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MJ- Foundations 2 Exam 2 > Conduction disorders > Flashcards

Conduction disorders Flashcards

1
Q

What do the PQRST of an ECG represent

A 
P: atrial depolarization 
PR: AV node delay
QRS: Ventricular depolarization 
ST: beginning of repolarization
T: Ventricular repolarization
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2
Q

“How to read a rhythm strip”

A

Assess rate
Regular or irregular
Wide or narrow QRS
P wave to QRS relationship

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3
Q

What is the big box method for counting HR

A 
300
150
100
75
60
50
(5 boxes= 1 second)
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4
Q

What is bradycardia due to

A

defect in impulse formation (SA) or impulse conduction (heart block)

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5
Q

What constitutes “NSR”

A

rate 60-100
one P for every QRS, one QRS for every P
P waves have same morphology
QRS (in same leads) have same morphology

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6
Q

What are symptoms of rhythm disorders

A

fatigue, palpitations, syncope, dizzy spells

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7
Q

Whats important to check on PE

A

thyroid exam; hypothyroid can cause bradycardia

Hyperthyroid can cause arrhythmia

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8
Q

What must you fix in order to correct chronic hypokalemia

A

Mg levels

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9
Q

What is the initial survey of ACLS

A

Circulation
Airway
Breathing

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10
Q

What are the class I anti-arrhythmic drugs

A

Na channel blockers;

1a: Mod Na block, some K & Ca. Prolong QRS
1b: weak Na block. Min ECG changes. used for Ventricular arrhythmias
* 1c: Strong Na block. wide QRS, SA node depression. NOT for CAD

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11
Q

What are the Class II anti-arrhythmic drugs

A

Beta blockers: decrease sinus rate, prolong PR

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12
Q

What are the Class III anti-arrhythmic drugs

A

K channel blockers: prolong QT

*amiodarone prolongs QT but side effects aren’t as bad

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13
Q

What are the class IV anti-arrhythmic drugs

A

Ca channel blocker: decrease sinus rate, prolong PR

decrease contractility and cause edema

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14
Q

What are other anti-arrhythmic drugs

A

Digoxin: increase vagal tone/ AV block
Adenosine: AV node blocker (half life 10 seconds)

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15
Q

What is sick sinus syndrome

A

chronic SA node dysfunction diagnosed by symptoms (brady, sinus arrest, tacky-brady) plus ECG findings)
-Usually d/t fibrosis form aging

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16
Q

What is sinus bradycardia

A

Normal rate and rhythm but HR under 60

Caused by fibrosis, acute injury, or med s/e

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17
Q

What are symptoms of bradycardia

A

fatigue, SOB, syncope

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18
Q

When would you place a pacemaker in a bradycardia patient

A

If symptomatic and d/t irreversible cause

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19
Q

How do you treat sick sinus syndrome

A

Treat tacky if sx
stop offending agents if brady
Permanent pacemaker to control tachy-brady

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20
Q

What is sinus arrest

A

failure of sinus node to initiate impulse causing pause >2 seconds

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21
Q

When would you pace a sinus arrest patient

A

if pause is > 6 seconds

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22
Q

What is tachy-brady syndrome

A

intermittent fast and slow rates from SA node or atria (<60, >100)
-periods of AFib,

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23
Q

When would you pace a tachy-brady patient

A

If Afib is present as well

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24
Q

What is first degree AV block

A

PR interval >200 sec (one big box)

patient asymptomatic, no treatment

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25
What is second degree AV block, Mobitz I
Wenkeback! progressive prolongation until failure to conduct and ventricular beat dropped site of block is in AV node
26
How do you treat Wenkebach
Not dangerous, so no treatment | usually asymptomatic
27
What is second degree AV block, Mobitz II
Fixed PR interval, but dropped QRS Block is in the HIS (below AV) EMERGENCY! can lead to complete heart block
28
What is complete heart block
no conduction from atria to ventricles P wave independent form QRS with ventricular escape rhythm EMERGENCY! must pace
29
What are symptoms of complete heart block
syncope, SOB, HF, fatigue
30
What are QRS width measurements of bundle branch blocks
Incomplete: 0.10-0.12 Complete: 0.12 or more (wider QRS= more extensive block)
31
How do you treat a bundle branch block
No treatment | but look further in ECG to find other indicators for conduction problems
32
What is RBBB
Rabbit ears; LV depolarizes first, then RV (passively) | Can have RAD
33
What does a LBBB look like on ECG
V1: negative, big Q wave V6: positive with LAD ST and T waves usually opposite (if Q is largely downwards, ST will be elevated)
34
What can you not diagnose if the patient has LBBB
an MI! Because ST will be elevated if Q is negative | LBBB associated with underlying cardiac dz until disproven
35
What is always indicated in a tachy patient that is NOT hemodynamically stable
Shock!! (light em up like a christmas tree....... smh)
36
When should you NOT use adenosine
If patient has WPW or is in Afib | if block is not in AV node, adenosine wont do anything
37
What is a PAC
early atrial depolarization with different P wave morphology (coming from different site)
38
What are symptoms of PAC
usually asymptomatic but can cause palpitations
39
How do you treat PAC
BB or CCB for symptoms. | dont need to treat if asymptomatic
40
What is SVT
``` narrow QRS (140-120 bpm) due to accessory pathway cause palpitations and syncope ```
41
What does SVT look like on ECG
P wave morphology different but buried in QRS
42
How do you treat SVT
Unstable: cardioversion Acute setting: Adneosine and vagal maneuver **First line tx: ablation anti-arrhythmics BB CCB for long term
43
What is WPW syndrome
Type of SVT- Conduction goes through accessory pathway AND AV node. Can lead to FATAL Afib (sending into VFib) To be syndrome, must have delta wave, Sx, and SVT
44
What is seen on WPW ECG
``` Delta wave (slurred upstroke of QRS) Narrow PR In tachycardia, delta wave disappears ```
45
How do you treat WPW
same as SVT: cardioversion, adenosine, BB, CCB, anti-arrhythmics
46
If patient has WPW plus AFib, what should you avoid
AV node blockers (digoxin, adenosine)
47
What is AFib
No discernible P waves (300-600 bpm)- Irregularly irregular. Ventricles can fire normal or 100+ Associated w/ other heart disease, do thorough workup
48
What are RF for AFib
age, HTN, CAD, valve dz, obesity, sleep apnea
49
What are symptoms of AFib
asymptomatic | fatigue, dyspnea, CP, palpitations, syncope, HF
50
What will you see on AFib ECG
QRS morphology same but can vary in interval length | P waves not discernible and irregular
51
What are the 3 types of AFib
Paroxysmal: terminates spontaneously w/in 7 days Persistent: fails to terminate after 7 days Longstanding persistent: longer than 12 mo Permanent: talk about rhythm treatment -Valvular AFib: patient also has mitral stenosis or rheumatic valve dz
52
What is the CHADSVASC scoring system
``` Risk stratification for CVA (stroke): C: congestive HF H: HTN A: age 65-74 (1) D: diabetes (1) S: stroke (2) V: A: Age 75+ (2) SC: Sex, female (1) ```
53
How do you read a CHADSVASC score
2+ qualify for anticoagulation (NOAC/Warfarin) 1: grey zone, talk to patient depending on points 0: aspirin
54
Who does CHADSVASC not apply to
Valvular Afib patients | They require WARFARIN (only)
55
What is warfarin
Vitamin K antagonist takes 2-3 days to be theraputic (higher doses dont help) *only anticoag for valvular Afib and mechanical heart valves Reversible with vitamin K
56
What is NOAC
novel oral anticoagulant, renally cleared $$$- but no monitoring! Onset in 2 hours
57
What are the types of NOAC
Direct thrombin inhibitor | Factor Xa inhibitor (Eliquis best safety profile)
58
What are contraindications to taking anticoagulants
Bleeding Previous ICH thrombocytopenia severe HTN
59
What is the treatment of Afib
Acute: AV node blocker (metoprolol, diltiazem, digoxin) Cardioversion (24-48 hr window if not on anti-coags- do TEE to check for LAA thrombus) Anticoag: all undergoing cardioversion, regardless of CHADSVASC (& 4 wks after)
60
How can you control rhythm and rate in AFib
Rhythm: anti-arrhythmic drug, catheter ablation, surgical maze Rate: BB, CCB, digoxin (AV node block)- pacemaker or AV node ablation for permanent AFib
61
What is atrial flutter
Short re-entrant circuit in RA going at 300 bpm, but ventricular response is normal (2:1, 3:1, 4:1) Carries risk of CVA, assess chadsvasc
62
What does na atrial flutter ECG look like
SAW TOOTH PATTERN in inferior leads (II, III, aVF) | -Atypical flutter doesn't have saw tooth
63
What are the symptoms for atrial flutter
same as AFib: fatigue, dyspnea, CP, palpitations
64
How do you treat Atrial flutter
Acute: cardioversion/TEE Chronic: catheter ablation -Class Ic or III anti-arrhythmic if patient cant do ablation
65
What is atrial tachycardia
tachy from atria but not SA node. Faster than SA, so it takes over (140-220). Benign Caused by atrial scarring/drugs (digoxin) and can lead to AFib
66
What can you find on Atrial tachy ECG
P wave hard to find (in T waves) but rhythm is regular
67
How do you treat Atrial tachycardia
treat based on symptoms (BB, CCB, class Ic or III) Adenosine won't work (not from AV node) Rarely need cardioversion
68
What are symptoms of Atrial tachy
palpitations
69
What is a PVC
Early ventricular depolarization causing wide QRS WITHOUT preceding P wave (bigeminal or trigeminal patterns) Can be monomorphic or polymorphic
70
What are symptoms of PVC
palpitations
71
What will you see on PVC PE
``` irregular pulse Effective bradycardia (electric beat on ECG w/o perfusion or pulse to match) ```
72
How do you treat PVCs
holter monitor to determine burden of PVC Initial: BB or CCB Antiarrhythmics (sotalol) If PVC causes cardiomyopathy, Ablation
73
What is VTach
3 or more PVC (160-200 bpm), usually d/t CAD/MI causing scar Non sustained: >3 beats, less than 30 seconds before spontaneous termination Sustained: >30 seconds, need cardioversion
74
What are symptoms of VTach
syncope, dizziness, palpitations, CP | May be stable or unstable on PE
75
How do you treat VTach
full cardiac work up and cardiac cath
76
What are the types of VTach
Monomorphic: due to re-entrant circuit in ventricle d/t scar Polymorphic: more electrically unstable, ominous (similar to Torsades and VF)
77
Is wide complex tachycardia always VT
yes until proven otherwise. Check 12 lead | If unstable, cardiovert!
78
How do you treat VT acutely
If unstable, cardiovert | Stable with pulse: acutely, IV amiodarone or BB. electrical cardioversion if SR not restored
79
How do you treat VT chronically
BB ICD Class III for long term anti-arrhythmic use If all fails, ablation
80
Do anti-arrhythmic improve survival
NOOOOOPE
81
What is Torsades
A polymorphic VT with LONG QT INTERVAL "twisting" QRS along isoelectric baseline **Can occur in complete heart block
82
How do you treat Torsades
Emergent Cardioversion, can lead to sudden cardiac death **Use Mag after cardioversion If unstable, defibrillate
83
What are symptoms of Torsades
Syncope! | patient may be hemodynamically unstable
84
Why would you want to temporarily pace a Torsades patient at 100 bpm
To shorten the QT interval
85
How do you treat long term Torsades
Long term BB and ICD | stop offending agents
86
What is VFib
Pulseless, no discernable ventricular activity (200-300!) | If untreated, causes systole (DEATH)
87
What must you emergently do in VFib
Defibrillate! Epinephrine, chest compressions, secure airway (Rapid resuscitation to prevent anoxic brain injury)
88
What is the most common cause of VFib
CAD
89
How are VFib patients most commonly found
Found down, or witnessed out of hospital arrest (3-5% survival)

MJ- Foundations 2 Exam 2 (18 decks)

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