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Cardio > Atrial Arrhythmias > Flashcards

Atrial Arrhythmias Flashcards

1
Q

What is a supraventricular arrhythmia?

A

An arrhythmia that occurs above the bundle of his

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2
Q

What types of arrhythmias require drug treatment?

A
  1. PSVT
  2. automatic atrial tachycardias
  3. afib/aflutter
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3
Q

What is a PSVT?

A

AV nodal reentry arrhythmia

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4
Q

What are the symptoms of PSVT?

A
  1. episodes of rapid HR
  2. abruptly start and stop
  3. syncope, chest or neck pressure
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5
Q

What is the severe symptom of PSVT?

A

HR > 200 bpm

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6
Q

What do you do to correct severe PSVT?

A

synchronized DCC

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7
Q

What do you try first to treat mild-moderate PSVT?

A

non-pharm treatments

  1. unilateral carotid massage
  2. valsalva maneuvers
  3. induced retching
  4. ice water facial immersion
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8
Q

What happens if the non-pharm treatments of mild-moderate PSVT fail?

A

Use drug treatment

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9
Q

What are the drug treatments for mild-moderate PSVT?

A
  1. adenosine IV push
  2. verapmil slow IV push
  3. diltiazem slow IV push
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10
Q

What is the MOA for adenosine, verapamil, and diltiazem?

A

Prolongs conduction time in slow anterograde pathway of the reentrant loop to terminate PSVT

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11
Q

What are the interactions with diltiazem and verapamil?

A

3A4 inhibitors - be careful with statins, HIV meds, and benzos

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12
Q

What is another way to treat PSVT other than long-term chronic drug therapy?

A

transcutaneous catheter ablation using radiofrequency currents

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13
Q

What is an automatic atrial tachycardia?

A

a supraventricular foci with enhanced automatic properties

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14
Q

What is often the underlying cause of automatic atrial tachycardias?

A

Severe pulmonary disease

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15
Q

What also causes automatic atrial tachycardias?

A
  1. acute infection
  2. sepsis
  3. dilated congestive cardiomyopathy
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16
Q

How do you treat automatic atrial tachycardias?

A

Correct the underlying factors (proper oxygenation and correct acid/base/electrolyte disorders)

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17
Q

How can you treat a symptomatic patient with automatic atrial tachycardias?

A

1st line: verapamil, diltiazem

2nd line: IV magnesium (high doses)

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18
Q

What is the most common arrhythmia seen in practice?

A

Atrial fibrillation

19
Q

What leads to higher rates of afib?

A
  1. Worsening HF symptoms
  2. Male
  3. Caucasians
20
Q

What is a common outcome of afib?

A

Not mortality –> Stroke!

21
Q

What cardiovascular conditions is afib usually associated with?

A
  1. HF
  2. mitral valve disease
  3. CAD
  4. HTN
  5. Diabetes
22
Q

What are the common acute causes of afib?

A
  1. MI or cardiac surgery
  2. Hyperthyroidism
  3. PE
  4. Pericarditis
  5. Alcohol intake
23
Q

What is paroxysmal afib?

A

AF that terminates within 7 days of onset

24
Q

What is persistent afib?

A

Continuous afib that is sustained for more than 7 days and does not terminate on its own

25
Q

What is permanent afib?

A

Does not terminate with cardioversion or when the patient and doctor agree to stop trying to restore SR

26
Q

What is acute afib?

A

onset within last 48 hours

27
Q

What is recurrent afib?

A

2 or more episodes (either paroxysmal or persistent afib)

28
Q

What is lone afib?

A

<60 years of age, without evidence of cardiopulmonary disease

29
Q

What is aflutter?

A

single dominant reentrant substrate

30
Q

What does AF do to CO?

A

It decreases CO and leads to an irregularly irregular rhythm

31
Q

What are the common symptoms of afib patients (if they are even symptomatic)?

A
  1. palpitations
  2. rapid HR
  3. worsening HF
  4. fatigue
  5. chest pain
  6. syncope
32
Q

What is a transthoracic ECHO used for?

A

To assess valve function, chamber size, and hypertrophy

33
Q

What is a transesophageal ECHO used for?

A

to screen for left atrial thrombus

34
Q

What test should you order for AF?

A
  1. EKG
  2. ECHO (TTE and TEE)
  3. Thyroid tests
  4. Electrophysiological study
35
Q

What are the goals of management of AF?

A
  1. evaluate need for acute treatment
  2. achieve ventricular rate control
  3. need for SR restoration and maintenance
  4. prevent long-term complications (thromboembolism)
  5. prevent recurrence
36
Q

How do you determine if patient is hemodynamically unstable?

A
  1. VR > 110
  2. Severe hypotension, pulmonary edema, or acute
    MI
37
Q

What do you do with a hemodynamically unstable patient?

A

DCC (shock)

38
Q

What energy level is used for shock of atrial flutter?

A

50 joules

39
Q

What energy level is used for shock of afib?

A

> 200 joules

40
Q

How do you select a drug to control ventricular rate?

A

Left ventricular function

41
Q

What do you use when LVEF > 40%?

A
  1. IV beta-blockers (metoprolol, propranolol, esmolol)

2. IV diltiazem, IV verapamil

42
Q

What do you use when LVEF < 40%?

A
  1. IV digoxin

2. IV amiodarone

43
Q

When do you use rate control?

A

In patients who are not symptomatic

44
Q

What is the maintenance rate control goal?

A

HR < 110 bpm according to RACE II trial

Cardio (11 decks)

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