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Foundations > Arrhythmias > Flashcards

Arrhythmias Flashcards

1
Q

Sick sinus syndrome/Tachy-Brady

A 
Hospitalize
Unstable-ACLS, Atropine, Dopamine, Epi
Stop CCB/BB
Transcutaneous/Transvenous pacing
Ultimately=Permanent pacemaker
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2
Q

Sinus arrest (>2 seconds)

A

If >6 seconds- Permanent pacemaker

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3
Q

First degree AV block

A

No tx

PR int over 200msec

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4
Q

Second degree AV block, Mobitz I

A

No tx

AKA Wekenbach, lengthening PR interval

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5
Q

Second degree AV block, Mobitz II

A

Emergency, need pacemaker.
Consistent PR interval. Dropped QRS, sometimes 2:1.
Block=below HIS (NOT AV)

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6
Q

Complete heart block

A

Emergency, need pacemaker.
Sx: SOB, Syncope, HF
Independent/Unassoc P & QRS

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7
Q

Bundle branch block

A 
No tx.
QRS >0.12 
RBBB= bunny-ears, may be normal
LBBB= negative V1 & positive V6. Never normal. Can't r/o MI EKG changes. 
ST/T waves in opposite direction.
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8
Q

Tachycardia

A

Unstable–SHOCK

DONT use Adenosine with WPW/AFib

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9
Q

PAC

A

Usually asx
Tx: BB or CCB for palpitations
P waves early & may be different morphology

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10
Q

SVT types

A
  1. AVRT- path within AV node

2. AVNRT - path outside the AV node. WPW.

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11
Q

SVT tx

A

Unstable-cardioversion
Stable-Adenosine or Vasovagal maneuver will terminate.
1st line: Catheter ablation
Other options: BB, CCB, anti-arrhythmics

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12
Q

SVT sx/EKG

A

P waves usually hidden, if seen will be different morphology.
Regular narrow QRS at 140-240 bpm.
Sx: palpitations & syncope

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13
Q

WPW EKG

A

Delta wave on resting/sinus (pre-excitation of ventricles)

Syndrome: Delta + SVT + Sx

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14
Q

WPW with AFib

A

NO Adenosine, if you block AV node conduction will only go through alternative pathway.
Adenosine will send into VFib
OK tx: Cardioversion, BB, CCB, acute anti-arrhythmics
Need cath ablation

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15
Q

Atrial fibrillation EKG

A

Irregularly irregular, no discernable P waves (300-600 if measurable).
Ventricular rates-100, but may be slow/normal. QRS same morphology but variable at intervals.
QT interval difficult to measure.
Most common chronic arrhythmia

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16
Q

AF risk factors/presentation

A

Age, Sleep apnea, Valve disease, Obesity, CAD, HTN
May present with embolic event.
Other sx same as others.

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17
Q

AF classifications

A
  1. Paroxysmal-terminates spontaneously/w/in 7 days
  2. Persistent-fails to terminates w/in 7 days of tx
  3. Longstanding persistent-continuous for >12mo.
  4. Permanent-constant & agreed on no rhythm meds.
18
Q

Valvular AF

A 
AF with MS/Rheumatic valve ds
Requires Warfarin (higher stroke risk)
19
Q

CHADSVASC

A 
C ongestive heart failure
H TN
A ge (65 1, >75 2)
D M 
S troke (2)
V
A scular ds 
S ex (F)
C haracteristic

2 or more=Anticoag
1=grey area
0=aspirin is an option

20
Q

AFib tx (anticoag vs procedure)

A

WATCHMAN/left atrial ligation procedure for CI to anti-coag.
1st line=NOAC
2nd line= Warfarin

21
Q

NOACs & CI

A

Adjust for renal fxn
2 hours effective.
Direct=Dabigitran/Pradaxa
Xa inhibitor=Apixiban/Eliquis (best safety)
CI: Bleeding, thrombocytopenia, Severe uncontrolled HTn

22
Q

Warfarin

A

Vitamin K antagonist (Vit K reverses)
Narrow therapeutic window-INR checks
Effective in 2-3 days

23
Q

Afib acute tx

A
  1. Rate: Metoprolol/Diltiazem (Digoxin if difficult)
  2. Cardioversion: Electric or with Amiodarone (Class III)
    W/o anticoag, OK 24-48hrs IF no MS or enlarged LA
    Unsure-TEE to look for LAA thrombus
    Anit-coag 4 wks before & after cardioversion.
24
Q

AFib long term tx

A
  1. Rhythm: (early) Anti-arrhythmics, Cath ablation, MAZE
  2. Rate: (older) BB, CCB, Digoxin
  3. AV ablation + pacemaker: if unable to get on BB, etc (low blood pressure)
25
Q

AFlutter EKG

A

Saw tooth P waves in inferior leads (II, III, aVF)
RA re-entry circuit, 300bpm
Ventricular response typically regular (2:1/3:1)
2:1 can show up as HR of 150, be suspicious

26
Q

AFlutter tx

A
  1. CHADSVASC anticoag.
  2. Same acute tx as AFib
  3. Chronic=catheter ablation is primary tx
    Antiarrhythmics if cannot undergo ablation. (not as good)
27
Q

Atrial tachycardia EKG

A

From atria, not SA node.
P waves hidden, 140-220.
Versus SVT (Adenosine does not terminate atrial tachy)

28
Q

Atrial tachycardia Tx

A

Normal self-limited, will terminate on its own.
BB, CCB, Ic & III for sx.
Rarely need cardioversion.

29
Q

PVC EKG/Sx

A

Wide premature QRS w/o preceding P wave
Sx=Palpitation
Need a holter monitor to assess Tx need

30
Q

Effective bradycardia

A

When PVC does not perfuse blood to extremities.

No pulse on that beat.

31
Q

PVC Indication for tx

A

> 20% burden of QRS are PVC

& Underlyig structural heart issues

32
Q

PVC Tx

A

Sotalol (antiarrhythmic)

Ablation (for uncontrolled sx or PVC causing CM)

33
Q

Ventricular Tachycardia EKG

A 
3 or more PVC in a row
Rate 160-200
Nonsustained= less than 30 sec
Sustained= more than 30 sec
Cause: Previous MI scar/LVOTO
34
Q

V tach Acute Tx

A
  1. Unstable: Shock
  2. Stable: IV Amioradone & BB
    Lidocaine/Procanimide if Am doesn’t work
    If still SV not restored–Cardiovert
    Full Cardiac workup including cath
    Always treat as VT (may be aberrant SVT)
35
Q

Monomorphic vs. Polymorphic VT

A
  1. Monomorphic: Re-entry circuit via MI scar

2. Polymorphic: More unstable, AMI

36
Q

Chronic VT Tx

A
  1. ICD
  2. Sotalol/Amiodarone
  3. Ablation
  4. BB (improves survival)
37
Q

Torsades & Acute Tx

A

Polymorphic VT due to long QTc/Complete hrt block
Tx: Mg & Cardioversion & IV BB
Temporary pace @ 100bpm (decreases QTc)

38
Q

Torsade chronic Tx

A
  1. Stop offending QTc agents

2. Congenital– BB long term

39
Q

Common QTc meds

A
  1. Antiarrhythmics
  2. Antihistamines
  3. Antimicrobials (Macrolide, Fluoroquinolones, Fungal)
  4. Antipsychotics
  5. Gastric motility agents
40
Q

VFib

A

No discernable activity, 200-300 if you could count
Need to shock ASAP
Death, pulseless.
MCC= CAD (Other CHF, Primary arrhythmia)

41
Q

VFib Tx

A 
ACLS:
Emergent DFib
Epinephrine
Chest compressions
Secure airway

Hypothermia minimizes brain injury.
ICD needed if not caused by MI.

Foundations (7 decks)

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