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Cardio > Cardiac Arrhythmias > Flashcards

Cardiac Arrhythmias Flashcards

1
Q 
Originates at the SA node
Follow appropriate conduction pathways 
Intrinsic rate 60-100 beats/min 
Rhythm is regular 
Every beat has a P wave and followed by QRS complex
A

Normal sinus rhythm

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2
Q

PR interval remains constant
R-R interval is regular and constant
P-P interval is constant

A

Normal Sinus Rhythm

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3
Q

PE findings:
Disappears with breath holding or with an increased heart rate ( from activity or exercise)

No clinical significance
Common in both the young and elderly

A

Normal sinus rhythm

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4
Q

Heart beat less than 60 ( due to increased vagal tone on normal pacemaker, organic disease of the SA node, or due to medications

A

Sinus Bradycardia

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5
Q

Physical findings of sinus bradycardia?

A 
Severe bradycardia < 45 beats/min 
Weakness
Chest pain
Lightheadedness 
N/V
Confusion
Syncope
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6
Q

Severe bradycardial rate usually increases with

A

Exercise

Administration of atropine

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7
Q

EKG findings of heart rate less that 60
Normal and consistent P wave morphology followed by QRS complex
Normal PR interval

Indicative?

A

Sinus bradycardia

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8
Q

Treatment for bradyarrhythmia

A

Rapid and primary assessments
Determine HR is less than 50bpm
Determine if stable or unstable

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9
Q

Unstable patient If have

A 
Changes in mental status 
Ischemic chest discomfort 
Hypotension
Signs of shock
Acute heart failure
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10
Q

If the patient is stable? ( bradyarrhythmia)

A

Monitor patient
Obtain vitals
Obtain 12 lead if able, attempt to identify and treat underlying causes

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11
Q

If patient is unstable ( bradyarrhythmia)

A

Give atropine 0.5mg IV push and repeat q 3-5 minutes for a max of 3 mg

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12
Q

What works by inhibiting all vagal input into the SA node

A

Atropine

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13
Q

Atropine does not work for patients that have undergone?

A

A heart transplant

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14
Q

Alternate treatments of atropine is ineffective

A

Transcutaneous pacing

Dopamine IV infusion at 2-10mcg/kg/min

Epi IV infusion 2-10 mcg/ min

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15
Q

What are the complications of bradyarrhythmia?

A

Atrial, junctional, and/or ventricular ectopic rhythms

AMI

Cerebral or renal ischemic

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16
Q

HR faster than 100 bpm ( rapid impulse formation from the SA node)

Occurs w/ fever, exercise, emotion, pain, anemia, heart failure, pregnancy, early shock, thyrotoxicosis, alcohol withdrawal or in response to many drugs

HR exceeds 150 bpm

A

Sinus tachycardia

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17
Q

Are abnormalities in cardiac rhythm and/ or conduction

A

Cardiac arrhythmias

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18
Q

How are arrhythmias differentiated?

A 
Rate ( tachy vs Brady)
QRS duration ( wide vs narrow)
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19
Q

PE of cardiac arrhythmias

A

Lethal ( sudden cardiac arrest)

Asymptomatic to palpitations to dizziness to pre syncope to syncope

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20
Q

What is a gold standard for monitoring and dx cardiac arrhythmias

A

ECG

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21
Q

Treatments

A

Depends on dysthymia and patient presentation

ABCs
IV
Oxygen 
Monitor 
Antiarrhythic drugs
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22
Q

Definitive treatments

A

Catheter ablation by cardiologist

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23
Q

Complications

A

Decreased perfusion can lead to AMI, syncope, cardiac arrest, and/or death

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24
Q

Disposition

A

Stabilize and MEDEVAC

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25
Q

ECG findings:
HR > 100 bpm
P wave is followed by a QRS complex and each QRS has a P wave preceding it
Normal duration ( QRS complex)

Indicative of?

A

Sinus tachycardia

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26
Q

Treatment for sinus tachycardia

A

ABCs, monitor, IV, O2 > 94%

Treat underlying condition

27
Q

If no identifiable etiology of sinus tachycardia is determined and patient is unstable then start

A

ACLs protocol

28
Q

Comes and goes
Originates above the ventricles
HR > 100 bpm
Often occurs in patients w/o structural heart disease
Most common mechanism is reentry ( AV node reentry)

A

Paroxysmal supraventricular tachycardia

29
Q 
EKG findings:
HR 150-240 ( common 160-220)
Reg. R-R interval 
Narrow QRS complex 
P wave often buried in the narrow QRS complex
A

Paroxysmal supraventricular tachycardia

30
Q

PE findings of PSVT

A 
Maybe asymptomatic 
Associated w/ palpitations mild chest pain or SOB
Episodes begin and end abruptly 
May cause syncope 
May cause AMI
31
Q

Treatments for PSVT

A

ABCs IV Monitor O2 > 94%
Determine if stable or not
Terminate attack if unstable via cardio version

32
Q

What are mechanical measures for stable patients with PSVT

A 
Stimulate vagus nerve and increase tone
Valsalva 
Breath hold
Dunk face in bowl of ICE cold water 
Carotid sinus massage
33
Q

What interrupts up to 50% of PSVT

Firm gentle pressure over R carotid sinus for 10-20 seconds, if unsuccessful attempt over left

A

Carotid sinus message

34
Q

What is the drug therapy for PSVT

A

IV agents

Adenosine 6 mg ( double the dose if first dose does not work)

35
Q

Second line meds for PSVT

A

Metoprolol 5mg IV repeat dose q 5 minutes up to 15 mg max

Or 50mg PO BID

Diltiazem ( CCB) 0.25mg/kg IV over 2 minutes ( followed by a second bolus of 0.35mg/kg if needed and then start an infusion at 5 mg/h and titrate up to 15mg/hr to keep HR <100

36
Q

If patient, with PSVT, is hemodynamically unstable what’s the treatment

A

Synchronized cardioversion ( 50-150 J )

37
Q

Complications of PSVT

A

Myocardial dysfunction/ischemia
CHF
Syncope

38
Q

An accessory electrical pathway or bypass tract between the atrium and the ventricle bypassing the AV node and can predispose to reentrant arrhythmias

Associated with PSVT rhythm

A

Wolf Parkinson white syndrome

39
Q

EKG findings:
Short PR interval ( < 0.12 seconds)
Wide, slurred QRS complex called a delta wave

A

Wolf Parkinson white syndrome

40
Q

Patients with wolf Parkinson white syndrome and unstable perform immediate

A

Synchronized cardioversion 50-150 J

41
Q

If stable and in PSVT you can attempt?

wolf Parkinson white syndrome

A

Vagal maneuvers

42
Q

Meds for Wolfs Parkinson white syndrome

A

Adenosine
Metoprolol
( same as PSVT)

43
Q

Complications ( WPWS)

A

Myocardial dysfunction/ischemia
CHF
Syncope

44
Q

Most common
Chronic arrhythmias
Prevalence increases with age

A

Atrial fibrillation

45
Q

Multiple areas of atrial myocardium continuously discharging causing the atrium to fibrillate rather than contract in an organized manner

A

Atrial fibrillation

46
Q

Heart rate may vary but the R-R pattern is irregularly irregular

A

Atrial fibrillation

47
Q

What diseases have an increased of atrial fibrillation

A 
Rheumatic heart disease 
HTN
Ischemic heart disease 
Thyrotoxicosis 
Pericarditis 
Excess ETOH or withdrawal ( holiday heart
Cardiomyopathy 
CHF
OSA
Electrolyte abnormalities esp. K and Mg
Excessive caffeine intake
48
Q

An A-Fib predisposes patients to?

A

Thromboembolic events

49
Q

A-FIB: frequently anti-coagulant with what medications on an outpatient basis

A

Coumadin
Rivaroxaban
Apixaban

50
Q

EKG readings:
R-R interval is irregularly irregular
Atrial rate ~400 bpm
Wavy baseline ( fibrillation waves)

A

Atrial fibrillation

51
Q 
Palpitations 
Dyspnea on exertion
Lightheadedness 
Fatigue 
Weakness
Chest pain 
Symptoms for?
A

Atrial fibrillation

52
Q

Up to 2/3 of patients experiencing their 1st episode of A-fib will spontaneously revert to sinus rhythm within?

A

24 hours

53
Q

What is the treatment for atrial fib?

A

Goal is to focus on ventricular rate control, conversion of hemodynamically unstable AF to sinus rhythm or both

54
Q

Patients with AF> 48 hours are at risk for?

A

Cardioembolic events and should not be cardioverted until anti-coagulated for a minimum of 3 weeks prior to attempting elective cardioversion

55
Q

Atrial fibrillation treatments

A

ABCs, IV, Monitor, vitals, oxygen if sat <94%

Assess to see if patient is unstable if so, perform synchronized cardioversion at 100-200j

56
Q

Medications for AFIB

A

Beta blockers: metoprolol 5mg IV q 5 minutes

CCB: Diltiazem 0.25 mg/kg IV over 2 minutes

Anticoagulant: enoxaoarin ( lovenox) 1mg/kg SC q 12hrs ( creatinine at baseline, CBC at baseline)

57
Q

Complications of AFIB

A

Embolic event leading to: ischemia stroke, or ischemic extremities

Rapid ventricular rate leading to myocardial dysfunction or ischemia

58
Q

Usually associated with pulmonary disease

Originates from a localized area in the atria

Predisposed to thromboembolic events

A

Atrial flutter

59
Q

Disorders that can cause A flutter

A 
Thyrotoxicosis 
Obesity 
OSA
Sick sinus syndrome 
Pericarditis 
Pulmonary disease 
Pulmonary embolism
60
Q

EKG findings:
Saw tooth flutter waves between QRS complexes
Atrial rate between 250-350 bpm
AV block ( Look in TG for specifics)

A

A-flutter

61
Q

A flutter sx

A 
Palpitations 
Dyspnea on exertion
Lightheadedness 
Fatigue
Weakness
Chest pain
62
Q

Treatments

A

Focus on ventricular rate control with metoprolol or diltiazem ( however more difficult to control)

If unstable ( cardioversion 100-200J)

63
Q

Complications of A flutter

A

Embolic event in chronic flutter
Myocardial ischemia
Dizziness or syncope
Heart failure

Cardio (6 decks)

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