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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
Q

what is the RF for ventriucalr tachyarrythmias and its RF

A

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
Q

what is the S/S for ventricualr tachyarrhmias ? stable and unstable

A

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
Q

what is the dx for ventricualr tahcyarrhymias?

A

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
Q

what is the tx for ventricualr tachyarrymias? stable, unstable and chronic

A

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
Q

what is ventricular fibrillation and its RF whats the perfect description

A

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
Q

what is the presenation and DX and TX for Vfib ?

A

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
Q

what is SCD and its RF and M/C?

A

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
Q

explain the background for sinus bradycardia

A

sinus rhythm w rate of < 60bpm

33
Q

what is the etiology of sinus bradycardia

A

: 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
Q

what is the SA node predominatly controled by ?

A

PSN via vagus nerve

35
Q

how does the parasympaethic cause bradycardia ?

A

increases vagal tone

36
Q

how does antiandrenergic casue bradycarida?

A

decrease sympathetic input

37
Q

how dos non-dihydro CCB casue bradycardia?

A

blocks Ca channeles in cardiac conducting cell which prolongs the cardiac condcution which increases refractory period and casues bradycardia

38
Q

what does the EKG look for sinus brady

A

ekg: sinus rhyhum of <60bpm and determine underlying casue

39
Q

how would u tx sinus bradycardia?

A

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
Q

what is AV block and how do u tx it? in general

A
  • Delay in electrical impulses from A  V
  • Idiopathic in more than 50% of cases
  • TRY TO TREAT UNDERLYING ETIOLOGY!!
41
Q

explain 1st AV block on EKG, S/S, TX

A
  • 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
Q

explain 2nd block mobitz 1 EKG, S/S, TX

A

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
Q

explain 2nd block mobitz 2 EKG, S/S, TX

A

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
Q

explain 3rd degree block EKG, S/S, Tx

A
  • COMPLETE loss of signal
  • *A is INDEPENDNT of V waves
  • Bradycardia; REGUALR pulse*
  • Fatigue, SOB, chest pain, syncope
  • TX: PERMANANT PACEMAKER
45
Q

when do u use pacemaker?

A
  • 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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