Arrhythmias

Question 1

Premature ventricular complex

Answer 1

wide QRS (slower than normal)
if sympotmatic: beta blockers

Question 2

a fib

Answer 2

undulating baseline
no p waves
irregular R-R interval
narrow QRS
pt: hyperthyroid, old, SOB, dizzines, palpitations, CHF, valve dz

Question 3

a fib tx

Answer 3

unstable: cardioversion
stable: rate control with beta blockers or CCB
anticoag if afib >48 hr

Question 4

cardioversion

Answer 4

with QRS complex

for Afib, aflutter, VT with pulse, SVT

Question 5

defibrillation

Answer 5

not with QRS

for vtach without pulse, v fib

Question 6

a flutter

Answer 6

regular rhythm with ventricular rate 125-150 and atrial rate of 250-300
saw tooth baseline
unstable: cardioversion
stable: rate control with beta blockers or CCB

Question 7

multifocal atrial tachycardia

Answer 7

varying PR and RR interval with 3 plus morphologically distinct p waves
older person with chronic lung dz (COPD)
tx: improve underlying lung dz (o2 and vent)
no cardioversion

Question 8

paroxysmal supraventricular tachycardia

Answer 8

regular narrow QRS complexes with no discernable p waves, 150-220
AV node re-entry circuit
sudden onset palpitations and dizziness
ischemic HD, digoxin toxin
carotid massage, cold water
ADENOSINE, verapamil, esmolol

Question 9

WPW

Answer 9

short PR interval followed by wide QRS> 120 with slurred deflection (delta wave, early ventricular activation via bundle of kent)
Procainamide, or radio ablation
avoid: digoxin, verapamil, beta blockers

Question 10

ventricular tachycardia

Answer 10

3 or more consecutive PVCs at 100-250 bpm
AV dissocation, p waves unaffected
Wide bizzare QRS
cannon a waves in neck, palpitations, dyspnea, lightheadedness
sudden cardiac death, cardiogenic shock

Question 11

ventricular tachycardia tx

Answer 11

stable: IV amiodarone, procainamide, stalol
Unstable: cardioversion
ICD

Question 12

ventricular fibrillation

Answer 12

medical emergency: no p or qrs seen, Chaotic irregular deflections of varying amplitude
Immediate DEFIBRILLATION (UNSYNCHORNIZED CARDIOVERSION) and CPR
follow with amiodarine, lidocaine
epinephrine

Question 13

Torsades de point

Answer 13

prolonged QT leaded to undulating rotation of QRS around baseline. can lead to v fib
Pt with low Mg, low K, Li, TCA OD, anticholenergics
IV mag

Question 14

hyper K

Answer 14

renal failure , crush injury, burn victim
Peaked t waves, wide QRS, short QT. at higher levels P wave widens and flattens, loss of p waves, bradycardia and sine wave
give IV Ca

Question 15

Cardiac tamponade

Answer 15

alternate beat variation in direction, amplitude, and duration of QRS, low voltage, tachy
Patent with pulsus paradoxus, hypotension, distant heart sounds, JVD

Question 16

pericarditis

Answer 16

diffuse ST elevation
Pt better with leaning forward, friction rub; worse with inspiration.
uremia, infections, autoimmune
NSAIDS

Question 17

heart block

Answer 17

first degree: prolonged PR, >.2, QRS follows each P wave. no tx
mobitz type 1: above AV node, progressive prolonged PR leading to dropped QRS. no tx
type 2: below AV node (His-Purkinje), consistent PR with suddenly dropped QRS. pacemaker.
type 3: av dissocitaion. pacemaker. cannone a waves

Question 18

sinus bradycardia

Answer 18

<60 bpm

atropine

Question 19

digoxin toxicity

Answer 19

arrhythmia
anorexia, n/v, adbom pain
neuro: fatigue, confusion, weakness, color vision alterations
etiology: amiodarone, verapamil, quinidine, propafenone