Chapter 11 PowerPoint

Question 1

What is atrial fibrillation?

Answer 1

350-450 BPM
Irregular rate, muscle is Quivering
Irritated foci depolarizing but running into each other.

Question 2

How does atrial fibrillation appear on an ECG?

Answer 2

No clear p wave
QRS spaced irregularity

Question 3

What is the biggest issue in atrial fibrillation?

Answer 3

Coagulation is biggest issue
Anticoagulation for more than month required before shock treatment

Question 4

What is the treatment for atrial fibrillation?

Answer 4

Treatment: Synchronized Cardioversion
VR> 100 is Rapid VR
< 100 is Normal rate

Question 5

What is the second most common type of SVT?

Answer 5

AV Reentrant Tachycardia (AVRT)

Question 6

What is Wolff-Parkinson-white syndrome?

Answer 6

A type of AVRT

Question 7

What occurs in Wolff-Parkinson-white syndrome?

Answer 7

Signal bypasses AV node and reaches Ventricle myocardium before normal signal causing pre-excitation.

Question 8

How does Wolff-Parkinson-white syndrome appear on an ECG?

Answer 8

Note Delta Waves just before QRS

Question 9

What is Wolff-Parkinson-white syndrome caused by?

Answer 9

Caused by a congenital bypass
“Bundle of Kent”

Question 10

How is Wolff-Parkinson-white syndrome solved?

Answer 10

Solved with Catheter Ablation

Question 11

Who is AV Nodal Reentrant Tachycardia most common in?

Answer 11

Most common in young women. Healthy hearts

Question 12

What is the typical rate of AV Nodal Reentrant Tachycardia?

Answer 12

Paroxysmal – Suddenly 250 +/- 50 bpm

Question 13

What are the symptoms of AVNRT?

Answer 13

Light headedness, dizziness SOB, chest pain/pressure, fatigue or anxiety

Question 14

What is AVNRT often misdiagnosed as?

Answer 14

Mis-diagnosed with anxiety or panic attacks

Question 15

What is the treatment for AVNRT?

Answer 15

Resolution of episode is on own. No treatment
Reentry refers to occurring bc of right circumstances

Question 16

How does AVNRT appear on an ECG?

Answer 16

ECG appearance
Rapid regular Ventricular Rate
Normal width QRS complex
No visible P wave
Retrograde p waves – II, III, aVF

Question 17

AVNRT is dependent on ____ of conduction and ____ time of ____ ____?

Answer 17

AVNRT is dependent on speed of conduction and refractory time of AV node

Question 18

What are four tachycardia rhythms?

Answer 18

Ventricular Tachycardia
-Monomorphic V-Tach
-Polymorphic V-Tach
Torsades De Points
-Polymorphic V-Tach w/ prolonged QT interval
Ventricular Flutter
Ventricular Fibrillation

Question 19

What is paroxysmal ventricular tachycardia?

Answer 19

3 PVC’s in a row or < 30 sec of PVC’s
Typically will convert back to NSR w/o medical intervention

Question 20

What does VT come from?

Answer 20

VT comes from Ectopic Foci triggering Vent Depol

Question 21

How does ventricular tachycardia appear on an ECG?

Answer 21

ECG appearance
Every Beat has Wide QRS w/ T wave in opp. deflection
Each beat is symmetrical and identical
Rhythm is regular or slightly irregular.
No P waves or sparse
Rate is >100 but < 250

Question 22

What are causes of paroxysmal VT?

Answer 22

Causes: History of MI with Heart disease, Myocardial ischemia, electrolyte disturbances, Cardiomyopathy, MVP, Myocardial contusion, drug toxicity, cocaine

Question 23

V-tach signs and symptoms?

Answer 23

Signs and symptoms
Derive from decreased Cardiac Output
Hypotension, dyspnea, dizziness, lightheadedness, syncope
Chest pain or acute MI

Question 24

Treatments for V-tach?

Answer 24

Medical treatment
911
Oxygen therapy, antiarrhythmic medication, cardioversion
Ablation if VT is consistently occurring

Question 25

What is Torsade's de pointes?

Answer 25

“Twisting around points” QRS complex twists around isoelectric axis Not typically a sustained run Spontaneously terminates, recurs and degrades to Vfib BTW VT and Vfib

Question 26

What is associated with long QT syndrome?

Answer 26

Torsade's de pointes

Question 27

What is torsade's de pointes generated by?

Answer 27

Generated from multiple foci in ventricles QRS changes from Beat to Beat Asymmetrical bc alternating in shape, height, and width

Question 28

What are causes of torsade's de pointes?

Answer 28

Cause -Electro-disturbances -Hypomagnesemia -Hypokalemia Medications -Antiarrhythmics -Tricyclic antidepressants -Antibiotics (erythromycin

Question 29

Treatment for torsade's de pointes?

Answer 29

Treat Immediately : Defibrillator after pushing magnesium therapy.

Question 30

Describe ventricular flutter?

Answer 30

250-350 BPM Deadly and ineffective rhythm 1 foci in ventricle is irritated creating concurrent ventricular depolarization No P waves No BP No Treatment but shock Cannot self resolve

Question 31

Describe ventricular fibrillation?

Answer 31

Rapid Arrythmia 400+/- 50 No organized depol or repol of ventricles Quivering No identifiable wave forms….. Chaotic electrical activity No organized contraction of LV = no Cardiac Output = unconscious and pulseless patient Defib required EMERGENCY – deadly rhythm 350-450BPM Irregular NO PULSE NO BREATH NO BLOOD PRESSURE Bigger irregular scribble No QRS complex Shock advised!!! Non synchronized cardioversion