arrhythmias & afib Flashcards by IFUNANYA CHRIS-UKAH

6 things in the SVT category

sinus tachy
atrial flutter
atrial tachy
AV nodal reentry
WPW
afib

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

sinus tachycardia

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

inappropriate sinus tachycardia

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

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

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

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

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macro-reentrant arrhythmia around a functional or anatomical circuit

typical a flutter

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what is the most common type of flutter

typical a flutter

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anatomical vs functional circuit

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

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atrial rate of 240-340bpm

typical a flutter

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what direction does most typical a flutter go?

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

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atrial rate of 340-430 bpm

atypical atrial flutter

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

atrial tachycardia

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atrial rate of 140-240 bpm

atrial tachycardia

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what causes atrial tachycardia (3)

automatic
triggered (caffeine, sleep, calcium, etc)
reentrant

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why isnt anticoags always required with atrial tachycardias

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

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3 tx for atrial tachycardias

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

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

AVNRT

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when does AVNRT become problematic?

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

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narrow QRS + no P or QRSP

make sure to look at ECG pics

AVNRT ECG

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

AVNRT

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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

WPW syndrome

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does having an accessory pathway imply SVT occurrence?

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short PT interval + delta wave

WPW

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early activation of ventricles through the accessory or bypass tract

delta wave

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

WPW arrhythmia

result of adenosine and valsalva in WPW

turs it into sinus node

how can WPW patient develop wide QRS tachy?

if theres anterograde conduction through accessory pathway

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

V tach

tachycardia where origin can be in right or left ventricle

normal heart VT

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

VT in normal heart symptoms

tachycardia involving reentrant mechanism around a scar in venetricle

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

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

VT in structural heart dz

how is v tach diagnosed?

ECHO

who should you refer patients to cardiologist or electrophysiologist

* all with SVT, VT or significant bradycardia * if new sx develop after successful ablation

2 tx for acute atrial flutter

* rate control + anticoagulant for stroke prevention * cardioversion

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

put patient on IV heparin

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

* anticoagulation x 3 consecutive weeks before * if no appropriate anticoagulation then do TEE to exclude atrial clot

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

give anticoag for at least a month after

chronic a flutter management w/o sx

rate control + anticoagulation

2 chronic mangement for a flutter w/ sx

* anti-arrhythmics * electrophysiology study w/ RF ablation

3 tx of AVNRT

* rate control * antiarrhythmics if having it everyday * EP study + RF ablation if refractory/intolerance to meds

best tx for WPW/bypass tracts?

EP study w/ RF ablation

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

AV nodal blocking agents like BB, CCB, digoxin

2 tx of V tach in normal heart

* rate control * **final** therapy: EP study w/ RF ablation

2 tx of v tach in structural heart dz

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

the most common sustained cardiac arrhythmia

a fib

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

afib ECG

atrial rate of 400-600bpm

afib

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

afib sx | sx reflect decreased CO as result of rapid ventricualr rate

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

unstable afib

adverse sequelae of afib & a flutter

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

natural hx of afib

paroxysmal > persistent > permanent

tx of acute afib (stable vs unstable)

* stable: rate control to slow AV node conduction * unstable: direct current synchronized cardioversion

4 tx options of chronic afib

* rate control (preferred), antirhythmics * cardioversion * RF cather ablation or surgical MAZE * anticoag-- NOAC, warfarin, dual antiplatelet therapy

when do you give anticoag with chronic afib

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

4 indications for catheter based radiofrequency ablation

* symptomatic drug-refractory afib * drug intolerance * tachy-induced cardiomyopathy * special populations-- WPW

4 indications for catheter based radiofrequency ablation

* symptomatic drug-refractory afib * drug intolerance * tachy-induced cardiomyopathy * special populations-- WPW

when is direct current cardioversion most successful when treating Afib

when used w/in 7 days after Afib onset

why would you do TEE before cardioversion

to ensure no atrial clots

indications of cardioversion in afib

for unstable AFib or long term Afib

2 C/I to cardioversion

incessant arrhythmia thrombus (delay it)