No discernible P waves, with variable and irregular QRS response

30
Q

Tx for AFib

A

Estimate risk of stroke using CHADS2 score. Anticoagulate if at or above 2.

Anticoagulation if more than 48h (to prevent CVA); rate control (B-blockers, CCBs, digoxin)

Initiate cardioversion only if new onset (less than 48h) or TEE shows no LA clot. OR after 3-6w of warfarin tx with a satisfactory INR of 2-3.

31
Q

Atrial Flutter etiology

A

Another SVT with atrial origin

Circular movement of electrical activity around the atrium at a rate of approximately 300 times per minute

32
Q

Signs of Atrial flutter

A

Usually ASx, but can present with palpitations, syncope, and lightheadedness

33
Q

ECG for Atrial flutter

A

Regular rhythm; “sawtooth” appearance of P waves can be seen. The atrial rate is usually 240-320bpm and the ventricular rate is about 150 bpm

34
Q

Treatment of Atrial flutter

A

Anticoagulation, rate control, and cardioversion guidelines just like in AFib

35
Q

Multifocal atrial tachycardia etiology

A

Another SVT with atrial origin

Multiple atrial pacemakers or reentrant pathways; COPD, hypoxemia

36
Q

Signs of MAT

A

May be ASx.

At least 3 different P-wave morphologies

37
Q

ECG for MAT

A

3 or more unique P wave morphologies

Rate above 100bpm

38
Q

Tx of MAT

A

Treat underlying disorder

Verapamil of B-blockers for rate control and suppression of atrial pacemakers (not very effective)

39
Q

AV nodal reentry tachycardia (AVNRT) etiology

A

an SVT with AV junction origin

A reentry circuit in the AV node depolarizes the atrium and ventricle nearly simultaneously

40
Q

Signs of AVNRT

A

Palpitations, SOB, Angina, Syncope, lightheadedness

41
Q

ECG for AVNRT

A

Rate 150-250bpm

P wave is often buried in QRS or shortly after**

42
Q

Tx of AVNRT

A

Cardiovert if hemodynamically unstable.

Carotid massage, valsalva, or adenosine can stop the arrhythmia

43
Q

Atrioventricular reciprocating tachycardia (AVRT) etiology

A

an SVT with AV junction etiology

An ectopic connection between the atrium and ventricle that causes a reentry circuit. Seen in WPW.

44
Q

Signs of AVRT

A

Palpitations, SOB, Angina, Syncope, lightheadedness

45
Q

ECG for AVRT

A

A retrograde P wave is often seen after a normal QRS.

A preexcitation delta wave is characteristically seen in WPW

46
Q

Tx for AVRT

A

Same as AVNRT

47
Q

Paroxysmal atrial tachycardia

A

an SVT with AV junction origin

Rapid ectopic pacemaker in the atrium (not sinus node)

48
Q

Signs of PAT

A

Palpitations, SOB, Angina, Syncope, lightheadedness

49
Q

ECG for PAT

A

Rate over 100bpm

P wave with an unusual axis before each normal QRS

50
Q

Tx for PAT

A

Adenosine can be used to unmask underlying atrial activity

51
Q

Premature ventricular contraction etiology

A

a VT

Ectopic beats arise from ventricular foci. Associated with hypoxia, electrolyte abnormalities and hyperthyroidism

52
Q

Signs of PVC

A

Usually ASx but may lead to palpitations

53
Q

ECG for PVC

A

Early, wide QRS not preceded by a P wave

PVCs are usually followed by a compensatory pause

54
Q

Tx for PVC

A

Treat underlying cause. If symptomatic give B-blockers or occasionally other antiarrhythmics

55
Q

Ventricular tachycardia etiology

A

a VT (clearly)

Can be associated with CAD, MI, and structural heart disease

56
Q

Signs of VTach

A

Nonsustained VT is often ASx

Sustained VT can lead to palpitations, hypotension, angina, and syncope

Can progress to VFib and death

57
Q

ECG for VT

A

3 or more consecutive PVCs

Wide QRS complexes in a regular rapid rhythm

May see AV dissociation

58
Q

Tx for VT

A

Cardioversion and antiarrhythmics (amiodarone, lidocaine, procainamide)

59
Q

VFib etiology

A

a VT

Associated with CAD and structural heart disease. Also associated with cardiac arrest (together with asystole)

60
Q

Signs of VFib

A

Syncope, absence of BP, pulselessness

61
Q

ECG for VFib

A

Totally erratic wide-complex tracing

62
Q

Tx for VFib

A

Immediate electrical cardioversion and ACLS protocol

63
Q

Torsades de pointes etiology

A

a VT

Associated with long QT syndrome, proarrhythmic response to meds, hypokalemia, congenital deafness and alcoholism

64
Q

Signs of Torsades

A

Can present with sudden cardiac death; typically associated with palpitations, dizziness, and syncope

65
Q

ECG of Torsades

A

Polymorphous QRS; VT with rates between 150 and 250 bpm.

66
Q

Tx for Torsades

A

Give magnesium initially and cardiovert if unstable

Correct hypokalemia

Withdraw offending drugs

Cardiovascular (16 decks)

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