arrhythmias pt 5 Flashcards
tisdale pg 43 to VF end
what are the features of PVCs?
wide QRS complexes
abnormal beats happening in ventricular tissue outside of bundle, slowing it down and making it wider
what are the types of PVCs?
simple - isolated single
frequent/repetitive forms –> pairs, bigeminy, trigeminy, quadrigeminy
what defines a PVC as being frequent?
at least one PVC on a 12-lead ECG or over 30 PVCs per hour
what is the MOA of PVCs?
increased automaticity of ventricular muscle cells/purkinje fibers
what are the risk factors of PVCs?
ischemic HD
MI
anemia
hypoxia
cardiac surgery
what are the symptoms of PVCs?
usually asymptomatic
frequent/repetitive can result in palpitations, dizziness, lightheadedness
in pts with established IHD, PVCs are associated with what?
increased risk of mortality
in MI survivors, what are frequent/repetitive PVCs associated with?
increased risk of sudden cardiac death –> enhanced further in pts with HF
what are very frequent PVCs associated with?
PVC-induced cardiomyopathy
what are frequent PVCs associated with?
increased long term risk of CVD and mortality
how should asymptomatic PVCs be treated?
they shouldn’t
drugs that may treat them were actually killing ppl instead
how should pts with symptomatic PVCs who do not have CAD or HF be treated?
BB, diltiazem, or verapamil
if unresponsive –> antiarrhythmic medications
how should pts with frequent symptomatic PVCs that are unresponsive to BB, CCBs, or antiarrhythmic drugs be treated?
catheter ablation
how should pts with symptomatic PVCs and CAD be treated?
BB, diltiazem, verapamil
if unresponsive –> anti arrhythmic medication
how should pt with symptomatic PVCs in pt who have HF be treated?
BB, but hopefully already on it
what are the features of VT?
regular rhythm but 100-250 bpm
wide QRS complexes
defined as a series of over 3 consecutive PVCs at a rate of over 100 bpm
what are the types of VT?
non sustained
sustained
sustained monomorphic VT in pts with no structural HD
what is nonsustained VT?
three or more consecutive PVCs, terminates spontaneously
what is sustained VT?
VT lasting greater than 30 seconds or requires termination because of hemodynamically stability in under 30 seconds
what is sustained monomorphic VT in pts with no structural HD?
known as idiopathic VT
sometimes responsive to verapamil (known as verapamil-sensitive VT)
may occur in the right or left ventricular outflow tract (known as outflow tract VT)
what is the MOA of VT?
increased automaticity in ventricular tissue
reentry within ventricles
what are the risk factors of VT?
CAD, MI, HF
electrolyte abnormalities (low K, low Mg)
what drugs can induced VT?
flecainide
propafenone
digoxin
what are the symptoms of VT?
may be asymptomatic in nonsustained
hypotension
palpitations
dizziness
lightheadedness
syncope
angina
what is significance of being diagnosed with VT?
sustained VT can progress to ventricular fibrillation (life threatening)
at risk for the syndrome of sudden cardiac death
what are the goals of treatment for VT?
terminate VT and restore normal sinus rhythm
prevent recurrence of VT
reduce risk of sudden cardiac death
what drugs are used to terminate VT?
procainamide
amiodarone
sotalol
verapamil
BB
what are the drug-drug interactions of procainamide?
cimetidine, ranitidine, and trimethorpim inhibit elimination of procainamide
how should termination of hemodynamically VT with structural HD be handled?
1st line –> DCC
2a –> IV procainamide
2b –> IV amiodarone or IV sotalol
how should a person be treated if they failed to successfully terminate their VT be treated?
receive DCC
how should a person who has successfully terminated their VT be treated?
therapy to prevent recurrence guided by underlying HD
how should a person without structural HD who is wishing to terminate their VT be treated?
based on ECG morphology so either verapamil- sensitivity VT or outflow tract VT
how should a person with outflow tract VT be treated?
BB
what is the 1st line choice to prevent recurrence/sudden cardiac death in VT pts?
implantable cardioverter-defibrillator (ICD)
what is the MOA of an ICD?
leads implanted directly onto the heart
inserted percutaneously like a pacemaker
delivers electric shock to heart if VT or VF develops
what are the AE of an ICD?
discomfort with shock
when is amiodarone/sotalol recommended in the prevention of recurrence/sudden cardiac death in VT pts?
in pts with ICDs who have significant symptoms or frequent ICD shocks
used to suppress recurrent VT and reduce frequency of shocks
when is catheter ablation recommended in prevention of recurrence/sudden cardiac death in VT pts?
in pts with prior MI and recurrent episodes of VT, who present with VT and who have failed or are intolerant of amiodarone or other anti-arrhythmic drugs
where does an ICD connect to?
attached to the right ventricle so its able to correct the arrhythmia
what are the features of ventricular fibrillation (VF)?
irregular, disorganized, chaotic electrical activity
no recognizable QRS complexes (due to no depolarization)
what are the risk factors of VF?
MI
HFrEF
CAD
what are the symptoms of VF?
syndrome of sudden cardiac death
no CO, no BP, pt will pass out
what is the goal of treatment for VF?
terminate VF, restore sinus rhythm and spontaneous circulation
what is the only effective treatment of VF?
defibrillation ASAP
drugs alone with not terminate ventricular fibrillation
what is the MOA of defibrillation?
simultaneously depolarizes all myocardial cells, allowing sinus node to resume as pacemaker
what drugs could be used to help aid in defibrillation of VF?
epinephrine
amiodarone
lidocaine
what are the AE of drugs used to treat VF?
post-resuscitation tachycardia (E), hypotension (A), confusion/seizures (L)
what is the process for termination of VF (or VT w/o a pulse)?
CPR x2 min, obtain IV/IO access
defib shock
CPR x 2min
Epi
Defib shock
CPR x 2min
Amiodarone or Lidocaine
Defib shock
CPR x 2min
Epi
Defib shock
CPR x 2min
Amiodarone or Lidocaine
Defib shock
CPR x 2min
Epi
continue
what is an AED
easy to use - machine talks user through procedure
