Cardiology: TachyArrhythmias Flashcards
what is etiology of sinus tachycardia? (6 causes)
normal physiologic response to fear, pain, and exercise hyperthyroidism volume contraction infection pulmonary embolism
name 4 types of atrial supraventricular tachyarrhythmias
sinus tachy
a fib
a flutter
multifocal atrial tachy
name 3 types of supraventricular AV junction tachyarrhythmias
AVNRT (atrioventricular nodal reentry tachycardia)
AVRT (atrioventricular reciprocating tachy)
paroxysmal atrial tachycardia
what are signs and symptoms of sinus tachy
palpitations and SOB
what are ECG findings in sinus tachycardia
sinus rhythm
ventricular rate >100bpm
what is treatment for sinus tachycardia?
treat underlying cause
what is etiology of atrial fibrillation? acute: use PIRATES mnemonic/ chronic
ACUTE: pulmonary disease ischemia rheumatic heart disease anemia/atrial myxoma thyrotoxicosis ethanol sepsis CHRONIC: HTN and CHF (due to left atrial enlargments)
what are symptoms of atrial fib
often asymptomatic SOB chest pain palpitation irregularly irregular pulse
what is see on ECG?
no discernible p waves
variable and irregular QRS response
what is treatment for a fib?
estimate risk of stroke (CHADS2 score). anti coagulate if >=2
anticoagulation if >48hrs (to prevent CVA)
rate control: beta blockers, CCB, digoxin
cardiovert only if new onset (<48 hrs) or TTE (transesophageal echo) shows no left atrial clot or after 3-6 wks of warfarin treatmtment with satisfactory INR (2-3)
what is etiology of atrial flutter
circular movement of electrical activity around the atrium at a rate of 300x per minute
what is symptoms of atrial flutter
usually asymptomatic
palpitations, syncope, lightheadedness
what is seen on ECG in atrial flutter?
regular rhythm, “sawtooth” appearance of p waves can be seen
atrial rate is 240-320 bpm
ventricular rate 150 bpm
what is used to treat atrial flutter
anticoagulation, rate control, cardioversion similar to atrial fib
estimate risk of stroke (CHADS2 score). anti coagulate if >=2
anticoagulation if >48hrs (to prevent CVA)
rate control: beta blockers, CCB, digoxin
cardiovert only if new onset (<48 hrs) or TTE (transesophageal echo) shows no left atrial clot or after 3-6 wks of warfarin treatmtment with satisfactory INR (2-3)
what is etiology of multifocal atrial tachycardia?
multiple atrial pacemakers or reentrant pathways
COPD
hypoxemia
what are symptoms of multifocal atrial tachy
may be asymptomatic
what is seen on ECG for multifocal atrial tachy
three or more unique p-wave morphologies
rate >100bpm
how is mutifocal atrial tachy treated?
treat underlying disorder
verapamil or beta-blockers for rate control
suppression of atrial pacemakers (not vry effective)
what is etiology of AVNRT (atrioventricular nodal reentry tachy)
a reentry circuit in the AV node depolarizes the atrial and ventricle nearly simultaneously
what is symptoms of AVNRT (atrioventricular nodal reentry tachy)
palpitations, SOB, angina, syncope, lightheadedness
what are ECG findings of AVNRT (atrioventricular nodal reentry tachy)
rate 150-250 bpm
p wave is often buried in QRS or shortly after
what is treatment for AVNRT (atrioventricular nodal reentry tachy)
cardiovert if hemodynamically unstable
carotid massage, valsalva or adenosine can stop arrhythmia
what is etiology of AVRT (atrioventricular reciprocating tachy)
and ectopic connection between atrium and ventricle that causes a reentry circuit. seen in WPW
what are symptoms of AVRT (atrioventricular reciprocating tachy)
palpitations, SOB, angina, syncope, lightheadedness
what are ECG findings in AVRT (atrivoentricular reciprocating tachy)
a retrograde p wave is seen after normal QRS
a preexcitation delta wave with WPW
how do you treat AVRT? atrioventricular reciprocating tachy
cardiovert if hemodynamically unstable
carotid massage
Valsalva, and adenosine can stop arrhythmia
what is etiology of paroxysmal atrial tachy
rapid ectopic pacemaker in atrium no in sinus node
what are symptoms of paroxysmal atrial tachycardia?
palpitations, SOB, angina, syncope, lightheadedness
what ecg findings in paroxysmal atrial tachy
rate>100 bpm; p wave with unusual axis before each normal QRS
what is treatment for paroxysmal atrial tachy
adenosine can be used to unmask underlying atrial activity
name the 4 types of ventricular tachy?
premature ventricular contraction
ventricular tachy
ventricular fibrillation (VF)
torsades de pointes
name the etiology of premature ventricular contraction (PVC)? what 3 things is it associated with?
ectopic beats arise from ventricular foci.
associated with hypoxia, electrolyte abnormaltiies, and hyperthyroidism
what are symptoms of PVCs?
usually asymptomatic
my lead to palpitations
what are ECG findings in premature ventricular contractions?
early, wide QRS not preceded by a p wave. PVCs are usually followed by a compensatory pause
what is treatment for PVCs?
treat the underlying cause. if symptomatic give beta blockers or occasionally other antiarrhythmics
what is etiology of ventricular tachy? 3
can be associated with CAD, MI and structural heart disease
what are symptoms of ventricular tachy?
non sustained VT is often asymptomatic
can lead to palpitations, can lead to hypotension, angina, and syncope.
can progress to VF and death
what ECG are in ventricular tachy
three or more consecutive PVCs
wide QRS complexes in regular rapid rhythm, may see AV dissociation
what is treatment for ventricular tachy?
cardioversion and antiarrhythmics (amiodarone, lidocaine, procainamide)
what is etiology of ventricular fibrillation (VF) 4 associations?
assocaited with CAD and structural heart disease
also associated with cardiac arrest together with asystole
what is symptoms of ventricular fib?
syncope
absence of BP
pulselessness
what are ecg finding in v fib?
totally erratic wide complex tracing
how is v fib treated?
immediate electrical cardioversion and ACLS protocol
what is etiology of torsades de pointes? (5 assocaitions)
associated with long QT syndrome, proarrhythmic response to medications, hypokalemia, congenitial deafness, and alcoholism
what is symptoms of torsdes de pointes?
can present with sudden cardiac death
typically associated with palpitations, dizziness, an syncope
what ECG findings are associated with torsades de pointes
polymorphous QRS
VT with rates between 150-250 bpm
what is treatment for torsades de pointes?
give magnesium initially
cardiovert if unstable
correct hypokalemia
withdrawal offending drugs
