Clinical Treatment of Arrhythmias

Question 1

etiology of bradyarrhythmias

Answer 1

can develop in the sinus node, AV node or below the AV node – be concerned when the patient is symptomatic and when the rhythm is infranodal

Question 2

etiology of tachyarrhythmias

Answer 2

supraventricular tachycardias (irregular), v-tach and v-fib (1:1 P to QRS)

Question 3

acute tx of bradyarrhythmias

Answer 3

stop offending meds, beta-agonists (dopamine or isoproterenol), transcutaneous pacing, temp transvenous pacing

Question 4

acute tx of tachyarrhythmias

Answer 4

all irregular tx sith rate control, antiarrhythmics or cardioversion and all regular can be tx with Adenosine
A fib: unstable = cardiovert, stable = rate control then assess sx
A Flutter: similar to afib
A tachy, AV nodal reentrant tachy and AV reentrant tachy (other SVTs): nonpharm maneuvers, meds only when symptomatic
V tach: cardiovert

Question 5

LT tx of bradyarrhythmias

Answer 5

permanent pacemaker

Question 6

LT tx of tachyarrhythmias

Answer 6

A fib: meds to control rhythm (esp if symptomatic): class IC (contraindicated in CAD), Class III anticoagulation; ablation
-meds to control rate: beta blockers, digozin, verapamil, diltiazen, amiodarone
A Flutter: similar to afib, cath ablation is curative
A tachy, AV nodal reentrant tachy and AV reentrant tachy (other SVTs): beta blockers, Ca2+ channel blockers, Class I antiarrhythmics, cath ablation
V tachy: beta blockers, Ca2+ channel blockers, class Ic agents, class III, ablation, ICD (when structural heart disease or significant risk factors)

Question 7

advantages and limitations of different arrhythmia treatment strategies

Answer 7

Meds vs. ablation: ablation is more effective but has more risks
Rate or rhythm control more difficult in afib
Ablation has more risk in afib than aflutter, and it is curative in aflutter
For vtach, ablation is low risk with 70-80% effectiveness

Question 8

what should determine tx of bradyarrhythm?

Answer 8

• sx and infranodal disease, which can progress to unreliable heart rhythms
• tx potential reversible causes
• stabilize pts

Question 9

what should you do in the case of any unstable tachyarrhy?

Answer 9

SHOCK

Question 10

what should you treat in tachyarrhythm?

Answer 10

underlying causes

Question 11

what can you use to see the p waves in SVT?

Answer 11

adenosine

Question 12

decision regarding ICDs

Answer 12

• structural heart disease

- risk of sudden death

Question 13

only available tx for sudden card death

Answer 13

basic life surrport and early defib