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Step up - Cardiovascular > Arrhythmias > Flashcards

Arrhythmias Flashcards

1
Q

What would you see on an ECG of a patient with PAC’s?

A

Early P waves with different morphology from normal

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2
Q

How do PAC’s affect QRS complex?

A

Normal because conduction is normal below the atria.

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3
Q

PAC’s can lead to what two clinical manifestations?

A

Palpitations

PSVT

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4
Q

What is the common treatment for asymptomatic patients with PAC’s?

A

None

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5
Q

What is used for symptomatic patients with PAC’s?

A

Beta blockers

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6
Q

What ECG finding is seen in PVC’s?

A

Wide QRS complex

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7
Q

Presence of PVC’s in patients with normal hearts is associated with…

A

increased mortality

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8
Q

Patients with frequent PVC’s and underlying heart disease are at increased risk of ….

A

sudden death due to cardiac arrhythmia (especially Vfib)

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9
Q

What test should be ordered for a patient with frequent PVC’s and underlying heart disease?

A

Electrophysiologic study

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10
Q

What treatment may be used for a patient with frequent PVC’s and underlying heart disease?

A

Implantable Cardio Defibrillator

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11
Q

Patients with AFib and underlying heart disease are at a high risk for what two things?

A

Embolization and hemodynamic compromise

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12
Q

What is cardioversion?

A

Delivery of a shock that is in sync with the QRS complex

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13
Q

What is cardioversion indicated for?

A

AFib, atrial flutter, VT with a pulse, SVT

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14
Q

What is defibrillation?

A

Delivery of a shock that is OUT of sync with the QRS complex

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15
Q

What is defibrillation indicated for?

A

VFib, VT without a pulse

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16
Q

What are the three main treatment goals in a stable patient with acute AFib?

A

Rate control
Cardioversion to sinus rhythm
Anticoagulation

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17
Q

What two classes of medications can be used for rate control in acute stable AFib patients?

A

Beta blocker

Calcium channel blocker

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18
Q

What three groups of patients with stable acute AFib are candidates for cardioversion?

A

Hemodynamic instability
Worsening symptoms
First case of AFib

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19
Q

For patients with acute AFib for an unknown period of time that going through cardioversion should be anticoagulated on what schedule?

A

Three weeks before and four weeks after cardioversion

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20
Q

What is the INR goal for AFib patients?

A

2 to 3

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21
Q

Patients with stable chronic AFib, what are the treatment goals?

A

Rate control

Anticoagulation

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22
Q

What group of patients with stable chronic AFib do NOT require anticoagulation?

A

<60
No heart disease
No cardiac risk factors

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23
Q

What are the side effects of adenosine?

A 
Headache
Flushing
SOB
Chest pressure
Nausea
24
Q

Adenosine is most commonly used to treat what?

A

Paroxysmal Supraventricular Tachycardia

25
Q

What are three alternatives to Adenosine for treatment of Paroxysmal SVT?

A

IV Verapamil, IV esmolol, digoxin

26
Q

If drugs do not stop paroxysmal SVT, what can be done?

A

Cardioversion

27
Q

Define ventricular tachycardia

A

Firing of three or more PVC’s in a row at a rate between 100-250bpm

28
Q

What happens to the P wave during ventricular tachycardia?

A

The P wave does not change and is consistent

29
Q

Most common cause of ventricular tachycardia

A

CAD with prior MI is the most common cause

30
Q

How long is sustained VT?

A

longer than 30 seconds

31
Q

ECG finding in ventricular tachycardia

A

wide bizarre QRS complexes

32
Q

How should a hemodynamically stable patient with sustained VTac bbe treated?

A

IV amiodarone or IV procainamide

33
Q

How should a hemodynamically unstable patient with sustained VTac be treated?

A

Immediate synchronous DC cardioversion

IV amiodarone

34
Q

Ideally, if a patient has VTac and decreased ejection, what should they be treated with?

A

ICD

35
Q

In a patient with unsustained VTac and no underlying cardiovascular disease, how should they be treated?

A

Do no treat. Not at risk of sudden death

36
Q

If a patient has nonsustained VTac with underlying heart disease, recent MI, or LV ejection dysfunction, how should they be treated?

A

ICD placement

37
Q

Most episodes of VFib begin with…

A

VTac

38
Q

Most common cause of VFib is…

A

ischemic heart disease

39
Q

What ECG findings are seen in VFib?

A

No atrial P waves
No QRS complexes
Only very irregular rhythm

40
Q

What are the first two treatments for someone presenting with VFib?

A

Defibrillation

CPR

41
Q

What are three clinical features/findings in a patient with VFib?

A

Cannot measure BP, no heart sounds, no pulse
Patient unconscious
If untreated, leads to sudden cardiac death

42
Q

How many sequential shocks can be given for a patient with VFib before trying medication?

A

3 - Check rhythm between each one

43
Q

If defibrillation does not work in stopping VFib, what should be tried next?

A

Epinephrine 1mg IV every 3-5 minutes

44
Q

After the first epinephrine dose for a patient with VFib, when should you attempt to defibrillate them again?

A

30-60 seconds after first epi dose

45
Q

If epinephrine and defibrillation have failed to stop VFib, what is the next option?

A

Amiodarone followed by shock

46
Q

If cardioversion is successful in stopping VFib, what two treatment should follow?

A
  1. Continue IV infusion of whatever antiarrhythmic stopped the VFib, usually amiodarone.
  2. Setup for implantable defibrillator
47
Q

When does sinus bradycardia become clinically significant?

A

<45 BPM

48
Q

What are the top three causes of bradycardia?

A

Ischemia
Increased vagal tone
Antiarrhythmic drugs

49
Q

What is used to treat persistent bradycardia?

A

Cardiac pacemaker

50
Q

What ECG change occurs in first degree AV block?

A

PR interval is prolonged (>0.20s)

51
Q

Mobitz type I and Mobitz type II are what kind of block?

A

2nd degree AV block

52
Q

What ECG change occurs in Mobitz Type I?

A

Progressive prolongation of PR interval until a P wave fails to conduct

53
Q

What ECG change occurs in Mobitz Type II?

A

P wave fails to conduct suddenly, without a preceding PR interval prolongation

54
Q

What part of the heart is responsible for Mobitz Type II?

A

His-Purkinje system

55
Q

What ECG changes occur in 3rd degree AV block?

A

Atrial impulses do not conduct to the ventricles. P waves are consistent with each other but inconsistent with QRS complexes, which in turn are consistent with themselves.

56
Q

Which heart blocks require pacemaker implantation?

A

Second degree Mobitz Type II (commonly leads to complete heart block)
Third degree

Step up - Cardiovascular (1 decks)

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