Arrhythmias-Dr. Hasan

Question 1

Are MI, Heart Attack, and Cardiac Arrest the same thing?

Answer 1

• Heart Attack=MI
• Cardiac Arrest
  
  • heart stops beating
  • arrhythmia can cause
  • low survival rate

Question 2

Define Arrhythmia

Answer 2

• Any variation in the normal heartbeat or sequences of electrical impulses
• includes disturbance in:
  
  • rhythm
  • rate
  • conduction pattern of heart

Question 3

What population of people do arrhythmias affect more frequently?

Answer 3

• Elderly
  
  • smokers
  • IHD
  • Drugs-cocaine
• Present in 13% >65y.o.
  
  • directly cause 36,000 deaths annually

Question 4

How many deaths do arrhythmias contribute to?

Answer 4

460,000

Question 5

What is the most common type of arrhythmia?

Answer 5

• Atrial Fibrillation
  
  • 2.6 million

Question 6

What drugs effect heartbeat?

Answer 6

• Asthma meds
  
  • cause fast heartbeat
  • inhaled corticosteroids
  • albuterol
• Antibiotics
  
  • fast heart rate
  • Azithromycin
  • Amoxicillin
  • Levofloxacin
  • Ciprofloxacin
• Thyroid
  
  • Levothyroxine
• Antidepressants
• Supplements
  
  • fast or irregular heartbeat
  • valerian

Question 7

Recreational Drugs which may effect heartbeat?

Answer 7

• Cocaine
• Methamphetamine
• LSD
• Ecstasy
• Synthetic Cathinone’s (Bath Salts
• Rohypnol
  
  • benzodiazepine

Question 8

Describe the Conduction system of the heart

Answer 8

• Depolarization of the SA (sinus) node
• Impulse spread to atria
  
  • atria contract
  • blood pumped out
• AV node depolarizes
• Impulse spread to Bundle of His-→R/R Bundle branches
  
  • Results in contraction of ventricles
  • blood pumped out of ventricles

Question 9

What are the different types of arrhythmias?

Answer 9

• Premature (extra) Beats
• Supraventricular Arrhythmias

Question 10

Arrhythmias: Premature Beats

Answer 10

• aka Extra Beats
• most common type
• harmless most of the time
• Causes:
  
  • Naturally-most common
  • heart disease
  • stress
  • to much exercise
  • to much caffeine or nicotine
• usually don’t cause symptoms
• Symptoms:
  
  • fluttering in chest
  • skipped heartbeat feeling
• No Tx

Question 11

What are premature beats that occur in the atria called?

Answer 11

Premature atrial contractions (PACs)

Question 12

What are premature beats that occur in the ventricles called?

Answer 12

Premature Ventricular Contractions (PVCs)

Question 13

Supraventricular Arrhythmias

Answer 13

• Tachycardia’s that start in the atria or AV node

Question 14

AV node

Answer 14

• group of cells located b/w the atria and ventricles

Question 15

What are the different types of supra ventricular arrhythmias?

Answer 15

• Atrial Fibrillation
• atrial flutter
• paroxysmal supraventricular tachycardia (PSVT)
• Wolff-Parkinson-White (WPW) syndrome

Question 16

Atrial Fibrillation

Answer 16

• most common serious arrhythmia
• very fast and irregular contraction of the atria
• Heart’s electrical signals don’t begin in the SA node
  
  • begin in another part of atria or in pulmonary veins
• risk increases with age

Question 17

Atrial Fibrillation

Answer 17

• most common serious arrhythmia
• very fast and irregular contraction of the atria
• Heart’s electrical signals don’t begin in the SA node
  
  • begin in another part of atria or in pulmonary veins
    *

Question 18

What causes Atrial Fibrillation

Answer 18

• Damage to heart’s electrical system due to other conditions that affect the health of the heart
  
  • Hypertension
  • Coronary Heart Disease
  • Rheumatic Heart Disease
  • Inflammation
• other conditions:
  
  • overactive thyroid-to much TH produced
  • Heavy alcohol use

Question 19

What are the 2 main complications of AF?

Answer 19

• Stroke
• Heart Failure

Question 20

Atrial Flutter

Answer 20

• Similar to AF except
  
  • hearts signals spread through atria fast and regular rhythm (not irregular)
• Less common than AF
• similar symptoms and complications to AF

Question 21

Paroxysmal Supraventricular Tachycardia

Answer 21

• PSVT
• very fast heart rate that begins and ends suddenly
• problems w/electrical conduction b/w atria and ventricles
  
  • signals that begin in the atria and travel to the ventricles can re-enter the atria, causing extra heartbeats
• Usually not dangerous
• young people
• vigorous physical activity

Question 22

Wolff-Parkinson-White-Syndrome

Answer 22

• special type of PSVT
• signals travel down extra pathway:
  
  • from atria to ventricles
  • disrupts timing of hearts electrical signals
• cause ventricles to beat very fast
• life threatening

Question 23

Ventricular Arrhythmias

Answer 23

• Start in the ventricles
• very dangerous
• require medical care right away

Question 24

What are the different types of ventricular arrhythmias?

Answer 24

• Types:
  
  • Ventricular tachycardia
  • ventricular fibrillation (V-fib)

Question 25

What are the different causes of ventricular arrhythmias?

Answer 25

* Causes: * Coronary Heart Disease * Heart Attack * weak heart muscle

Question 26

Ventricular Tachycardia

Answer 26

* Fast, regular beating of ventricles * Lastsonly a few seconds or longer * Few beats-no probblems * longer-dangerous * can turn into other more serious arrhythmias * V-fib

Question 27

Ventricular Fibrillation

Answer 27

* when disorganized signals make ventricles quiver instead of pump normally * sudden cardiac arrest and death can occur within minutes * to prevent death * must be treated right away w/defibrillation-electric shot to heart * Can occur: * during or after heart attack or * in already weak heart due to another condition

Question 28

Bradyarrhythmias

Answer 28

* slow HR * if HR is too slow, not enough blood reaches the brain * can cause you to pass out * In Adults: HR\<60BPM * normal in people who are fit

Question 29

What can cause bradyarrhythmias?

Answer 29

* Heart Attacks * conditions that harm or change the hearts electrical activity * underachieve thyroid * aging * Potassium imbalance in blood * Medicines * beta blockers * calcium channel blockers * anti arrhythmic meds * digoxin

Question 30

Diagnosis: Physical Exam

Answer 30

* Listen: * to rate & rhythm of heartbeat * for heart murmur * extra or unusual sound * Check * pulse * swelling in legs or feet * signs of enlarged heart or HF * Look for signs of other diseases * thyroid disease

Question 31

What do doctors do if they want to diagnose arrhythmias that come and go?

Answer 31

* Wear portable EKG monitor * Holter * Event monitors

Question 32

Holter & Event Monitors

Answer 32

* Holter monitor * records hearts electrical signal for 24-48 hours * Event monitor * only records hearts electrical activity at certain times * push bottom to start the monitor when they feel symptoms * some start automatically when they sense abnormal heart rhythms * send data to central monitoring station * wear for weeks or until symptoms occur

Question 33

Diagnosis: Diagnostic Tests & Procedures

Answer 33

* Electrocardiogram (EKG)

Question 34

Diagnosis: Other Tests

Answer 34

* Blood tests * Chest X-ray * Echocardiography * Stress test

Question 35

Treatments: Medicines

Answer 35

No medicines to speed up slow HR * Used to Slow Fast HR & Tx AF * Beta Blockers (-olol) * Calcium channel blockers * diltiazem * verapamil * digoxin * Restore normal heart rhythm→side effects make arrhythmia worse or cause different kind * amiodarone * propafenone * Both * Antiarrhythmics * slow down heart when beating to fast * change abnormal heart rhythm to normal, steady * Blood Thinners→Tx AF * Warfarin * heparin * asprin

Question 36

Treatments: Medical Procedures

Answer 36

* Slow HR * Pacemakers * Cardioversion (aka defibrillation) * jolt of electricity to heart * Implantable Cardioverter defibrillation (ICD) * V-Fib * electrical impulses or shocks to help control life-threatening arrhytmias * continuously monitors heartbeat