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Clin med 2 > CARDIO exam 2: UNIT 8 > Flashcards

CARDIO exam 2: UNIT 8 Flashcards

1
Q

what is PSVT ? and explain the two pathways

A

-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)

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2
Q

explain re entry tachycardia? HARd

A

-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

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3
Q

whats the presentation for PSVT and what could be stimulus

A

M/C palpitation, fast HR, Chest pain, SOB, lightheadedness

nicotine, cocaine, alc, drugd

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4
Q

whats the DX for PSVT and whats the heart rate?

A

-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)

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5
Q

HOW WOULD you tx stable PSVT?

A

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

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6
Q

how would you tx unstable and chronic PSVT?

A

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)

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7
Q

what is sinus tachycardia? what will you see on the EKG and heart rate?

A

HR > 100 bpm; has P wave and QRS complex

Originates from SA node, thus NOT ABNROMAL RHYTHM

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8
Q

whats the RF for sinus tachy?

A

Causes: pain, anxiety, fever, HYPERthyroidism, pulmonary embolism, low CO, anemia

TX: tx underlying cause

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9
Q

which dx increases with age and is the m/c arrhythmias?

A

AFIB

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10
Q

which is known as the holiday heart

A

AFIB

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11
Q

what is AFIB? REALLY BIG ONE

A

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

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12
Q

whats the RF for AFIB?

A

Age, heart disease, hyperthyroidism, pulmonary disease, sepsis, DM, electrolyte abnormalities, stress ,pheochromocytomawh

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13
Q

what the presentation of AFIB? axs and sx

A

AXS – cardiogenic shock

SX - Fatigue, SOB w exertion, palpitation (M/C), dizziness, angina, irregular pulse

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14
Q

whats the dx for AFIB

A

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

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15
Q

why would you want to r/u thombus in AFIB?

A

Complication:
-Thromboembolic events (stroke): blood stasis due to ineffective contraction leads to formation of intramural thrombi that can embolize the BRAIN

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16
Q

whats the three methods of tx AFIB?

A

1.RATE CONTROL
2.RHYTHM CONTROL
3.ANTICOAGULATION

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17
Q

what do you intially have to determine for AFIB?

A

the stage!! Determine if acute or chronic.
If acute, determine stable or unstable

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18
Q

how would you tx acute and chronic AFIB

A

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)

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19
Q

how would you tx anticoagulation method for AFIB

A

Anticoagulation in AFIB:
-pt are assessed for risk of embolic event using CHA2-DS2-VASc SCORE
-need to reduce the risk of ischemic stroke

  • SCORE > 2: moderate to high risk. Warfarin or NOAC (rivaroxaban (Xarelto); apixaban (Eliquis))
  • Score 1: low risk; weigh risk vs benefit
    Score O - very low risk
20
Q

what is atrial flutter and the RF

A

-Regular rhythm
atrial rate is between 250-300 bpm

Causes:
- COPD M/C
- Heart diseases, rheumatic heart disease, CAD, CHF
- ASD

21
Q

which dx would you see a saw tooth appearnace on the EKG

A

atrial flutter

22
Q

what is the EKG for atrial flutter

A

-Flutter/jagged waves (saw tooth appearance) on EKG

23
Q

how would you tx atrial flutter ?

A
  • Similar to AFIB:

-Cardiovascular if unstable
-Rate control:
- Acute: BB + CCB
- Chronic: amiodarone, quinidine, sotalol, procainamide
-Ablation of Foci

24
Q

what is ventriucalr tachyarryhtmias? what are the two types?

A

Originates from below bundle of HIS

Monomorphic Ventricular Tachycardia: WIDE QRS complex tachycardia consisting of > 3PVCs with uniform QRS

Polymorphic Ventricular tachycardia: wide QRS complex tachycardia consisting of > 3 PVC with variable QRS
Sustained: last more than 30s

25
what is the RF for ventriucalr tachyarrythmias and its RF
Ischemic/excitable ventricular tissue emit premature electrical impulses, PVCs which enter a re-entry circuit Quivering heart  ineffective ventricular contractions  low CO RF: M/C ischemic HD, ischemic HF, cardiomyopathies
26
what is the S/S for ventricualr tachyarrhmias ? stable and unstable
LOW CO Stable: palpitation, SOB, chest pain, syncope Unstable: HYPOtension, altered MS, HF Cardiac Arrest: no CO and pulsus PT can have pulse or be pulseless
27
what is the dx for ventricualr tahcyarrhymias?
EKG: Monomorphic: wide QRS complex tachycardia, through uniform morphology. ALL OTHER WAVES ABSENT Polymorphic (like torsade’s de pointes): WIDE QRS complex tachycardia with variable morphology; TdP has twisting around baseline
28
what is the tx for ventricualr tachyarrymias? stable, unstable and chronic
Stable: IV antiarrhythmic (amiodarone, lidocaine, procainamide) Unstable: Pulseless/Cardiac Arrest: initiate ACLS, CPR, epi and unsynchronized cardioversion/defibrillation With pulse: synchronized cardioversion, start anti-arrhythmia if Vtach persist Look for torsade’s de pointes: long QT interval caused by antiarrhythmic drug (quinidine, procainamide) TX: IV Mg  treat QT prolongation Chronic therapy: AICD placement, BB, +/- oral antiarrhythmics, Cather ablation if other fails
29
what is ventricular fibrillation and its RF whats the perfect description
Irregular fibrillatory waves without discernible QRS complex - NO PULSE!! The heart is quivering like bags of worms!!! RF: -Myocardial ischemia/infarction -HF -hypertrophic caardiomyopatheis -polyorphic Vtachy -antiarrhytmic drugs -ectopic ventricular electrical impulses from injured tissues CAN CREATE re-entract circuits  ventircualr fibrillation
30
what is the presenation and DX and TX for Vfib ?
impeding cardiac arrest (no ventricular function  no CO  no pulse EKG: irregular fibrillatory waves W/O discernible QRS complex TX: ACLS (advance cardiac life support) (CPR, defibrillation/unsynchronized, epi, drugs)
31
what is SCD and its RF and M/C?
50% of deaths due to AMI are SCD Ventricular tachyarrhythmias M/C Due to acute heart attach, HF, drugs, cardiomyopahteis, electrical disturbances RF: prior hx of SCD, EF less than 35%, fx hs of SCD, severe cardiomyopathy
32
explain the background for sinus bradycardia
sinus rhythm w rate of < 60bpm
33
what is the etiology of sinus bradycardia
: normal in healthy patients who are well-conditioned or young * MEDS: which depresses SA node Parasympathomimetics (e.g. Cholinergics) Antiadrenergic (e.g. beta blockers) Non-dihydropyridine Calcium Channel Blockers (diltiazem, verapamil) Opiates/Benzodiazepines Amiodarone (and other antiarrhythmics) Acute Myocardial Infarction: usually involving Right Coronary Artery RCA supplies the SA node in ~60% of patients Hypothyroidism, hypothermia, etc.
34
what is the SA node predominatly controled by ?
PSN via vagus nerve
35
how does the parasympaethic cause bradycardia ?
increases vagal tone
36
how does antiandrenergic casue bradycarida?
decrease sympathetic input
37
how dos non-dihydro CCB casue bradycardia?
blocks Ca channeles in cardiac conducting cell which prolongs the cardiac condcution which increases refractory period and casues bradycardia
38
what does the EKG look for sinus brady
ekg: sinus rhyhum of <60bpm and determine underlying casue
39
how would u tx sinus bradycardia?
ASX: treat underlying casue if present SX or hemodynamic instability: -atropine -transcutaneous cardiac pacing - temproizing measure whcih will increase CO, painfull -transvenous cardiac pariing-less painfull -permananent pacemake- DEFINTIVE
40
what is AV block and how do u tx it? in general
- Delay in electrical impulses from A  V - Idiopathic in more than 50% of cases - TRY TO TREAT UNDERLYING ETIOLOGY!!
41
explain 1st AV block on EKG, S/S, TX
- Delayed conduction from A to V - PR interval is GREATER THAN 0.2 seconds - NO LOSS OF SIGNAL  signals still reaches the ventricle - NO QRS DROPPED - Fixed PROLONGED PR INTERVAL - AXS - Typically no tx needed snce it does not progress to other AV blocks
42
explain 2nd block mobitz 1 EKG, S/S, TX
o Mobitz 1: progressively longer PR internal BEFORE loss of QRS  Usually AXS but could have +/- bradycardia; irregular pulse  Typically no tx needed BUT IF ITS BRADYCARDIA TX IT: ATROPINE, CARDAIC PACING, PACEMAKER
43
explain 2nd block mobitz 2 EKG, S/S, TX
o Mobitz 2: fixed PR interval before occasional loss of QRS  Usually SX showing fatigue, SOB, chest pain, syncope  Bradycardia; irregular pulse!  Tx: PERMANENT PACEMAKER = DEFINTIITVE since it can progress to 3rd AV block 
44
explain 3rd degree block EKG, S/S, Tx
- COMPLETE loss of signal - *A is INDEPENDNT of V waves - Bradycardia; REGUALR pulse* - Fatigue, SOB, chest pain, syncope - TX: PERMANANT PACEMAKER
45
when do u use pacemaker?
- For COMPLELTE HEART BLOCK - 2nd degree AV BLOCKS which can progress - SX bradycardia - Sick sinus syndrome

Clin med 2 (7 decks)

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