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SAM I > Arrhythmias Part 2 (diagnosis) > Flashcards

Arrhythmias Part 2 (diagnosis) Flashcards

1
Q

Why do arrhythmias occur?

A
  1. Heart is diseased

2. Extra-cardiac disease is affecting the heart’s electrical activity and/or cardiac blood supply (i.e. GDV)

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2
Q

What are the mechanisms of arrhythmias?

A
  1. Disturbances of impulse formation (excitability)
  2. Disturbances of impulse transmission (conduction)
  3. Complex: disorders involving both
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3
Q

If cardiac excitability is increased and intermittent it will create what kind of impulse formation?

A

premature heart beats

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4
Q

If cardiac excitability is increased and sustained it will create what kind of impulse formation?

A

tachycardia

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5
Q

If cardiac excitability is intermittenly decreased it will create what?

A

lack of sinus complexes (sinus pause)

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6
Q

If cardiac excitability is decreased and sustained it will create what kind of impulse formation?

A

bradycardia or asystole

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7
Q

What is a sinus bradycardia?

A

Sinus rhythm with an abnormally low heart rate (prolonged R-R interval)

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8
Q

What is a primary cause of sinus bradycardia?

A

Sinus node dysfunction

Sick Sinus syndrome

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9
Q

What is a secondary cause of sinus bradycardia?

A

increased/high vagal (parasympathetic) tone

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10
Q

Which is more common in both sinus bradycardia/tachycardia?

A. Primary cause
B. Secondary cause

A

B. Secondary cause

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11
Q

What are pathological causes of high vagal tone?

A
  • respiratory/ intrathoracic disease
  • GI disease
  • neurologic disease (increased ICP)
  • opthalmic disease (increased IOP)
  • drugs/deep anesthesia/ toxins
  • hypothermia
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12
Q

What are non-pathologic causes of high vagal tone?

A
  • sleep/rest
  • athleticism
  • brachycephalics
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13
Q

What is sinus tachycardia?

A

A sinus rhythm with an abnormally high heart rate (shortened R-R intervals)

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14
Q

What are primary causes of sinus tachycardia?

A

Sinus node dysfunction

Sick Sinus Syndrome

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15
Q

What are secondary causes of sinus tachycardia?

A

Increased/high sympathetic tone

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16
Q

What are causes of high sympathetic tone?

A 
Hypotension 
Hypoxia 
Anemia 
Pain/excitment 
Drugs/toxins
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17
Q

What is a supraventricular premature complex (SVPC)?

A

Premature depolarization generated by an ectopic impulse located above the ventricles

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18
Q

Where is the most common ectopic impulse located for a SVPC?

A

Atrial

Others: AV node/junction, SA node

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19
Q

In SVPC, what would you see in an ECG?

A
  • Premature P-QRS-T (P’ might not be visable)
  • narrow QRS
  • QRS associated with a P’
  • often followed by a pause
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20
Q

What are causes of SVPC?

A
  • atrial dilation
  • atrial tumor
  • various systemic and metabolic diseases
  • drugs
  • old age
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21
Q

What is supraventricular tachycardia (SVT)?

A

Any pathological tachycardia originating above the ventricle (atria, AV node/junction, SA node)

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22
Q

What are the different types of SVT?

A
  • Atrial
  • AV nodal
  • Junctional
  • SA nodal
  • Bypass tract
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23
Q

In SVT, what will you see on the ECG?

A
  • 3 or more SVPCs with abnormally high rate (tachycardia!)
  • P’ waves instead of P waves
  • can be sustained (continuous) or paroxysmal (intermittent)
  • usually a regular rhythm
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24
Q

What is atrial fibrillation (AF)?

A

Chaotic and very rapid atrial impulses (400-1200/min) and a large surface area is required

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25
Q

In A Fib, what will you see on the ECG?

A
  • irregularly irregular R-R intervals
  • No P waves
  • Fibrillation waves
  • QRS is usually narrow
  • HR usually fast but can be normal or slow
  • usually a sustained (continuous) rhythm
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26
Q

In dogs and cats, atrial fibrillation is usually secondary to atrial dilation associated with a structural heart disease.

A. True
B. False

A

A. True

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27
Q

What are causes of A Fib?

A
  • general anesthesia
  • GI disease
  • hypothyroidism
  • post-pericardiaocentesis
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28
Q

What is a lone (primary) atrial fibrillation? And what breeds do you see it most commonly in?

A
  • no structural heart disease

- giant and large breed dogs

29
Q

What is atrial flutter?

A
  • organized and rapid atrial impulse (280-400/min)
30
Q

In Atrial flutter, what do you usually see in the ECG?

A
  • No P waves
  • Flutter waves (look like saw tooth)
  • QRS usually narrow
  • No return back to baseline (isoelectric)
  • heart rate is often fast but can be normal or low
  • usually a sustained (continuous) rhythm
31
Q

How can you tell the difference between ST, SVT or Atrial flutter?

A
  • ST rarely exceed 220 bpm in dogs/ 280 bpm in cats

- vagal maneuver can be performed so you can visualize a P, P’ or flutter wave

32
Q

What is a ventricular premature complex (VPC)?

A

Premature depolarization generated by an ectopic focus located in the ventricular tissue (i.e. beyond the bundle branches and Purkinje fibers)

33
Q

What is a common cardiac cause of VPC?

A

cardiomyopathies

34
Q

What are non-cardiac causes of VPCs?

A
  • abdominal tumors (splenic/hepatic)
  • GDV
  • hypokalemia
  • acidosis
  • anemia
  • hypoxemia
  • trauma
  • sepsis
  • hypovolemia
  • drugs/toxins
35
Q

In VPC, what will you see on ECG?

A
  • premature QRS
  • wide QRS
  • VPC often followed by a pause
  • VPC can be + (upright), - (downward) or biphasic
36
Q

VPC from the left ventricle will be…

A. positive deflection
B. negative deflection

A

B. negative deflection

37
Q

VPC from the right ventricle will be…

A. positive deflection
B. negative deflection

A

A. positive deflection

38
Q

What is a ventricular tachycardia (VT)?

A

Tachycardia originating from the ventricle

39
Q

In VT, what can you see on ECG?

A
  • 3 or more consecutive VPCs with abnormally high heart rate
  • VT can be sustained or paroxysmal
  • VT usually is a regular rhythm
  • Wide QRS
  • regular rhythm
40
Q

What is Ventricular fibrillation?

A

Chaotic/disorganized and rapid ventricular impulses (ventricles are quivering not contraction so no CO or BP)

41
Q

What is concerning about VF compared to all other arrhythmias?

A

Fatal rhythm (1 cause of cardiac arrest)

42
Q

What is accelerated idioventricular rhythm (AIVR)?

A
  • looks like a VT without the T
  • usually due to non- cardiac disease
  • don’t treat with anti-arrhythmic drugs
  • treat the cause treat the arrhythmia
43
Q

What are the disorders of impulse conduction?

A
  • AV blocks
  • bundle branch blocks
  • atrial standstill
44
Q

What is a first degree AV block?

A

Conduction in the AV node is delayed

45
Q

What will you see on ECG in first degree AV block?

A
  • Prolonged PR interval
  • Consistent PR interval
  • QRS normal
46
Q

What causes first degree AV block?

A
  • high vagal tone (most common)
  • drugs/toxins (digoxin)

*Not hemodynamically significant

47
Q

What is a second degree AV block?

A

Conduction through the AV node is stopped BUT only intermittenly

48
Q

In a second degree AV block what will you see on ECG?

A
  • Some P waves do not have a QRS after them
  • QRS normal
  • Rhythm can be regular or irregular
49
Q

In second degree AV block, what is Mobitz type I?

A

leading up to the block the PR interval gradually increases (prolongation)

50
Q

In second degree AV block what is Mobitz type II (low grade)?

A
  • no prolongation of the PR interval prior to the block

- most of the impulses are getting down the ventricles

51
Q

In second degree AV block what is Mobitz type II (high grade)?

A
  • no prolongation of the PR interval prior to the block
  • there are more impulses not getting through than there are impulses getting through (more Ps less QRS)
  • causes a bradycardia!!
52
Q

What is a third degree AV block?

A

Conduction through the AV node is stopped permanently

53
Q

In third degree AV block what will you see on ECG?

A
  • Ps without QRS
  • PR interval is not consisten (AV disassociation)
  • before a QRS there is a pause (escape complex)
  • bradycardia
  • rhythm is usually regular
54
Q

What is a typical cause of first degree AV block and second degree AV block Mobitz type I?

A
  • high vagal tone (most common)

- drugs (digoxin + alpha 2 agonist)

55
Q

What are typical causes of second degree AV block Mobitz type II and third degree AV block?

A
  • structural disease of AV node most common
  • hyperkalemia
  • drugs (digoxin)
56
Q

What are bundle branch blocks?

A

Delays in conduction or lack of conduction in the left and/or right bundle branch

57
Q

In bundle branch blocks what will you see on ECG?

A
  • wide QRS complex (>70ms dogs, >40ms cats)
58
Q

In a right bundle branch block, on ECG (lead II) the QRS will deflect…

A. positively
B. negatively

A

B. negatively

59
Q

In a left bundle branch block, on ECG (lead II) the QRS will deflect…

A. positively
B. negatively

A

A. positively

60
Q

What is an atrial standstill?

A

Absence of atrial depolarization

61
Q

In atrial standstill, what will you see on ECG?

A
  • no P waves
  • No fibrillation/flutter waves
  • QRS normal
62
Q

What can cause atrial standstill?

A
  • hyperkalemia (urinary obstruction, Addison’s)

- atrial myopathy (springer spaniel nueromyopathy)

63
Q

What can you see with Sick Sinus syndrome?

A
  • sinus bradycardia and/or sinus arrest (sinus pause)
  • SVPC, VPC, SVT, VT
  • first or second degree AV block
64
Q

What are predisposed breeds to Sick sinus syndrome?

A
  • miniature schnauzer
  • Westie
  • Dachshund
  • cocker spaniel
65
Q

What will you see with hypokalemia?

A
  • prolong repolarization (VPC/APC)

- lowers the resting membrane potention

66
Q

What will you see with MILD hyperkalemia?

A

shortened repolarization and tented T waves

*** NAVLE

67
Q

What do you see with MODERATE hyperkalemia?

A

prolonged transmission velocity (WIDE QRS complexes)

68
Q

What do you see with SEVERE hyperkalemia?

A
  • prolonged PR interval or absent P waves
  • ventricular fibrillation
  • pulseless electrical activity/electromechanical dissociation

SAM I (2 decks)

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