Cardiology: TachyArrhythmias Flashcards by Ade Ighodaro

what is etiology of sinus tachycardia? (6 causes)

normal physiologic response to fear, pain, and exercise
hyperthyroidism
volume contraction
infection
pulmonary embolism

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name 4 types of atrial supraventricular tachyarrhythmias

sinus tachy
a fib
a flutter
multifocal atrial tachy

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name 3 types of supraventricular AV junction tachyarrhythmias

AVNRT (atrioventricular nodal reentry tachycardia)
AVRT (atrioventricular reciprocating tachy)
paroxysmal atrial tachycardia

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what are signs and symptoms of sinus tachy

palpitations and SOB

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what are ECG findings in sinus tachycardia

sinus rhythm

ventricular rate >100bpm

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what is treatment for sinus tachycardia?

treat underlying cause

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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)

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what are symptoms of atrial fib

often asymptomatic
SOB
chest pain
palpitation
irregularly irregular pulse

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what is see on ECG?

no discernible p waves

variable and irregular QRS response

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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)

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what is etiology of atrial flutter

circular movement of electrical activity around the atrium at a rate of 300x per minute

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what is symptoms of atrial flutter

usually asymptomatic

palpitations, syncope, lightheadedness

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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

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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)

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what is etiology of multifocal atrial tachycardia?

multiple atrial pacemakers or reentrant pathways
COPD
hypoxemia

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what are symptoms of multifocal atrial tachy

may be asymptomatic

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what is seen on ECG for multifocal atrial tachy

three or more unique p-wave morphologies

rate >100bpm

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how is mutifocal atrial tachy treated?

treat underlying disorder
verapamil or beta-blockers for rate control
suppression of atrial pacemakers (not vry effective)

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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