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cardiology #2 > arrhythmias & afib > Flashcards

arrhythmias & afib Flashcards

1
Q

6 things in the SVT category

A
  • sinus tachy
  • atrial flutter
  • atrial tachy
  • AV nodal reentry
  • WPW
  • afib
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2
Q

usually has a reason like fever, pain, anemia, hypoxemia, anxiety, hyperthyroid, pheo; you treat the patient not the pulse rate

A

sinus tachycardia

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3
Q

when the underlying cause of tachycardia is ruled out, you could use BB, ablation but this is hard to treat and its their default

A

inappropriate sinus tachycardia

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4
Q

whats the difference between typical and atypical aflutter? in their rates?

A
  • with typical you know where the macro-reentrant circuit is
  • atypical has faster atrial rate
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5
Q

how are both types of A. flutter diagnosed w/ maneuvers?

A

adenosine or valsalva will NOT terminate the tachycardia; it exposes the sawtooth pattern

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6
Q

macro-reentrant arrhythmia around a functional or anatomical circuit

A

typical a flutter

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7
Q

what is the most common type of flutter

A

typical a flutter

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8
Q

anatomical vs functional circuit

A
  • anatomical–path around a barrier like valve, scar
  • functional– from heart conditions like long QT syndrome
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9
Q

atrial rate of 240-340bpm

A

typical a flutter

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10
Q

what direction does most typical a flutter go?

A

counterclockwise
* negative sawtooth in II,III,avF
* positive in V1

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11
Q

atrial rate of 340-430 bpm

A

atypical atrial flutter

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12
Q

includes several tachycardia that originate in atria with a different P wave morphology

A

atrial tachycardia

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13
Q

atrial rate of 140-240 bpm

A

atrial tachycardia

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14
Q

what causes atrial tachycardia (3)

A
  • automatic
  • triggered (caffeine, sleep, calcium, etc)
  • reentrant
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15
Q

why isnt anticoags always required with atrial tachycardias

A

theres enough propulsion of blood bc its not going THAT fast
if unsure, can give it

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16
Q

3 tx for atrial tachycardias

A
  • rate control w/ BB, CCB +/- digoxin
  • antiarrhythmics if rate control fails
  • electrophysiology study w/ RF ablation
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17
Q

dual AV node physiology with both a slow and fast pathway between the atria & ventricle; can be unproblematic

A

AVNRT

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18
Q

when does AVNRT become problematic?

A

when the two pathways are going in opposite direction and the slow gets there first instead

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19
Q

narrow QRS + no P or QRSP

make sure to look at ECG pics

A

AVNRT ECG

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20
Q

atrial tachycardia that can terminate w/ valsalva or adenosine bc they cause an AV block

A

AVNRT

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21
Q

accessory pathway or bypass tract (not the AV node) btwn A & V located around tricuspid or mitral annulus; can have mulitple pathways in one patient

A

WPW syndrome

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22
Q

does having an accessory pathway imply SVT occurrence?

A

NO

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23
Q

short PT interval + delta wave

A

WPW

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24
Q

early activation of ventricles through the accessory or bypass tract

A

delta wave

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25
Q

tends to have narrow QRS and involved reentrant circuit w/ retrograde conduction through accessory pathway

A

WPW arrhythmia

26
Q

result of adenosine and valsalva in WPW

A

turs it into sinus node

27
Q

how can WPW patient develop wide QRS tachy?

A

if theres anterograde conduction through accessory pathway

28
Q

wide QRS complex tachycardia originating from ventricles; AV dissociation on ECG

A

V tach

29
Q

tachycardia where origin can be in right or left ventricle

A

normal heart VT

30
Q

type of tachycardia where sx include palpitations and dizziness frequently related to exercise; sudden death is RARE

A

VT in normal heart symptoms

31
Q

tachycardia involving reentrant mechanism around a scar in venetricle

A

VT in structural heart dz (most are in ischemic heart dz)

32
Q

tachy where sx include syncope, very symptomatic/hypotensive or with sudden death

A

VT in structural heart dz

33
Q

how is v tach diagnosed?

A

ECHO

34
Q

who should you refer patients to cardiologist or electrophysiologist

A
  • all with SVT, VT or significant bradycardia
  • if new sx develop after successful ablation
35
Q

2 tx for acute atrial flutter

A
  • rate control + anticoagulant for stroke prevention
  • cardioversion
36
Q

its been less than 48 h since a flutter and you want to do cardioversion, what must be done?

A

put patient on IV heparin

37
Q

its been over 48h since a flutter and you want to do cardioversion. what needs to happen? (2)

A
  • anticoagulation x 3 consecutive weeks before
  • if no appropriate anticoagulation then do TEE to exclude atrial clot
38
Q

regardless of timeline, if you do cardioversion what must be done after?

A

give anticoag for at least a month after

39
Q

chronic a flutter management w/o sx

A

rate control + anticoagulation

40
Q

2 chronic mangement for a flutter w/ sx

A
  • anti-arrhythmics
  • electrophysiology study w/ RF ablation
41
Q

3 tx of AVNRT

A
  • rate control
  • antiarrhythmics if having it everyday
  • EP study + RF ablation if refractory/intolerance to meds
42
Q

best tx for WPW/bypass tracts?

A

EP study w/ RF ablation

43
Q

we should avoid ____ when treating WPW because it can lead to preferential conduction through the accessory pathway

A

AV nodal blocking agents like BB, CCB, digoxin

44
Q

2 tx of V tach in normal heart

A
  • rate control
  • final therapy: EP study w/ RF ablation
45
Q

2 tx of v tach in structural heart dz

A
  • ICDs w/ option of anti-arrhythmics
    * palliative therapy w/ EP study and RF ablation
46
Q

the most common sustained cardiac arrhythmia

A

a fib

47
Q

irregularly irregular SVT with fine oscillations of the baseline d/t absence of organized atrial activity

A

afib ECG

48
Q

atrial rate of 400-600bpm

A

afib

49
Q

mostly asymptomatic but sx could include palpitations, dizziness, fatigue, general weakness, poor exercise tolerance, mild dyspnea and presyncope

A

afib sx

sx reflect decreased CO as result of rapid ventricualr rate

50
Q

sx d/t hypoperfusion and include sig hypotension (double digits), altered mental status, refractory chest pain and decompensated CHF

A

unstable afib

51
Q

adverse sequelae of afib & a flutter

A

increased risk of atrial thrombus formation that can lead to cerebral &/or systemic embolization (acute ischemic stroke)

52
Q

natural hx of afib

A

paroxysmal > persistent > permanent

53
Q

tx of acute afib (stable vs unstable)

A
  • stable: rate control to slow AV node conduction
  • unstable: direct current synchronized cardioversion
54
Q

4 tx options of chronic afib

A
  • rate control (preferred), antirhythmics
  • cardioversion
  • RF cather ablation or surgical MAZE
  • anticoag– NOAC, warfarin, dual antiplatelet therapy
55
Q

when do you give anticoag with chronic afib

A

CHADS score of 2+ bc then risk of stroke is higher than risk of bleeding from the anticoagulant

56
Q

4 indications for catheter based radiofrequency ablation

A
  • symptomatic drug-refractory afib
  • drug intolerance
  • tachy-induced cardiomyopathy
  • special populations– WPW
56
Q

4 indications for catheter based radiofrequency ablation

A
  • symptomatic drug-refractory afib
  • drug intolerance
  • tachy-induced cardiomyopathy
  • special populations– WPW
57
Q

when is direct current cardioversion most successful when treating Afib

A

when used w/in 7 days after Afib onset

58
Q

why would you do TEE before cardioversion

A

to ensure no atrial clots

59
Q

indications of cardioversion in afib

A

for unstable AFib or long term Afib

60
Q

2 C/I to cardioversion

A

incessant arrhythmia
thrombus (delay it)

cardiology #2 (12 decks)

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