Conduction Disorders Flashcards
What is the treatment for a patient in Sinus Bradycardia that is symptomatic or hemodynamically unstable?
Atropine
Loss of Sinus “P” Wave for less than 2 seconds.
Sinus Pause
Loss of Sinus “P” Wave for more than 2 seconds.
Sinus Arrest
What medications can cause Sinus Arrest or Pause?
Digoxin
Beta Blockers
Verapamil
Diltiazem
What is the treatment for Sinus Arrest or Pause?
Asymptomatic = None
Discontinue Offending Drug
Pacemaker if necessary
What is Sick Sinus Syndrome known as?
Tachy-Brady Syndrome
What is the treatment for Sick Sinus Syndrome?
Symptomatic = Permanent Pacemaker with Dual Chamber Pacing
Bradycardia + Ventricular Tach = Permanent Pacemaker with Implantable Cardioverter-Defibrillator
What is the most common chronic Arrhythmia?
A-Fib
What are some risk factors of A-Fib?
Cardiac Disease
Lung Disease
Hyperthyroidism
A-Fib that terminates spontaneously or with intervention in < 7 days.
Paroxysmal A-Fib
A-Fib that lasts for > 7 days.
Persistent A-Fib
A-Fib that lasts longer than 12 months.
Longstanding Persistent A-Fib
A-Fib that is jointly decided by both the patient and clinician not to treat.
Permanent A-Fib
A-Fib in the absence of rheumatic mitral stenosis, mechanical or bioprosthetic heart valve, or mitral valve repair.
Nonvalvular A-Fib
What is used to assess the risk of stroke in a patient with A-Fib?
CHA2DS2-VASc Risk Score
What are the components of the:
CHA2DS2-VASc
CHF or LVEF < 40% = 1
Hypertension = 1
Age > 75 = 2
Diabetes = 1
Stroke/TIA = 2
Vascular Disease = 1
Age 65 - 74. = 1
Female = 1
What CHA2DS2-VASc score would recommend oral anticoagulation?
> 2 in Men
3 in Women
What CHA2DS2-VASc score would you consider oral anticoagulation?
1 in Men
2 in Women
When should you admit a patient with A-Fib to the hospital?
Active Ischemia
Heart Failure
Hypotension
Difficult Rate Control
Confusion
Acute Renal Injury
What is the first-line treatment for RHYTHM Control in a patient with onset and identifiable cause of A-Fib, or if the patients remains symptomatic despite rate control?
Cardioversion
How is A-Fib treated in an unstable patient?
IV Heparin
IV Rate Control
- Calcium Channel Blocker or Beta Blocker
Cardioversion (120 - 200 J)
What medication do you NOT give for rate control in patients with A-Fib + COPD
Beta Blockers
What medication do you NOT give for rate control in patients with LV Dysfunction + Heart Failure
Calcium Channel Blockers
What medications can be given to patients without Cardiovascular Disease to control A-Fib rate?
Beta Blocker
Diltiazem
Verapamil
What is the drug of choice for A-Fib rhythm control?
Amiodarone
What would be some indications for Rhythm Control (Cardioversion) instead of Long-Term Rate Control in A-Fib?
Hemodynamic Instability
Failure of Rate Control
First Episode
Younger Patients (< 65)
CHF
Potentially Reversible Causes
What are the Anticoagulants of choice for A-Fib stroke prophylaxis?
Warfarin
Apixaban or Rivaroxaban
Dabigatran
Atrial Rhythm characterized by a rapid and regular atrial depolarizations with an atrial rate of 250 - 300.
A-Flutter
A-Flutter is best seen in which leads?
Inferior Leads
(II, III, avF)
What is the preferred treatment for A-Flutter?
Catheter Ablation
What are the two rhythms caused by Atrioventricular Re-Entrant Tachycardia (AVRT)
SVT
Wolff-Parkinson-White
Type of AVRT where the impulse travels down the normal AV node first and returns via the accessory pathway.
Orthodromic (95%)
What kind of QRS complex results from Orthodromic AVRT?
Narrow QRS
Type of AVRT where the impulse travels down the accessory pathway first and returns via the normal pathway.
Antidromic
What kind of QRS complex results Antidromic AVRT?
Wide QRS
SVT is most common among which population of patients?
Young Females
How do you treat Stable SVT?
Vagal Maneuvers
Adenosine
How do you treat Unstable SVT?
Cardioversion
What is the treatment for Wolff-Parkinson-White Syndrome?
Radiofrequency Ablation
What medications can be used to treat Wolff-Parkinson-White?
Procainamide
Ibutilide
What medications should you avoid in patients with WPW?
Digoxin
Beta Blockers
Calcium Channel Blockers
Adenosine
What is the difference between Multifocal Atrial Tachycardia and Wandering Atrial Pacemaker?
MAT > 100 bpm
WAP = 60 - 100
Patients with Multifocal Atrial Tachycardia commonly have what?
Chronic Lung Disease
What is the treatment for a First Degree AV Block?
No Treatment
What is the treatment for a Second Degree Type 1 AV Block?
Asymptomatic = Nothing
Symptomatic = Atropine or Epi
What AV Block often progresses to a 3rd Degree?
Second Degree Type 2
How do you treat a 2nd Degree Type 2 AV Block?
Atropine or Pacing
Permanent Pacemaker if not resolved
Type of AV Block where no atrial impulses reach the ventricles.
Third Degree AV Block
(Atrial Rate > Ventricular Rate)
What is the treatment for a 3rd Degree AV Block?
Temporary Pacing
Permanent Pacemaker
What type of QRS complex is seen with a bundle branch block?
Wide QRS
What is the primary cause of V-Tach?
Coronary Artery Disease + Prior MI
How long must V-Tach be to be considered sustained?
Longer than 30 seconds
What rhythm can V-Tach progress to?
V-Fib
What should all patients with Sustained V-Tach have?
Implantable Caridoverting Defibrillator
How do you treat stable but symptomatic V-Tach?
Amiodarone
How do you treat unstable V-Tach?
Cardioversion + Amiodarone
What usually causes Torsades de Pointes?
QT Prolongation
- ↓ Mg, K, or Ca
How do you treat Torsades de Pointes?
Cardioversion
Magnesium
Fatally arrhythmia that usually begins as V-Tach and has a rate > 300
V-Fib
