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CVPR Unit 1 > Clinical Treatment of Arrhythmias > Flashcards

Clinical Treatment of Arrhythmias Flashcards

1
Q

Slow arrhythmia

A

brady arrhythmias

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2
Q

If the rhythm is too slow, where in the conduction system is it affected?

A
  • sinus node
  • AV node
  • below the av node
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3
Q

Sinus node dysfunctions

A
  • Sinus bradycardia
  • sinus arrest/pause
  • tachy-brady syndrome
  • chronotropic incompetence
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4
Q

Sinus Arrest

A

Failure of sinus node discharge resulting in the absence of atrial depolarization and periods of ventricular asystole

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5
Q

Bradycardia-Tachycardia (Brady-Tachy) Syndrome

A

Intermittent episodes of slow and fast rates from the SA node or atria

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6
Q

AV node dysfunctions

A
  • first degree AV block

- Mobitz I 2nd degree AV block (Wenkebach)

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7
Q

1st degree AV block

A

AV conduction is delayed, and the PR interval is prolonged (> 200 ms or .2 seconds). each atrial signal is conducted to the ventricles (1:1 ratio).

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8
Q

Second-Degree AV Block – Mobitz I (Wenckebach)

A

Progressive prolongation of the PR interval until a ventricular beat is dropped
-Ventricular rate: irregular

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9
Q

below the AV node dysfunctions

A
  • Mobitz II 2nd degree AV block

- complete heart block

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10
Q

Second-Degree AV Block – Mobitz II

A
  • Intermittently dropped ventricular beats preceded by constant PR intervals
  • The infranodal (His bundle) tissue is most commonly the site of Mobitz II block.
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11
Q

Third-Degree AV Block

A
  • No impulse conduction from the atria to the ventricles
  • PR interval = variable
  • also referred to as complete heart block
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12
Q

When should you be concerned about a bradyarrhythmia pt?

A
  1. When the patient is symptomatic, no matter which part of the conduction system is affected.
  2. When the rhythm is infranodal (below the AV node).
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13
Q

Treatment of bradyarrhythmia?

A
  • Find and treat reversible causes– ischemia/infarction, hypothyroidism, neurologic causes, Lyme disease
  • Stop offending medications, if possible: antiarrhythmics, clonidine, lithium, among others.
  • Acute treatment for unstable patient: beta-agonists (dopamine or isoproterenol), transcutaneous pacing, temporary transvenous pacing.
  • Long term: Permanent pacemaker
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14
Q

Types/origins of tachyarrhythmias

A 
Above ventricle:
-Supraventricular Tachycardias (SVT)
Ventricles:
-Ventricular Tachycardia
-Ventricular Fibrillation
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15
Q

Acute treatment of irregular SVT

A

If unstable: shock

Stable: can control their rates, use antiarrhythmics, or cardioversion

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16
Q

5 C’s of A. Fib management

A 
Cause:  Reverse 
Control Rate
antiCoagulation (I know, no C there)
Control Rhythm
Cure:  Ablation
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17
Q

Common causes of A. Fib

A 
Hypertension 14%
IHD
Mitral valve Disease
Alcohol
Cardiomyopathies
Hyperthyroidism
Lone AF      14%
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18
Q

Immediate Tx of A Fib

A

Cardiovert

Control the Rate

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19
Q

Pharmacological rhythm control in A fib

A

Less successful
Does not require sedation
Class III agents- ibutilide, amiodarone, dofetilide, sotalol
Class IC agents- flecainide, propafenone

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20
Q

Electrical rhythm control in A Fib

A

DC Shock 70-90% success
Day procedure in hospital
Needs sedation

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21
Q

T or F: Patients with recurrent AF may require long term maintenance medications to control rhythm

A

True, especially if they are symptomatic in AF.

22
Q

When are Class IC agents contraindicated?

A

in CAD and structural heart disease

23
Q

Should Patients with a rhythm control agent should still be anticoagulated?

A

Yes, risk still present for thromboembolism, as rhythm control is not a cure.

24
Q

T or F: Digoxin controls rate during exercise well

A

False

25
Q

Rate control medications

A 
Betablockers 
Digoxin
Verapamil
Diltiazem
Amiodarone: can be used as a rate-controlling agent, especially in setting of decompensated heart failure.
26
Q

Which medications control HR during exercise?

A

Betablockers and rate limiting Ca Antagonists

27
Q

T or F: Use of medications in combination can develop heart block

A

True

28
Q

Tx strategies for atrial flutter

A
  • Similar to A Fib
  • Catheter ablation more successful than medications, 95% cure rate
  • with successful catheter ablation, anticoagulation no longer necessary
  • Lower ablation risk when compared to A fib
29
Q

List other SVT categories

A
  • AV nodal reentrant tachycardia (circuit within the AV node): most common, accounts for ~65% of regular SVTs (not including AF/flutters).
  • Accessory pathway-mediated tachycardias: abnormal connection between atrium and ventricle.
  • Focal atrial tachycardias: least common, abnormal focus of atrial tissue with enhanced automaticity– a “hotspot”.
30
Q

Tx options for other SVTs

A
  • Nonpharmacologic maneuvers: vagal maneuvers.
  • Pill in pocket: Medication only with symptoms.
  • Long term: beta blockers, calcium channel blockers to block AV node, Class I antiarrhythmics to suppress hotspots or premature beats that are triggers for tachycardia.
  • Ablation
31
Q

What are the 2 types of arrhythmias?

A

Tachy- and bradyarrhythmia

32
Q

What is chronotropic incompetence

A

inability to mount age-appropriate HR with exercise

33
Q

An SVT can be subdivided into those that are _________________.

A

irregular and those that are regular.

34
Q

Irregular SVT can be broken down into what 3 types?

A

-atrial fibrillation, where there are no discrete P waves

35
Q

Regular SVTs have what P to QRS ratio?

A

1:1, (sometimes can’t see p waves)

36
Q

Acute treatment of regular SVT

A

adenosine

37
Q

T or F: Cardioversion can be achieved either with drugs or electricity

A

True, Drugs are less successful but do not require sedation .

38
Q

T or F: atrial flutter Can be more difficult to rate or rhythm control than AF

A

True

39
Q

What is the most common SVT?

A

AV nodal reentrant tachycardia, circuit w/in the AV node

40
Q

What is the least common SVT?

A

Focal atrial tachycardias

41
Q

If pt has coronary artery disease, 90% of the time the wide complex tachycardia is _______

A

Ventricular tachyarrhythmia

42
Q

What is the acute Tx approach for stable ventricular Tachyarrhythmias?

A 
-Medications:
     Amiodarone
     Lidocaine 
     Procainamide
-Treat underlying causes
43
Q

What is the acute Tx approach for UNstable ventricular Tachyarrhythmias?

A
  • SHOCK
  • Treat underlying causes
  • Medications
44
Q

T or F: If there is structural heart disease with the ventricular arrhythmia, then they most likely will require a defibrillator.

A

True

45
Q

First line of therapy for ventricular tachyarrhythmias?

A

Ablation and medications are first line therapy , ICDs are sometimes contraindicated

46
Q

When is a defibrillator needed for VTs?

A
  • Secondary prevention: When the patient has had a sudden cardiac arrest due to VT or VF without a reversible cause (ischemia, drugs, electrolytes).
  • Primary prevention: When the patient has not had a cardiac arrest but is at significant risk.
47
Q

What is the difference b/t the leads of a pacemaker and an ICD?

A

ICD leads have coils

48
Q

Sudden Cardiac Death (SCD) prognosis

A

Only one-third of SCD cases are resuscitated and 10% survive to leave the hospital, many with morbidities

49
Q

The go to treatment for Any unstable tachyarrhythmia

A

SHOCK

50
Q

How can adenosine help dx SVT?

A

helps you see the P wave

CVPR Unit 1 (27 decks)

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