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CV Quiz 2 > Cardiac Arrhythmias pt 2 > Flashcards

Cardiac Arrhythmias pt 2 Flashcards

1
Q

Define bradyarrhythmias

A

Definition: Heart rate < 60 bpm • Arise from disorders of impulse formation or impaired conduction

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2
Q

Sinus bradycardia is decreased firing SA node; can be both phyisiologic and pathologic: what are some examples

A

intrinsic SA node disease and extrinsic factors like autonomic regulation SA node, medications, metabolic causes.

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3
Q

Pt was admited with a HR of 45bmp, she was dizzy, confused. No other irregularities on ECG.. Whats a possible Dx?

A

Sick sinus syndrome; which is an intrinsic SA node disease

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4
Q

Escape Rhythms originate from:

A

latent pacemakers: both junctional and ventricular

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5
Q

_________ escape beats arise from AV node or His bundle. Typically narrow, rate typically 40-60 bpm. Not preceded by normal P wave but retrograde P may be present (after QRS, inverted inferior leads)

A

Junctional

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6
Q

________escape slower (30-40 bpm), wide QRS with morphology determined by origin escape pacemaker cells.

A

Ventricular

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7
Q

First Degree AV Block:
– PR prolongation due to

A

prolongation of normal delay between atrial and ventricular depolarization

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8
Q

In first degree bundle block:

– PR =
_____AV relationship

A

– PR > 200 ms
– 1:1 AV relationship

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9
Q

What are the causes of 1st degree heart block, both reversible and irreversible?

A

Conduction delay usually within AV node
– Reversible causes: autonomic, transient AV nodal ischemia, drugs
– Irreversible causes: myocardial infarction, chronic degenerative disease often seen with aging

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10
Q

What treatment do we give to pt with 1st degree heart block?

A

– Usually benign and asymptomatic, requiring no specific therapy

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11
Q

What happens to the PR interval in Morbitz type I block (2nd degree block)

A

PR gradually increases until an impulse is completely blocked, after which PR shortens again to its initial length

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12
Q

In Morbitz type I, conduction is usually impairedin the _______

What symptoms do we expect and what are the causes?

A

Conduction is impaired in AV node.
• Usually benign and asymptomatic
• Causes include autonomic tone, acute MI either due to increased vagal tone or ischemia AVN

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13
Q

Sudden intermittent loss of AV conduction without preceding gradual PR lengthening.

A

Morbitz II: 2nd degree block

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14
Q

Where is the block located in Morbitz II?

A

Conduction block usually distal to AVN (His-Purkinje) and QRS often widened due to His Purkinje system disease

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15
Q

What is concerning about MOrbitz II?

A

May progress to third degree AVB without warning, typically requires pacemaker.

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16
Q

What is the cause of a Morbtiz II block?

A

Results for scar, myocardial infarct, chronic degenerative disease of conduction system

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17
Q

A second degree block is due to:

A

intermittent failure of AV Conduction

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18
Q

Complete failure of conduction between atria and ventricles.
• No relationship between P and QRS complexes
• Distal escape rhythm or asystole in ventricles.

A

Third degree heart block

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19
Q

Causes of third degree heart block

A

Causes include myocardial infarct, chronic degeneration of conductive pathways. Congenital form associated with neonatal lupus.

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20
Q

In thrid degree heart block: More proximal escape results in ________ QRS;
distal produces_____ QRS.

A

relatively narrow

wide

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21
Q

Symptoms and Tx for third degree heart block

A

Symptoms: lightheadedness, syncope, exercise intolerance.
• Treatment: Permanent pacemaker.

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22
Q

When figuring out what type of bradyarrhythmia your pts has, look at the relationship between P wave and QRS complex….

If its 1:1 it could be:

A

sinus bradycardia or first degree AV block

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23
Q

When figuring out what type of bradyarrhythmia your pts has, look at the relationship between P wave and QRS complex….

if it has an intermittent block:

A

Second degree AV block (morbitz I or II)

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24
Q

When figuring out what type of bradyarrhythmia your pts has, look at the relationship between P wave and QRS complex….

it its dissociated

A

Complete heart block

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25
Q

Definition of tachycardia

: Heart rate

A

> 100 bpm for 3 or more beats

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26
Q

Mechanism of tachycardia

A

enhanced automaticity, reentry and triggered activityf

27
Q

How is tachycardia usually classified?

A

It’s origin

–origin above ventricle = supraventricular

origin w/in ventrcles = ventricular

28
Q

Origin SA node, Rate > 100 bpm, P and QRS complexes normal in appearance

A

Sinus tachycardia

29
Q

Causes of sinus tachycardia:

A

Results from increased sympathetic or decreased vagal tone.

May be appropriate (exercise, physiologic stress- fever, anemia, hypoxia,hypovolemia, hyperthyroidism) or inappropriate (inappopriate sinus tachycardia)

30
Q
  • Automaticity or reentry in an atrial focus outside SA node.
  • May cause palpitations.
  • Produce early P wave with abnormal shape, dissimilar to sinus rhythm P wave.
A

Atrial Premature Beats/Atrial
tachycardia

31
Q

What do we see with the P wave in atrial tachycardia?

A

Produce early P wave with abnormal shape, dissimilar to sinus rhythm P wave.

32
Q

If pt has atrial tachycardia, when do we give them B-blockers

A

If symptomatic, beta blockers often used to treat, usually benign

33
Q

If automatic focus generates series of consecutive atrial premature beats with resulting HR > 100, we term this:

A

atrial tachycardia

34
Q

Rapid regular atrial activation produced by reentry over a large fixed circuit.

A

SVT: Atrial Flutter

35
Q

What’s the difference between counter clockwise and clockwise atrial flutter?

A

Counterclockwise typical flutter: circuit produces right atrialdepolarization up the septum, across the roof and down the RA free wall, then along the floor of RA between tricuspid valve and inferior vena cava “tricuspid-caval isthmus”, producing “saw tooth” pattern.
• Clockwise flutter: same circuit, opposite direction.

36
Q

What kind of AV conduction do we see in atrial flutter?

A

AV conduction is variable, can be 1:1 but more commonly more flutter waves than QRS complexes.

37
Q

Drugs that slow atrial flutter circuit (e.g. flecainide) may promote 1:1 AV conduction which will:

A

paradoxically increasing ventricular rate.

38
Q

Atrial flutter can be asymptomatic or symptomatic: what are some symptoms?

A

May be asymptomatic or associated with palpitations, dyspnea, weakness, and stroke from atrial thrombus (loss atrial contractility d/t rapid A rates).

39
Q

What are the predisposing factor for atrial flutter?

A

• Predisposing factors: prior heart surgery, coronary disease, cardiomyopathy.

40
Q

What is this shit?

A

Atrial flutter: see there is sawtooth pattern with variable AV conduction

41
Q

What abnormalities do we see in atrial flutter?

A

see more flutter waves then QRS complexes

42
Q

What tx do we prescribe for RATE controle in atrial flutter?

A

Rate control: beta blockers, calcium channel blockers, digoxin

43
Q

Pt has had atrial flutter for over 48 hours.. your attending asks you what the first step of action should be….

A

– Duration > 48 hours necessitates transesophageal echo to rule out left atrial thrombus or 3 weeks anticoagulation prior to conversion. Anticoagulation continued post cardioversion at
least 4 weeks (delay recovery mechanical atrial function).

44
Q

What tx do we provide for pts with atrial flutter for rhythm control?

A

– Electrical cardioversion
– Pace termination
– Catheter ablation of tricuspid caval isthmus, curative 95%, thus preferred
– Antiarrhythmic drug therapy (class I, III agents) for sinus rhythm maintenance, occasional chemically convert, modestly effective.

45
Q

What drug therapies are recommended for RHYTHM control in atrial flutter?

A

– Antiarrhythmic drug therapy (class I, III agents) for sinus rhythm maintenance, occasional chemically convert, modestly effective.

46
Q

PT comes in with Chaotic rapid rhythm with atrial rates > 400 discharges/min).
• No distinct P waves.
• Most of P waves find AV node refractory, only some of the depolarizations are conducted to ventricle, resulting in “irregularly irregular” rhythm.

Whats going on?

A

Atrial fibrillation

47
Q

What do we see in pt with atrial fibrillation;

P waves

atrial rate:

rhythm:

A

See no distinct P waves

chaotic rapid rhythm

atrial rates >400 discharges

48
Q

Mechanism of atrial fibrillation

A

triggered by rapid firing from atrial foci often localized to atrial muscle extending into pulmonary veins.

49
Q

How is atrial fibrillation sustained in the heart?

A

by multiple wandering reentrant circuits within the atria; minimum number of circuits required for AF, thus AF promoted by enlarged atrium.

50
Q

What are the predisposing causes of atrial fibrillation?

A

Predisposing factors: ETOH, CHF, valvular disease, enlarged atria, hypertension, coronary disease, pulmonary disease, sleep apnea, hyperthyroidism, cardiothoracic surgery.

51
Q

In atrial fibrillation, ventricular response rates may be rapid and lead to:

A

symptoms, hypotension or heart failure.

52
Q

In atrial fibrillation, Rapid atrial activation results in

A

absence of organized atrial contraction, blood stasis in atrium and risk of thrombus formation, especially in left atrial appendage, with risk of embolization and stroke.

53
Q

Treatment for acute atrial fibrillation you use anticoagulation, specifically in

acute:

chronic:

A

cardioversion

CHADSVasc score

54
Q
A
55
Q

What is key for rate control in atrial fibrillation?

A

AV nodal blockade (Beta blocker, calcium channel blocker, digoxin)

56
Q

What are three key therapies to restore sinus rhythm in atrial fibrillation?

A

– Cardioversion (>48 hours, preceded by 3 weeks anticoagulation or TEE)
– Antiarrhythmic Drugs
– Catheter ablation

57
Q

AF Is Associated With Increased Thromboembolic Risk

A

Major cause of stroke in elderly1
• 5-fold ↑ in risk of stroke
• 15% of strokes in US are attributable to AF
• Stroke severity (and mortality) is worse with AF than without AF
• Incidence of all-cause stroke in patients with AF: 5%
• Stroke risk persists even in asymptomatic AF

58
Q

CHA2DS2-VASc Score

Past disease states that give you 1 point

A

Congestive HF

Hypertension

Diabetes

Vascular disease

59
Q

CHA2DS2-VASc Score

What earns you 2 points?

A

Age over 75

having a stroke

60
Q

What risk factors (non-disease states) will earn you 1 point in the CHA2DS2-VASc Score

A

being female and being over 65

61
Q

CHA2DS2-VASc Score

Score of 0 =

Score of 1 =

**score of 2 or more = **

A

0= no therapy or aspirin (no therapy preferred)

1= aspirin or oral anticoagulation

2 or more = oral anticoagulation

62
Q
A
63
Q

Key management of AF stroke prevention is:

A

anticoagulation: use coumadin (warfarin) Dabigatran, Rivaroxaban, Apixaban

(or anti-platele; aspirin)

CV Quiz 2 (16 decks)

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