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arrythmia Flashcards

1
Q

what is the anatomy of the conduction system ?

A

SA node

internodal pathway

AV node

Common bundle of his

left bundle branch

right bundle branch

purkinje system

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2
Q

describe the normal sinus rhythm?

A

60-100

regular rhythm

P wave present

P —> QRS 1:1 every p wave followed by QRS

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3
Q

what are the causes of cardiac arrhythmias ?

A

ENHACED AUTOMATICITY:
- Enhanced normal automaticity —> sinus tachycardia
-abnormal automaticity Ischemic

TRIGGERED ACTIVITY:
Early after depolarization EAD –> hypoxia, hypokalemia, acidosis, ion channel defects

delayed after depolarization DAD —> digoxin toxicity

RE ENTRY :

macro LARGE reentry commonest as in scar —> atrial flutter

micro SMALL reentry –> Ischemic Heart D induced arrhythmias , brugada syndrome

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4
Q

how do you approach and analysis ECG ?

A

Rate —> normal/tachy/brady

rhythm —> regular/irregular

QRS width —> normal wide

P wave —> is present or nah 1:1

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5
Q

what are the supraventricular arrhythmia?

A

Sinus tachy

atrial premature contraction ( APC ):
premature atrial beat
atrial premature beat
premature atrial complex

atrial fibrillation

atrial flutter

Reentry tachy

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6
Q

describe sinus tachycardia ?

A

rate is more than 100/min

regular rhythm

P waves are present

p —> QRS 1:1 conduction

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7
Q

what are the causes of sinus tachycardia ?

A

anemia
fever
thyrotoxicosis
heat failure
pulmonary embolism
shock

js treat the cause in case of pathological

physiological :

exercise
Fear
anger
Emotions

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8
Q

describe the premature atrial contraction PAC?

A

rate : sinus rate

rhythm : occasionally irregular - interrupted by the premature atrial contraction

-incomplete compensatory pause –> after the contraction LAG in the one behind to understand what happened

P waves : usually different morphology ( a wave for premature contraction before P wave )

P:QRS : usually 1:1 with the premature atrial contraction

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9
Q

what is the treatment for PREMATURE ATRIAL PAC?

A

treat underlying cause if present

usually occurs on normal hearts so no treatment needed

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10
Q

what are the different accessory pathways in SVT?

A

AV reentry tachycardia AVRT —> accessory pathway between the atrium and ventricle that is not AV node —> creating circuit between atrium and ventricle

AV nodal reentry tachycardia AVNRT ( COMMONEST ) —-> the AV node has an reentrant circuit near it leading to –> one signal keeps stimulating it over and over

Atrial tachycardia —> ectopic atrial focus

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11
Q

what is AVNRT usually associated with ?

A

Premature atrial contraction

also sometimes occur on normal hearts and sometimes due to disease or drug/substances

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12
Q

describe the ecg AV nodal reentry tachycardia?

A

rate : atrial rate 150-250 bpm

Rhythm : Abrupt onset and offset of tachycardia
Regular rhythm

P waves : hidden with QRS and sometimes retrograde

P:QRS –> regular conduction 1:1

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13
Q

what is the treatment for AVNRT?

A

Hemodynamically stable :

  • Vagus maneuvers
  • Adenosine 1st , Verapamil 2nd , BB or amiodarone 3rd line

IF hemodynamically unstable : DC

IF recurrent : Radiofrequency ablation of AV nodal slow pathway

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14
Q

describe ecg atrial flutter ?

A

rate : Atrial rate 250-400 bpm

Rhythm :
atrial rhythm is regular
Ventricular rhythm irregular or regular
irregular when 2:1 av block

P waves : Absent —> replaced by flutter waves , SAWTOOTH APPERANCE ( F WAVES )

F wave : QRS : conduction is regular unless AV block 2:1

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15
Q

what is the treatment for atrial flutter?

A

same as atrial fibrillation

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16
Q

what are the causes of atrial fibrillation ?

A

idiopathic

hypertension

myocardial ischemia

mitral stenosis

myocarditis

constrictive pericarditis

Cardiomyopathy

thyrotoxicosis

Drugs – > digoxin

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17
Q

describe the ECG of atrial fibrillation ?

A

RATE:

Atrial rate cannot be measured —> 400-600
Ventricle rate : variable ( irregular or regular )

RHYTHM :
Irregularly irregular

P waves : ABSENT –> FIBRILLATION WAVE ( F WAVE )

F : QRS : irregular

18
Q

what is the treatment of atrial fibrillation ?

A

slow ventricle rate by rate control

anticoagulation

restore sinus rhythm

treat underlying cause

19
Q

what are the treatment triad for atrial fib and atrial flutter ?

A

Anticoagulation : to protect from stroke

Ventricular rate control :
- BB, CCB, Digoxin ( in heart failure )
-AV node ablation + permanent pacemaker

Conversion to sinus rhythm IF STRUCTURE IS STILL NORMAL :
- Medically : flecainide , amiodarone, propafenone, quinidine

DC : if hemodynamically unstable and as an elective after 3 weeks of anticoagulation

20
Q

what is the timing where you use DC?

A

synchronized with :

Peak of R wave

Nadir of S wave ( Deepest point

21
Q

what are the ventricular arrhythmias?

A

premature ventricular contraction PVC :
ventricular premature contraction VPC
premature ventricular beat PVB
premature ventricular complex

Ventricular tachycardia

ventricular fibrillation

pulseless electrical activity –> non shockable

asystole –> non shockable

22
Q

what are the cardiac arrest rhythms ?

A

Ventricular tachy : if pulseless

Ventricular fibrillation

pulseless electrical activity PEA

Asystole

23
Q

describe the premature ventricular contraction PVC?

A

wide bizarre QRS complex larger than 0.12 seconds

originating from the ventricles

followed by a period of pause ( lag pause )

sinus node is continuous and continue to discharge normally

24
Q

what are the types of premature ventricular contraction ?

A

unifocal isolated PVC –> one PVC , occur sporadically , no specific rhythm

Bigeminy —-> occur in a pattern , one PVC after one normal beat so , PVC normal PVC normal

MULTIFOCAL PVC : multiple ectopic foci , PVC different in sizes and origin , irregular rhythm

PVC couplet : 2 pvcs back to back

Non sustained VT/ VT run : 3 OR MORE PVC BACK TO BACK AND TERMINATE SPONTANEOUSLY ( LESS THAN 30 SECONDS )

25
Q

what is the treatment of premature ventricular contraction PVC?

A

usually no need to for treatment

BB if persistent symptoms

treatment of the underlying cause if present

26
Q

describe the ECG of ventricular tachycardia?

A

sustained v tach more than 30 seconds

WIDE qrs higher than 0,12 seconds

rate : atrial rate normal

RHYTHM :
onset of tachycardia : abrupt

regular HR 160-240 bpm

P waves : hidden in QRS ( AV DISSOCIATION )

P:QRS : blocked by AV node

27
Q

what are the causes v tachy?

A

Ischemic heart disease

myocarditis

cardiomyopathy

28
Q

what are the clinical features of V tach?

A

palpitation

hypotension

heart failure

myocardial ischemia

sudden death

frequent cannon waves on JVP jugular venous pulse due to AV dissociation

29
Q

what are the treatments of V tach?

A

complicated with hypotension and HF and IHD —> DC

if patient is stable : lidocaine/ amiodarone

preventing attacks : intra ventricular cardioverter defibrillator

30
Q

describe polymorphic V tach?

A

aka torsade de pointe

Rate : atrial rate normal obscured

rhythm : onset of tachycardia is absrupt FATAL

irregularly regular

P waves : hidden with QRS complexes

31
Q

what is the treatment of polymorphic V tach?

A

unsynchronized defibrillation shock

magnesium —> stops prolonged QT

32
Q

describe ventricular fibrillation ECG?

A

Rate : chaotic ,uncountable

Rhythm : Onset is abrupt, irregular , fatal

P waves: absent

QRS : no organized QRS complexes

33
Q

what are the treatment for v fib?

A

immediate unsynchronized defibrillation shock

34
Q

what are the shockable rhythms?

A

ve tach- –> monomorphic , Pulseless –> synchronized

Polymorphic V tach ( torsade de pointe ) –> unsynchronized

V fib —> unyschronized

35
Q

what are the un shockable rhythms?

A

pulseless electric activity

asystole

36
Q

describe ECG of pulseless electrical activity PEA

A

rate : variable- depends on baseline rhythm

Rhythm : not single rhythm
Organized Rhythm but no pulse

37
Q

what is the treatment of Pulseless electrical activity PEA?

A

CPR : cardiopulmonary resuscitation

epinephrine during CPR , NO DC cuz no electrical problems

identify the cause :

5 Hs : hypovolemia, hypoxia, hydrogen ion ( Acidosis ), hypo/hyperkalemia , hypothermia

5 Ts: tension pneumothorax, tamponade , toxin, thrombosis ( pulmonary ), thrombosis ( coronary )

38
Q

describe ECG of asystole?

A

Rate : absent

rhythm : none ( flatline )

P waves : absent

QRS : absent

P/QRS : not applicable

39
Q

what is the treatment for ASYSTOLE?

A

CPR, epinephrine,

no dc cuz nothing to restart

5 HS, 5 TS

40
Q

what are the types of transvenous pacemakers?

A

Single atrial —> rare

dual chamber : in atrium and ventricle –> commonest

Single ventricular

41
Q

what are the cells affected in sick sinus syndrome?

A

Pacemaker cells P cells —> if affected no generation of pulse

Transitional cells T CELLS —> if affected the signal wont exit the SA node –> exit block

hospital (3 decks)

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