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Cardio > Bradycardias and Ventricular Arrhythmias > Flashcards

Bradycardias and Ventricular Arrhythmias Flashcards

1
Q

bradyarrhythmia HR

A

< 60 bpm

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2
Q

patients are usually symptomatic at what heartrate

A

< 50 bpm

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3
Q

bradyarrhythmia may result from

A

sinus node dysfunction due to underlying structural heart disease or aging

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4
Q

risk factors for bradyarrhythmia

A

age, hypothyroidism, drugs, other toxins, cardiac disease, sleep apnea, electrolyte imbalances, hypothermia, hypoglycemia

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5
Q

sick sinus syndrome

A

symptomatic sinus bradycardia and/or periods of sinus arrest

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6
Q

tachy-brady syndrome

A

alternating tachyarrhythmias and bradyarrhythmias

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7
Q

long term treatment of sick sinus syndrome

A

permanent ventricular pacemaker

  • improves symptoms
  • decreases incidence of paroxysmal AF and embolism
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8
Q

AV block definition

A

conduction delay or block can occur in any are of the AV system

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9
Q

av block occurs in patients

A

without underlying structural heart disease (trained athletes)

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10
Q

1st degree av block

A

prolonged PR interval ( > 0.2 seconds)

1:1 AV conduction (usually AVN)

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11
Q

2nd degree av block

Mobitz I

A

progressive PR prolongation until QRS is dropped

< 1:1 AV conduction (AVN)

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12
Q

2nd degree av block

Mobitz II

A

random non-conducted beats (absence of QRS)

< 1:1 AV conduction (below AVN)

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13
Q

3rd degree av block

A

AV dissociation

Absence of AV conduction (AVN or below)

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14
Q

Mobitz II or 3rd degree block + signs of poor perfusion

A
  • initiate transcutaneous pacing immediately
  • atropine 0.5 mg IV
  • epi, dopamine, if atropine failes
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15
Q

3rd degree block can lead to

A

sudden cardiac arrest and death

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16
Q

first step in treating HR < 50 bpm

A

identify and treat underlying cause

  • maintain airway
  • oxygen if hypoxemic
  • cardiac monitor
  • IV access
  • ECG
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17
Q

persistent bradyarrhythmia can cause

A

hypotension, acutely altered mental status, signs of shock, ischemic chest discomfort, or acute heart failure

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18
Q

treatment you give is bradyarrhythmia is causing problems

A

Atropine IV dose

- 0.5 mg bolus, repeat every 3-5 minutes (max is 3 mg)

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19
Q

if atropine doesn’t work, what’s next

A

transcutaneous pacing, dopamine infusion, or epinephrine infusion

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20
Q

dopamine infusion

A

usual infusion rate is 2-20 mcg/kg per minute. titrate to patient response and taper slowly

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21
Q

epinephrine infusion

A

2-10 mcg per minute infusion. titrate to patient response

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22
Q

most common ventricular arrhythmias

A

premature ventricular complexes (PVC), ventricular tachycardia (VT), ventricular fibrillation (VF)

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23
Q

symptoms of ventricular arrhythmias

A
  • sometimes asymptomatic
  • mild palpitations with PVCs, chest pain, dyspnea, and syncope
  • VT progressing to life threatening hemodynamic collapse with VF necessitating CPR
24
Q

PVC occurs in patients

A

with or without structural heart disease

25
Q

causes of pvc

A

may be caused by abnormal automaticity, triggered activity, or reentrant mechanisms

26
Q

PVCs + period of MI

A

risk factor for death independent of LV dysfunction, atherosclerosis

27
Q

simple PVCs

A

infrequent, all waves look alike

28
Q

complex PVCs

A

> 5 PVCs/min, couplets, R-on-T beats, multiform waves, associated with higher mortality

29
Q

treatment for symptomatic PVCs with underlying heart disease

A

initiate BB

30
Q

Define VT

A

more than 3 consecutive PVCs at rate greater than 100 bpm

31
Q

causes of wide QRS VT that are reversible

5 H’s

A

hypoxemia, hypovolemia, hydrogen ions (acidosis), hypo/hyperkalemia, hypothermia

32
Q

causes of wide QRS VT that are reversible

5 T’s

A

tension pneumothorax, tamponade (cardiac), toxins, thrombosis (pulmonary), thrombosis (cardiac)

33
Q

most important treatment of VT/VF

A

synchronized DCC

34
Q

drugs used in VF/VT

A

epinephrine and amiodarone

35
Q

epi in cardiac arrest

A

dose = 1 mg IV push every 3-5 minutes

may repeat with every cycle

36
Q

amiodarone in cardiac arrest

A

dose = 300 mg first cycle, 150 mg second cycle

37
Q

route of administrations in ACLS

A

IV, IO

if you can’t get either of those, Endotracheal (ET)

38
Q

IV roa in ACLS

A

quick IV push followed by normal saline flush (20 mL) to distribute drug throughout the body

39
Q

IO access in ACLS

A

intraosseous if IV access not available

40
Q

ET access in ACLS

A

drugs are dosed 2-2.5 times the IV dose diluted in 10 mL normal saline

41
Q

drugs that can be used in ET roa

A 
Naloxone
Atropine
Vasopressin
Epinephrine
Lidocaine
42
Q

most effective agent after vf/vt occurrence

A

amiodarone

43
Q

non drug therapies for after vf/vt occurrence

A
  • catheter ablation
  • implantable cardioverter-defibrillator (ICD)
  • leads implanted trans venously
44
Q

non drug therapy

tiered therapy approach

A
  1. anti-tachycardia pacing
  2. low energy defibrillation
  3. painful, high energy defibrillation shock if needed
45
Q

VF

A
  • death rapidly ensues without resuscitation

- common sudden cardiac death cause

46
Q

TdP

A

rapid form of VT (delayed ventricular repolarization)

considered a deadly rhythm

47
Q

drugs that cause QT prolongation

antiarrhythmic

A 
quinidine
procainamide
disopyramide
amiodarone
dofetilide
sotalol
ibutilide
48
Q

drugs that cause QT prolongation

psychotropics

A

TCAs
haloperidol/droperidol
pimozide
atypical antipsychotics

49
Q

drug classes that cause QT prolongation

A

antiarrhythmic, psychotropics, toxins, antihistamines, antibiotics, methadone, PPI

50
Q

drugs that cause QT prolongation

toxins

A

organophosphates

arsenic

51
Q

drugs that cause QT prolongation

antibiotics

A

macrolides (erythromycin and clarithromycin)
Bactrim
fluoroquinolones
antifungals (fluconazole, voriconazole, posaconazole)

52
Q

drugs that cause QT prolongation

misc

A 
corticosteroids
diuretics
quinine
chloroquine
chloral hydrate
cisapride
tacrimolus
53
Q

pts w baseline QTc interval > 450

A

should not receive those agents

54
Q

pts w an increase in QTc interval to > 560 msec after drug initiation

A

decrease dose or discontinue

55
Q

TdP likely to recur after

A

DCC and restoration of stable rhythm

56
Q

therapy to prevent recurrence of TdP

A

IV magnesium sulfate

temporary transvenous pacing or pharmacological pacing

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