Clinical Treatment of arrhythmias

Question 1

QRS will show when

Answer 1

The QRS complex on the ECG represents the depolarization of the ventricular muscle mass.

Question 2

A small portion of the last part of the _________ is represented by the conduction time through the Purkinje system.

Answer 2

PR interval

Question 3

Arrhythmias can be?

Answer 3

Too fast or too slow

Question 4

TOO SLOW

Answer 4

Bradyarrhythmias

Question 5

TOO FAST

Answer 5

Tachyarrhythmias

Question 6

Where in the conduction system can problems develop?

Answer 6

Sinus node
AV node
Below the AV node

Question 7

When should you be concerned about arrhythmia?

Answer 7

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).

Question 8

Find and treat reversible causes arrhythmia?

Answer 8

ischemia/infarction
hypothyroidism
neurologic causes
Lyme disease

Question 9

Stop offending medications, if possible causes arrhythmia?

Answer 9

antiarrhythmics, clonidine, lithium, among others.

Question 10

Acute treatment for unstable patient w/ arrhythmia?

Answer 10

beta-agonists (dopamine or isoproterenol)
transcutaneous pacing
temporary transvenous pacing

Question 11

Bradyarrhythmia Take Home Points

Answer 11

Determine block responsible: SA, AV, infranodal

s/s and infranodal disease (which can progress to unreliable heart rhythms) should dictate rx

Treat potential reversible causes.

Acutely stabilize patients.

long-term rx is a permanent pacemaker.

Question 12

___________ describes slow heart rate, typically defined as a rate of less than 60 beats per minute.

Answer 12

Bradyarrhythmia

Question 13

Tachyarrhythmias Above Ventricle

Answer 13

Supraventricular Tachycardias (SVT)

Question 14

Tachyarrhythmias Ventricle

Answer 14

Ventricular Tachycardia

Ventricular Fibrillation

Question 15

Tachyarrhythmias: Rx of Atrial Fibrillation- 5 C’s

Answer 15

Cause: Reverse

Control Rate

antiCoagulation

Control Rhythm

? Cure: Ablation

Question 16

Common Causes of AF

Answer 16

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

Question 17

Immediate Treatment

Answer 17

Cardiovert in unstable
Hemodynamic collapse

Control the Rate in stable
Assess symptoms

Question 18

RHYTHM CONTROL(CARDIOVERSION) works with

Answer 18

1- electrical

2- pharmacological (less successful but no sedation) via class Ic and 3

Question 19

Patients with recurrent AF may require long term maintenance medications to control rhythm, especially if they are symptomatic in AF.

Answer 19

Class IC agents – contraindicated in CAD and structural heart disease

Class III agents – ex amiodarone

**anticoags (stroke risk)

Question 20

Rate Control Medications

Answer 20

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

Question 21

Increased stroke risk in patients with certain risk factors (AF) often treated by

Answer 21

aspirin

sometimes warfarin

Question 22

Atrial Flutter rx

Answer 22

Catheter ablation more successful than medications (and compared to AF ablation), with 95% cure rate.

Question 23

abnormal heart rhythm, similar to AF. Both conditions are types of supraventricular (above the ventricles) tachycardia (rapid heart beat).

upper chambers (atria) of the heart beat too fast, which results in atrial muscle contractions that are faster than and out of sync with the lower chambers (ventricles).

Answer 23

Atrial Flutter

Question 24

Atrial flutter ablation is a straightforward, low risk procedure targeting a known critical ________ in the right atrium between the tricuspid valve and the inferior vena cava, thus blocking the circuit that causes atrial flutter.

Answer 24

isthmus

Question 25

Atrial flutter ablation is a straightforward, low risk procedure targeting a known critical isthmus in the right atrium between the tricuspid valve and the inferior vena cava, thus _________________

Answer 25

blocking the circuit that causes atrial flutter.

Question 26

Three main categories of "other" SVTs

Answer 26

AV nodal reentrant tachycardia Accessory pathway-mediated tachycardias Focal atrial tachycardias

Question 27

least common, abnormal focus of atrial tissue with enhanced automaticity– a “hotspot”.

Answer 27

Focal atrial tachycardias:

Question 28

Ventricular Tachyarrhythmias ACUTE TREATMENT Unstable

Answer 28

SHOCK Treat underlying causes Medications

Question 29

Ventricular Tachyarrhythmias ACUTE TREATMENT Stable

Answer 29

Medications: Amiodarone Lidocaine Procainamide Treat underlying causes

Question 30

abnormal connection between atrium and ventricle.

Answer 30

Accessory pathway-mediated tachycardias:

Question 31

(circuit within the AV node): most common, accounts for ~65% of regular SVTs (not including AF/flutters).

Answer 31

AV nodal reentrant tachycardia

Question 32

Ventricular Tachyarrhythmias NO STRUCTURAL HEART DISEASE

Answer 32

``` Idiopathic: focal arrhythmogenic trigger Usually “benign” Medications or ablation Rarely defibrillator is necessary ```

Question 33

Ventricular Tachyarrhythmias WITH STRUCTURAL HEART DISEASE

Answer 33

Treat underlying causes Risk stratify for defibrillator Medications/ ablation adjunct to defibrillator- NO CURE W/ THIS

Question 34

Tachyarrhythmia Take Home Points

Answer 34

Tachyarrhythmias are divided into supraventricular arrhythmias and those coming from the ventricle. Any unstable tachyarrhythmia--> SHOCK. Treat and reverse the underlying causes.

Question 35

SVT: treatment is individualized according to the specific mechanism so MAKE THE DIAGNOSIS (Adenosine to see p waves).

Answer 35

There are a variety of treatment options for SVTs

Question 36

Decisions regarding implantable defibrillators

Answer 36

structural heart disease | what is risk of sudden death with the arrhythmia

Question 37

Most sudden deaths from ventricular arrhythmias occur in general population before_____________

Answer 37

they can be risk stratified.

Question 38

Only available treatments for sudden cardiac death: _____________ YOU- as a potential bystander- can make a difference

Answer 38

basic life support and early defibrillation.