CABS Arrhythmias Flashcards
PAC’s (premature atrial contraction) is when
May originate within ______ area of the atria or the _______ node.
atria getting wonky and cause premature contraction
not from sinus nodal cells
may originate within another area of the atria or the AV node
PAC’s morphology
narrow; looks like everywhere else just coming in early (QRS complex)
will have a change in the PR interval
PAC’s can degenerate into ________ __________ and can cause _________.
other arrhythmias
Atrial myopathy (atria might enlarge)
PVC’s (premature ventricular contraction) is when
abnormal beats are coming from ventricular myocardium
PVC’s morphology
wider - did not come from the Atria came from the ventricles since it had to go around-about way to stimulate the electrical impulse so it takes longer
PVC subtypes (descriptions on the ratio)
Bigeminy - every 2 beats
Trigeminy - two normal, PVC
Quadrigeminy - three normal, PVC
Blocks are a delay in conduction along the _________ pathway
Ventricular
1st degree block is a delay in transmission from _______ through the ______ node to the ________
atria
AV node
Ventricles
On ECG in first degree block you will see ___________.
prolonged PR interval (> 200ms or 3+ boxes)
1st degree AV block has no impact on ______________.
Cardiac output
2nd degree Atrioventricular Block (AV Block) has two types =
Mobitz Type 1 (Wenckebach)
Mobitz Type 2
Mobitz Type 1 =
Wenckebach - progressive prolongation until beat drop (first PR segment is normal)
beat, beat, beat, drop - now you got a Wenckebach
Mobitz Type 2 =
PR is maintained but will occasionally not conduct through to the ventricles (worse, more unpredictable loss of QRS complex)
Second degree may be associated with ______ involving/ near the conduction system
MI
3rd degree Atrioventricular Block (AV Block) =
complete heart block, no atrial impulses reach the ventricle (not sharing the electricity, wide QRS complex, p waves are normal but do not really correlate with one another)
In 3rd degree block, the atria and ventricles are ______ communicating and HR is typically < ______ bpm
not
45 bpm
A result of 3rd degree block is bradycardia and decreased end diastolic filling, pt may present with:
lightheadedness
palpitations
syncope
weakness
fatigue
chest pain (not enough O2)
Bundle branch blocks is
disruption of electrical conduction down one of the bundle branches coming off of the Bundle of His
Right bundle branch block (RBBB) are associated with increased ___________ ventricle hypertrophy, increased ventricular ________, MI, infarction, inflammation and iatrogenic meds
right
pressure
Left Bundle Branch Block (LBBB) are often associated with ______/_________, __________ (abscess), post _______ changes.
MI/ infarction
endocarditis
post surgical changes
RBBB on ECG
“bunny ears” in V1-3
Normal speed and pattern down the left bundle, RV contraction is activated via the septum, R-wave is delayed
LBBB on ECG
Wider QRS complex
Normal speed/pattern down the right bundle, bulk of ventricular depolarization and muscle tone is on the left side, results in slow QRS complex (Wide)
Things to ask yourself about arrhythmias
regular or irregular
fast or slow
wide or narrow
P-waves
Tachyarrhythmias that are Narrow and Regular on ECG
sinus tachycardia
supraventricular tachycardia
atrial flutter
Tachyarrhythmias that are narrow and irregular on ECG
multifocal atrial tachycardia
atrial fibrillation
tachyarrhythmias that are wide and regular on ECG
ventricular tachycardia
hyperkalemia
Tachyarrhythmias that are wide and irregular on ECG
polymorphic ventricular tachycardia
ventricular fibrillation
tachyarrhythmias: are typically associated with
increased automaticity
increased triggering
re-entry circuit
Sinus tachycardia is the m/c tachyarrhythmia they are usually -
HR > than _____ bpm and is a ________ dysrhythmia
100 bpm
benign (no end organ damage)
Tx of sinus tachycardia
treat the underlying cause
Causes of sinus tachycardia
increased automaticity (increased SA node firing)
increased sympathetic tone (catecholamines)
Paroxysmal Supraventricular tachycardia is a sustained ________ loop within the ________ node, _____-waves are typically not visualized
re-entry
AV node
P-waves
Difference between PSVT and sinus tach
sinus tach =
HR will always stay high but rate will fluctuate
PSVT =
HR never changes
PSVT on ECG
rate 150-250
P-waves are buried within the QRS complex or P on T (no PR interval)
Narrow QRS
Tx for PSVT
adenosine - slow down HR
vasovagal maneuver - bear down, blow up a syringe while doing sit up
carotid massage - one at a time to stimulate baroreceptors
Atrial fibrillation is …
due to _______ areas of _________ that are desynchronized within the ________.
irregularly irregular rhythm with narrow QRS complex (not a sinus rhythm)
multiple
automaticity
atria (SA node is not in control)
3 types of Afib are
paroxysmal
persistent
permanent
Paroxysmal Afib lasts less than …
7 days with spontaneous conversion
Persistent Afib is over _____ or needs _______.
7 days or needs cardioversion
Permanent Afib is …
Long standing (staying in Afib for forever)
Afib on ECG shows
No clear P waves
QRS are narrow
Irregularly irregular QRS complex
seen best in V1
Left atrial appendage has a big tendency to lead to
Stroke
Atrial flutter on ECG looks like …
regular rate (R-R is regular)
narrow QRS
single morphology P-waves in sawtooth pattern
typically 150 bpm
For ventricular tachycardia impulses originate in the myocardium of the __________ and is most associated with previous _______.
Ventricles
MI
1 cause of ventricular tachycardia is
long QT
Torsades de Pointes is
twisting of the points - a polymorphic VT (wide and narrow) from prolonged QT, increased automaticity
Tx of torsades de pointes
magnesium IV bollus
Ventricular fibrillation - primary disease is most commonly associated with
ischemic disease
two types of ventricular fibrillation
coarse and fine
Ventricular fibrillation on ECG looks like
course or fine
No P-waves, defined QRS, T waves
unable to determine real rate (very irregular)
Bradyarrhythmia may be associated with decreased
automaticity
sinus bradycardia causes
increased vagal tone (parasympathetic)
medications that slow AV conduction
metabolic changes
electrolyte abnormalities
brain herniation (cushing triad)
sick sinus dysfunction is
dysfunction within the SA node, tachy brady syndrome
