CARDIO exam 2: UNIT 8 Flashcards
what is PSVT ? and explain the two pathways
-Supraventricular tachycardia = any tachyarrhythmias originating from above the ventricle.
Related to a presence of AV nodal re-entry pathway (AVNRT)
TWO distinct electrical circuits:
-Fast pathway: fast conduction, but slow recovery (long refractory period)
-Slow pathway: slow conduction, but fast recovery (short refractory period)
explain re entry tachycardia? HARd
-Premature Atrial Complex, PAC (ectopic, premature atrial impulse)
- Randomly goes off and enters the SLOW PATHWAY as the fast pathway is still recovering the PAC circles around into the FAST PATHWAY PAC cycles around the circuit and sends a signal to the ventricle each time RE ENTRY TACHYCARDIA
whats the presentation for PSVT and what could be stimulus
M/C palpitation, fast HR, Chest pain, SOB, lightheadedness
nicotine, cocaine, alc, drugd
whats the DX for PSVT and whats the heart rate?
-REGULAR rhythm!!!!
-Narrow QRS complex tachy; p- waves often hidden (due to rapid rate) or after QRS complex (A circles around AV node)
-Ventricular rate: classically > 150bpm (120-220bpm)
HOW WOULD you tx stable PSVT?
Stable
#1 Valsalva maneuvers increases parasympathetic tone; standard Valsalva or modified Valsalva maneuver
#2 carotid massage but auscultate for BRUITS first!
- carotid bruits can indicate high grade common carotid or extracranial internal carotid artery stenosis
-
#3 Adenosine IV: 6mg, 12mg, 12-18mg (1st line in PPP)
#4 BB + CCB (verapamil) if adenosine does not work
how would you tx unstable and chronic PSVT?
Unstable
- Synchronized cardioversion (low voltage shock synchronized with QRS complex)
- S/S: Hypotension, AMS, chest pain, HF
Chronic Prevention
-M/C Vagal maneuver education
-BB, CCB
-Catheter ablation (pathway ablation)
what is sinus tachycardia? what will you see on the EKG and heart rate?
HR > 100 bpm; has P wave and QRS complex
Originates from SA node, thus NOT ABNROMAL RHYTHM
whats the RF for sinus tachy?
Causes: pain, anxiety, fever, HYPERthyroidism, pulmonary embolism, low CO, anemia
TX: tx underlying cause
which dx increases with age and is the m/c arrhythmias?
AFIB
which is known as the holiday heart
AFIB
what is AFIB? REALLY BIG ONE
Irregularly irregular rhythm on EKG
-NO organized atrial electrical activity. MULTIPLE foci in the atria FIRE in chaotic pattern causing a totally irregular rapid ventricular rate!
Atria quiver!!! Atria is having a seizure
whats the RF for AFIB?
Age, heart disease, hyperthyroidism, pulmonary disease, sepsis, DM, electrolyte abnormalities, stress ,pheochromocytomawh
what the presentation of AFIB? axs and sx
AXS – cardiogenic shock
SX - Fatigue, SOB w exertion, palpitation (M/C), dizziness, angina, irregular pulse
whats the dx for AFIB
NO DEFINED P WAVES
EKG: irregularly irregular rhyme (irregular PR interval and rapid series of tiny erratic spikes with a wavy baseline and no defined P wave)
R-R irregualr
atrial rate 400+ bpm
ventricualr rate 100-200 bpm
ECHO: to r/o thombosis
why would you want to r/u thombus in AFIB?
Complication:
-Thromboembolic events (stroke): blood stasis due to ineffective contraction leads to formation of intramural thrombi that can embolize the BRAIN
whats the three methods of tx AFIB?
1.RATE CONTROL
2.RHYTHM CONTROL
3.ANTICOAGULATION
what do you intially have to determine for AFIB?
the stage!! Determine if acute or chronic.
If acute, determine stable or unstable
how would you tx acute and chronic AFIB
Acute AFIB:
Hemodynamically unstable:
-immediate electrical cardioversion to sinus rhythm < 48hr
-Hemodynamically stable:
- Rate control: CCB, BB
- Cardioversion to sinus rhythm once rate is achieved; electrical cardioversion is preferred over pharmacological
- anticoagulation to prevent embolic CVA
Chronic AFIB:
-Rate control with CCB or BB
-Anticoagulation (warfarin)