Arrthymia Flashcards
Prolonged QTC in Males and Females ?
QTc >450 msec in males and >470 msec in females.
Classic ECG findings like a short PR interval, delta wave, and widened QRS.
This patient’s presentation and ECG findings suggest Wolff-Parkinson-White (WPW) syndrome. In WPW, normal sinus impulses reach the ventricles via the accessory pathway before the atrioventricular (AV) node, causing preexcitation and However, most WPW patients are asymptomatic.
WPW syndrome refers to patients with an ECG WPW pattern who develop symptomatic supraventricular arrhythmias involving the accessory pathway. These symptoms include palpitations, lightheadedness, presyncope or syncope, chest pain, and sudden cardiac death (in about 1% of patients).
Symptomatic supraventricular arrhythmias occur when the accessory pathway forms a reentrant circuit back to the atria, causing the initial widened QRS complex to narrow. Atrioventricular reentrant tachycardia (AVRT) is the most common, found in up to 80% of WPW patients, and manifests as a regular narrow QRS complex tachycardia.
(Choices A and B) Atrial fibrillation can occur in 15%-30% of WPW patients due to short refractory periods that preferentially transmit atrial impulses to the ventricle, causing irregular or regular wide QRS complex tachycardia. Rapid repetitive ventricular conduction can lead to rapid ventricular response and subsequent ventricular fibrillation.
Educational objective:
WPW pattern ECG findings include a short PR interval, delta wave, and widened QRS complexes. Asymptomatic patients have the pattern, while symptomatic patients have the syndrome. The most common supraventricular arrhythmia is atrioventricular reentrant tachycardia, a regular narrow complex reentrant tachycardia.
Junctional Escape Beats
When the sinus rate falls below the SA node discharge rate, with the AV node becoming the dominant pacemaker.
Regular wide QRS complexes due to accessory pathway conduction in the forward direction and AV node/His-Purkinje system conduction in the reverse.
Antidromic AVRT, the rarest arrhythmia seen in WPW syndrome
What is WPW Syndrome?
WPW syndrome refers to patients with pre-existing WPW pattern on ECG who develop symptomatic supraventricular arrhythmias involving the accessory pathway.
Managemenet of 1st degree AV block?
Management of 2nd degree AV block + Symptoms ?
Management of 2nd degree AV block + Asymptomatic ?
ECG showing a 2:1 ratio prevents distinguishing between Mobitz type I and Mobitz type II second-degree AV block.
Asymptomatic+ secondary mobitz type II block (carries a high risk of progression to ) third-degree AV block and needs—-> PPM
Symptomatic + Second-degree AV block (Mobitz type I + II) ——-> PPM (treat symptoms)
Mobitz type - no intervention
Dobutamine can be used to treat …………………
Dobutamine can be used to treat patients with refractory heart failure caused by AV block.
According to the advanced cardiac life support protocol, hemodynamically unstable patients, such as those with hypotension, confusion, or chest pain, who are bradycardic, should be treated with**
However, atropine can sometimes ** bradycardia
According to the advanced cardiac life support protocol, hemodynamically unstable patients, such as those with hypotension, confusion, or chest pain, who are bradycardic, should be treated with intravenous atropine (1 mg every 3-5 minutes) or transcutaneous cardiac pacing.
However, atropine can sometimes EXASCERBATE bradycardia that’s due to Second-degree AV block and is not recommended for stable patients like this one.
Catheter ablation is a recommended treatment option for patients with symptomatic paroxysmal atrial fibrillation who have not responded to________.
class l or class ll anti-arrhythmic
PLACE PICK HERE
Patients with prior rheumatic fever are at high risk for recurrent rheumatic fever and subsequent progression of rheumatic heart disease ****
Patients with prior rheumatic fever are at high risk for recurrent rheumatic fever and subsequent progression of rheumatic heart disease due to repeated exposure to Group A Streptococcus (GAS).
Patient
Therefore, continuous antibiotic prophylaxis is essential to prevent GAS pharyngitis. The preferred approach for secondary prevention of rheumatic fever recurrence is long-acting penicillin G benzathine administered intramuscularly every 3-4 weeks. The duration of antibiotic prophylaxis depends on the severity of the underlying rheumatic heart disease, which may include the presence or absence of carditis and valvular disease.
Dual antiplatelet therapy (DAPT) involving aspirin and a platelet P2Y12 receptor blocker (such as clopidogrel, prasugrel, or ticagrelor) is strongly advised for at least 6 to 12 months after the placement of either drug-eluting or bare metal stents (BMS). In cases where the risk of bleeding is high, compliance is poor, or there are planned surgical procedures, treatment can be limited to 1 month after BMS placement. However, premature discontinuation of DAPT is the most significant factor associated with stent thrombosis. This patient’s gastroenteritis likely prevented him from tolerating DAPT alone for only 2 weeks after BMS placement, placing him at a high risk of stent thrombosis.
Dual antiplatelet therapy (DAPT) involving aspirin and a platelet P2Y12 receptor blocker (such as clopidogrel, prasugrel, or ticagrelor) is strongly advised for at least 6 to 12 months after the placement of either drug-eluting or bare metal stents (BMS). In cases where the risk of bleeding is high, compliance is poor, or there are planned surgical procedures, treatment can be limited to 1 month after BMS placement. However, premature discontinuation of DAPT is the most significant factor associated with stent thrombosis. This patient’s gastroenteritis likely prevented him from tolerating DAPT alone for only 2 weeks after BMS placement, placing him at a high risk of stent thrombosis.
