Cardiac Rhythm Disturbances (Atrial, Junctional, Ventricular

Question 1

Symptoms of arrhythmias

Answer 1

Palpitations, Light headedness, Syncope, Chest pain, Dyspnea, Sudden death

Question 2

Medical conditions/situations associated with sinus bradycardia

Answer 2

healthy athlete, obstructive jaundice (bile salts affect SAN), sliding hiatal hernia, valsalva maneuver

Question 3

Sinus Tachycardia

Answer 3

100+BPM

emotion, pregnancy, anemia, CHF, HYPOVOLEMIA

Question 4

Answer 4

Sinus arrhythmia

Question 5

Bradicardia causes - what are diseases of the atrium or SAN - CAD due to?

Answer 5

inflammation, invasive neoplasm, cardiomyopathy, muscular dystrophy, amyloidosis

Question 6

Bradycardia causes - drugs /electroytes, b-blockers

Answer 6

Drugs/electrolytes - digitalis, quinidie, hyperK; HTN drugs that decrese symp tone (clonidine, methyldopa, reserpine)

BB - propranolol, metoprolol

Question 7

Sinus Arrhythmia due to…

Answer 7

SAN forming irregular impulses

• Wax/wane with respiration
• HR inc. with inspiration
• HR dec. with expiration

Question 8

Answer 8

Sinus bradycardia with sinus arrythmia

• Rate <60BPM
• Rhythm - sinus
• Constant/normal PRi (0.12-0.20 sec)
• Constant P wave configuration in each lead
• Constant P wave configuration in each lead
• reuglar or slightly irrgular P-P or R-R cycle

Question 9

Answer 9

nonconducted PAC, followed by nonconducted atrial bigeminy

Question 10

Answer 10

• SSS - tachy - brady
• EKG - S.B.
• S Arrest
• S A Block - slow junctional rhythm
• See in ischemic, sclerotic, inflammatory changes in SAN
  
  • May cause syncope, dizziness, fatigue, HF

Question 11

Tx of sinus bradycardia

Answer 11

• May not require tx
• Atropine (0.3 >> 0.5 >> 2mg IV)
• Epi - 2-10 ug/min
• Isoprotenerol - 1mg in 500cc D5W
• Pacemaker

Question 12

What are signs of hemodynamic compromise? What do you do?

Answer 12

Dec. BP

Dec. CO, SV, renal perfusion = OLIGURIA

Dec. cerebral profusion, SOB = CONFUSION

Fatigue, cool, clammy, syncope

If HR <45-50 = UNSTABLE ACUTE SITUATION

Question 13

What is automaticity?

Answer 13

Property of cardiac cell to depol spontaneously during phase 4 of AP/leads to generation of an impulse

Question 14

When are premature atrial contractions seen?

Answer 14

Absence of significatn heart disease, associated with stress, alcohol, tobacco, coffee, COPD, and CAD

Question 15

Answer 15

Question 16

What is a Premature Atrical Beat?

Answer 16

ORiginates in atrial ectopic focus and produces abnormal P wave earlier than expected.

Question 17

Answer 17

PACs arriving very early in the cycle may not be conducted to the ventricles at all. In this case, you will see an abnormal P wave that is not followed by a QRS complex (“blocked PAC”). It is usually followed by a compensatory pause as the sinus node resets

Question 18

Treatment of PAC

Answer 18

• Reverse causes
• Bblocker
• Metroprolol 25-50mg BID-TID