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PANCE 2.0 > Cardiology #6 (Rhythms) > Flashcards

Cardiology #6 (Rhythms) Flashcards

1
Q

What is the normal rate in a normal sinus rhythm?

A

60-100 bpm

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2
Q

Sinus arrhythmia increases with _____ and decreases with ______

A

Increases with inspiration

Decreases with expiration

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3
Q

What is sinus tachycardia defined as?

A

Increased heart rate > 100 bpm originating from the sinus node

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4
Q

Although sinus tachycardia is normal in young children and infants, as well as response to emotional or physical stress, what are some causes that are abnormal?

A
  • fever
  • hypoxia
  • infection
  • hypoglycemia
  • anxiety
  • shock
  • cocaine
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5
Q

Treatment for sinus tachycardia

A
  • Treat underlying cause

- However, BB (Metoprolol) are used if tachycardia with ACS

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6
Q

What is sinus bradycardia?

A

Decreased HR < 60 bpm originating from sinus node

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7
Q

What are some causes of pathologic sinus bradycardia?

A
  • BB, CCB
  • Digoxin
  • Carotid Massage
  • Hypothyroidism
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8
Q

Treatment for sinus bradycardia, both symptomatic and asymptomatic

A

Symptomatic: Atropine; if not responsive to Atropine, use Epinephrine or Transcutaneous pacing

Asymptomatic: no treatment needed if physiologic (young athletes, nausea, vomiting)

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9
Q

What is sick sinus syndrome?

A

Combination of sinus arrest with alternating paroxysms of tachycardia and bradycardia

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10
Q

What are the etiologies of sick sinus syndrome?

A
  • Sinus node fibrosis (MC)
  • Older age
  • Medications
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11
Q

Management for sick sinus syndrome

A
  • Stable: symptoms are transient, may not require therapy
  • Unstable: Atropine (first line). Transcutaneous pacing
  • Long-term: permanent pacemaker definitive. AICD if alternating between tachycardia and bradycardia
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12
Q

What is seen on ECG in a patient with a 1st degree AV block?

A

-Prolonged PR interval (> 0.20 seconds) + all P waves are followed by QRS complexes

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13
Q

What is the treatment for a patient with a first-degree AV block?

A
  • Asymptomatic: no treatment
  • Symptomatic: Atropine (first line), epinephrine
  • Pacemaker is definitive if persistent and severe
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14
Q

Explain what an ECG shows in a patient with a Mobitz I - Wenkebach 2nd degree AV block.

A

-Progressive PRI lengthening –> dropped QRS

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15
Q

What should be given for a Wenkenbach AV block?

A

Atropine, Epinephrine +/- pacemaker

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16
Q

What is special about a Mobitz II 2nd degree AV block?

A

Constant/Prolonged PRI –> dropped QRS

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17
Q

Treatment for a Mobitz II block

A

Atropine or temporary pacing

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18
Q

Progression of a Mobitz II to a ____ is common, so what treatment is definitive?

A

3rd degree AV block

Permanent pacemaker

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19
Q

What are etiologies of a Mobitz I 2nd degree AV block?

A
  • Inferior Wall MI
  • AV nodal blocking agents (BB, Digoxin, CCB)
  • Myocarditis due to Lyme
  • cardiac surgery
  • Hyperkalemia
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20
Q

A Mobitz II 2nd degree AV block is rarely seen in patients without

A

structural heart disease (Myocarditis, myocardial ischemia, endocarditis)

21
Q

What is a 3rd degree AV block?

A

AV dissociation = no atrial impulses reach the ventricles, so the atrial activity is independent of the ventricular activity

22
Q

Causes of a 3rd degree AV block

A
  • Inferior wall MI
  • AV nodal blocking agents (BB, CCB, Digoxin)
  • Myocarditis (due to Lyme)
  • Cardiac Surgery
  • Endocarditis
23
Q

ECG of a 3rd degree AV block

A

-regularly P-P intervals and regular R-R intervals, but they are not related to each other. Patients are often bradycardia.

24
Q

Treatment for 3rd degree AV block if the patient is symptomatic

A

Transcutaneous pacing often followed by permanent pacemaker placement (Definitive)

25
Q

What is true about patients with A-fib and Atrial Flutter?

A

-Increased risk of thrombus formation that can lead to cerebral and/or systemic embolization (stroke)

26
Q

What are some symptoms of unstable atrial flutter?

A

refractory chest pain, hypotension, AMS

27
Q

Describe the ECG in a patient with atrial flutter

A

-Sawtooth atrial waves usually around 300 beats per minute but no discernible P waves

28
Q

Management of a patient with stable atrial flutter

A
  • Vagal maneuvers

- BB or CCB (Diltiazem, Verapamil)

29
Q

Management of a patient with unstable atrial flutter

A

Direct current (synchronized) cardioversion

30
Q

In a patient with atrial flutter, what is the definitive treatment?

A

Radiofrequency catheter ablation

31
Q

MC chronic arrythmia

A

A-fib

32
Q

Risk factors for A-fib

A 
Men > Women
Increasing age
Whites > blacks
Drug or alcohol use
Medications
Genetics
Thyroid disorders
33
Q

Unstable A-fib provides symptoms such as

A

Hypotension, refractory chest pain, AMS

34
Q

Describe an ECG of A-fib

A

Irregularly irregular rhythm with fibrillary waves (no discrete P waves)
-Often > 250 bpm

35
Q

With A-fib, what is Ashman’s phenomenon?

A

occasional aberrantly conducted beats (wide QRS) after short R-R cycles

36
Q

Management of a patient with STABLE A-fib

A

-Rate control with BB OR CCB (Diltiazem, Verapamil)

37
Q

Management of a patient with UNSTABLE A-fib

A

-Direct current (synchronized) Cardioversion

38
Q

What is the long-term treatment for a patient with A-fib

A

Rate control usually preferred over rhythm control for long-term management

  • Direct cardioversion or pharm cardioversion
  • Radiofrequency catheter ablation
  • Anticoagulation (in patients with a risk for embolization)
39
Q

Cardioversion is most successful when performed within ______ after onset of A-fib

A

7 days

40
Q

What is needed BEFORE cardioversion to ensure there are no atrial clots?

A

Echocardiogram

41
Q

Anticoagulation is the treatment for A-fib, but is dependent on the time A-fib has been present. Explain.

A

AF > 48 hours: anticoagulation for at least 3 weeks before cardioversion or a TEE-guided approach with abbreviated anticoagulation

AF < 48 hours: elective cardioversion, but anticoagulation is recommended beforehand

42
Q

Anticoagulation must be continued for how long after cardioversion?

A

4 weeks

43
Q

The CHA2DS2-VASc score is used to determine risk for embolization in patients with A-fib. Chronic oral anticoagulation (Warfarin or Novel oral anticoagulants) are required for those with what score?

A

2 or greater

44
Q

What are the components of the CHA2DS2 VASc criteria and their point values?

A 
Congestive Heart Failure: 1
Hypertension: 1
Age 75 or more: 2
DM: 1
Stroke, TIA, Thrombus: 2
Vascular Disease (prior MI, PAD): 1
Age 65-74: 1
Sex (Female): 1
45
Q

Non-Vitamin K antagonist oral anticoagulants (NOAC) are usually preferred over Warfarin due to lower rates of major bleeding and lower risk of ischemic stroke (do not have to check INR and less drug interactions). Name some of these medications.

A
  • Dabigatran (binds and inhibits thrombin)

- Rivaroxaban, Apixaban, Edoxaban (factor Xa inhibitors)

46
Q

When would Warfarin be the preferred anticoagulant?

A
  • In patients with severe chronic kidney disease

- Contraindications to NOAC (HIV patients, on anti epileptic medications)

47
Q

What is the normal INR goal of a patient on Warfarin?

A

goal of 2-3

48
Q

Dual anti platelet therapy with what two medications is reserved for patients who cannot be treated with anticoagulation (for reasons OTHER than bleeding risk)?

A

Aspirin + Clopidogrel

PANCE 2.0 (62 decks)

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