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Cardiology (inpatient) > Atrial Arrhythmias > Flashcards

Atrial Arrhythmias Flashcards

1
Q

sinus Pause/arrest

A

variable time when there is no sinus pacemaker working

-transient absence of sinus P waves on EKG

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2
Q

what can a sinus pause/arrest lead to?

A

an escape rhythm or asystole

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3
Q

what can cause a sinus pause/arrest?

A

ischemia, inflammatory, infiltrative or fibrotic dz of the SA node, excessive vagal tone, sleep apnea, digitatlis

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4
Q

what are sx of sinus pause/arrest?

A

dizzy, presyncope/syncope, rarely death

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5
Q

how is sinus pause/arrest tx?

A

most of the time, nada.

discontinue or decrease meds

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6
Q

why would sleep apnea cause sinus pause/arrest?

A

holding breath, so the pressure change can cause a dropped beat

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7
Q

ectopic rhythm

A

deals w/ impulse formation

-impulse orginates from tissue other than SA node

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8
Q

what are some causes of an ectopic rhythm?

A

another pacemaker cell fires at a rate faster than the SA node=premature beat

or

escaped beat

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9
Q

what is an escaped beat>

A

slowing of the SA node rate allowing faster focie to take control

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10
Q

what are three tipes of ectopic beats?

A

Premature Atrial Contractions (PAC)

Premature Junctional Contration (PJC_

premature ventricular contractions(PVC)

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11
Q

what is a PAC?

A

Other pacemaker cell in the atria fires at a rate faster than the SA node

Triggers a premature heartbeat

Acceleration of HR usually abolishes most PACs

-Can be predictive of future development of Atrial Flutter/Fibrillation

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12
Q

sx of PAC

A

often ASx

will see a “resetting” of the SA beat

palpitations, dizziness

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13
Q

how does exercise affect PACs

A

may make them go away (increase HR)

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14
Q

tx of PAC

A

nada

BB

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15
Q

what is an ectopic atrial tachycardia

A

when an ectopic atrial focus fires more quikkly than the underlying sinus rate

episodes aren’t usually sustained for a extended period

(random fast rhythm)

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16
Q

what is a wandering atrial pacemaker?

A

created by multiple atrial pacemakers firing at its own pace

varying distances cuases 3 + different morphologies of P waves (the varing P wave axis causes diff int hthe morphology

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17
Q

EKG evaluation of WAP

A 
Rate: 100
Rhythm: Irregularly irregular
P wave: At least 3 different morphologies
P:QRS ratio: 1:1
PR interval: Variable, depending on foci
QRS: Normal
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18
Q

what is multifocal atrial tachycardia

A

tachycardic WAP

> 100 bpm

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19
Q

what dz state is associated with MAT?

A

COPD (pulmonary dz)

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20
Q

sx of MAT

A

palpitations, dizzy, SOB

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21
Q

how to you tx MAP?

A

tx underlying condition

Mg and K stability

CCB, BB, ablation

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22
Q

what is paroxysmal supraventricular tachycardia?

A

AKA AV nodal re-entrant tachy

**episodic

  • dual pathways (slow and fast) w/in AV node until terminated
  • think of the heart pc
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23
Q

what dz state is PSVT found?

A

structural heart dz

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24
Q

what are the sx of PSVT

A

palpiations, angina, SOB, abrupt

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25
Q

what is tx of PSVT

A

mechanical-vagal stimulation

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26
Q

what are drug tx of PSVT?

A

adenosine or CCB

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27
Q

how does adenosine work in PSVT

A

blocks electrical conduction through the AV node

28
Q

what dz state must one be careful with when giving adenaosine

A

reactive airway dz bc adenosine can cause bronchospasms

29
Q

what do CCB do for PSV?

A

rapidly induce AV block and break episodes of reentrave

30
Q

what is last resort for PSVT?

A

ablation

31
Q

what level do you cardiovert a pt with PSVT?

A

synchronized electrical cardioversion (100J)

32
Q

Atrial flutter

A

originates in the right atrium

250-350 bpm

33
Q

what does the ventricular rate depend on in A flutter

A

AV node conduction (most common is 2:1 so 150), but can have 3: 1, or 4:1

34
Q

what is the most dangerous A:V rater?

A

1:1 bc it can lead to ventricular fib

35
Q

what are sx of a flutter

A 
-fatigue
SOB
palpitaions
dizzy
presyncope, syncope
36
Q

tx of a flutter: rate control

A

CCB, BB, amiodarone

digoxin if heart failure

37
Q

tx of a flutter: chemical conversion

A

synchornized cardioversion: 50 J

IV ibutilide

38
Q

drug of choice for chronic a fluter

A

dofetilides, but can also use dronedarone, amiodarone, sotalol, procainamide,

39
Q

A Fib

A

chaotic firing of numerous pacemaker cells

-no atrial contraction, no PWave

40
Q

what is the mose common cardiac arrhythmia

A

a fib

41
Q

what population is most likely to get a fib

A

men and with increasedin age

> 80

42
Q

what are causes of a fib

A

valvular disoders, heart dz, dilated cardiomayopathy, HTN, sleep apnea, thyrotoxicosis, pericaditis, Cardiothoracic surgery, pulmonary dz, holiday heart, fatigue, DM

43
Q

what is paroxysmal AFib>

A

AF that terminates spontaneously or with intervention within seven days of onset. Episodes may recur with variable frequency

44
Q

what is persistent AFib?

A

fails to self-terminate within seven days. Episodes often require pharmacologic or electrical cardioversion to restore sinus rhythm. While a patient who has had persistent AF can have later episodes of paroxysmal AF, AF is generally considered a progressive disease

45
Q

lons standing Afib

A

> 12 mnths

46
Q

Permanent AF

A

Persistent AF where a joint decision by the patient and clinician has been made to no longer pursue a rhythm control strategy.

47
Q

Nonvalvular AF:

A

AF in the absence of rheumatic mitral stenosis, a mechanical or biprosthetic heart valve, or mitral valve repair

48
Q

sx of AFib

A

same as any rate issues

49
Q

tx of Afib new onset and unstable

A

present ins Rapid ventricular rate

+/- cardioversion

50
Q

when would a pt need to be cardioverted in Afib

A

active ischemia

organ hypoperfusion (cold clammy skin, confusion, acute kidney injury)

severe manifestations of heart failure (pulmonary edema

51
Q

what about stable pts in afib?

A

+/- thrombus

+/-HF

52
Q

pt w. thrombus or high risk (including being in a fib for more than 48 hours)

A

tx with anticoags (heparin or enoxaprin and warfarin or dabigatran) for 3-4 wks prior to concersio

53
Q

what are rate conrol methods in the presence of HF in pts w/ afib

A

dioxin, amiodarone, dronedarone

54
Q

if no HF, and in a fib,

A

metoprolol, esmolol, or CCb

55
Q

what can be used to chemically convert pts in afib?

A

flecainaide, propafenons, amiodarone, dronedarone, ibutilide

56
Q

what is Wolff-Parkinsons-White syndrome?

A

due to an abnormal accessory electrical conduction pathway btw the atria and vetricles

signals travel down the bundle of kent and stimulate the ventricles to contract prematurely “pre-excitation syndrome”

57
Q

what is WPW assocated with?

A

tachycardias bc this abnormal pathway doesn’t share the rate slowing properties of the AV node

58
Q

what are sx of WPW

A

palpitations, dizzyiness, syncope, anxiety, fatigue, CP, SOB

  • often occurs during exercise
  • stimulate and alcohol can trigger

*think of kid playing soccer and gets CP

59
Q

what are tx for WPW

A

vagal maneuvers

Class 1a or 1c antiarrhythmics if not candiate for ablations

60
Q

what you must avoid tx in pts w/ WPW

A

BB, CCB, and digoxin bc won’t help for this pathhway

61
Q

what will you see on an EKG in a pt with WPW

A

delta wave- no Q wave, slurs up into the R wave

62
Q

what is a junctional rhythm?

A

occurs when the normal pacemaking fx of the atria and SA node is absent or another pacemaker takes over

63
Q

EKG findings in a junctinal rhythm?

A 
Rate: 40-60 
Rhythm: Regular
P wave: None or inverted P before/QRS complex
P:QRS ratio: None or 1:1 
PR Interval: None or short
QRS: Normal to narrow
64
Q

what is an accelerated junctional rhythm

A

originates in a junctional pacemaker that fires faster than the normal pacemaker

65
Q

what would you see o an EKG in accelerated junctional rhythm?

A

Rate: 60-100, if >100 junctional tachycardia
Rhythm: Regular
P wave: None or inverted P before/QRS complex
P:QRS ratio: None or 1:1
PR Interval: None or short
QRS: Normal to narrow

Cardiology (inpatient) (14 decks)

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