Dysrhythmias Flashcards
what is sinus arrythmia?
- patho
- ekg findings
- treatment
- normal finding – exaggerated in young healthy individuals
the heart is responding to the ANS system – respirations
inhale: increased HR (faster conduction on EKG)
exhale: decreased HR (slower conduction on EKG)
still normal sinus, with a P wave and still coming from the SA node
treatment:
- no treatment needed
Sinus Tachycardia & Bradycardia
- what are they
- a result from what
- treatment
Tachycardia
- increase sinuse rate of heart > 100 bpm
- gradual in onset and offset
Resulting of…
- stress, anxiety
- fever/infection
- shock/blood loss
- cocaine
treatment
- treat underlying issue
Bradycardia
- normal sinus rhythm, just slower than 60 BPM
Resulting from…
- ischemia/SA node dysfunction
- most commonly: a vagal maneuver
- athletes
- beta blockers
- sleep apnea
- hypothyroid
Treatment
- none needed
- if still slow: atropine will increase HR
Premature Atrial Contractions (PACs)
- from where & patho
- pt presentation
- EKG finding
- a sign of what
- signals from the atrial foci triggering another heart beat to happen before the previous one is finished
EKG
- see an abnormal p wave on top of the previous T wave
Pt presents
- “heat is skipping a beat”
Sign of what
- increase sympatheic stimulation
- caffiene, stress, anxiety
- alcohol
Premature Ventricular Contractions (PVCs)
- pt presentation
- EKG finding
- a sign of what
- from where & patho
- beats of the heart originating from the ventricules triggering another beat before the previous one is completed
Pt. Presentation
- heart skipping a beat
EKG
- abnormally tall and bizzare QRS complexes occurring imediately after or during downslope of the T wave of previous
A sign of
- Ischemia (low O2)
- inflammation
- can also be stress, anxiety & caffeine
AV blocks: where do you look on EKG to find the issue
the PR interval!!! indicated an issue with getting signal from the SA node to the AV node
will tell you
1st degree
2nd degree
3rd degree
First Degree AV Block
- patho
- EKG
- treament
- the impulse is conducting from the atria to the ventricles – just taking longer than expected to get from SA to AV node
EKG
- result is prolonged PR interval > .2 seconds
- see the PR segment, constantly prolonged greater than 1 big block on the EKG
Treatment
- none; observe for progression
Second Degree AV Block
- two types
- patho
- EKG findings
- symptoms
- treatment
- not every P wave has a QRS that follows it!
Type 1: Weinchebach - “long, longer, longer then drop”
- EKG: PR interval gets longer and longer and longer then it drops off
- pt. will be asymptomatic usually
- if symptoms: bradycardia: give atropine, epi or pacemaker
Type 2: Mobitz II
- constantly or prolonged PR intervals, then a sudden drop of the QRS complex (PR could be normal too!)
- pt. will be asymptomatic
- if symptomatic: bradycardia: give atropine, epi or pacemarker
- watch out: this is more liekly to become a 3rd degree HB
Third Degree Heart Block
- patho
- EKG findings
- pt. presentation
- treatment
completel disassocation of the atria and ventricles
- due to AV nodal disease!!!
- no communication between the atria and the ventricles
EKG:
- P wave at they’re own beat
- QRS at they’re own beat
- no relation between the two
increased risk of cardiac death
- pts. will be symptomatic – bradycardia (fatigue or SOB)
Treatment
- temporary pacing (transcutaneous)
- perminant pacemaker needed
- if symptomatic: brady = atropine
Superventricualr Arrythmias
- WAP
- MAT
- patho
- EKG findings
- pt. presentation
- treatment
WAP - wandering atrial pacemaker
- multiple etopic foci creating the impulse to beat
- EKG : ** 3+ P wave morphologies & HR < 100**
MAT: multifocal atrial tachycardia
- multiple etopic foci creating the beat
- EKG: ** 3+ P waves & HR > 100** since its tachy!!
- see in COPD pts.
Superventricaulr Arrythmias
- AV Junctional Rhythms
3 types
- patho/reasons
- EKG findings
Patho
- SA node is dysfunctional
- CAD/ischemia of the SA node area – RCA
- digoxin toxcitiy
- so… the AV node area takes over as the priamary pacemaker — 3 rhythms
1. Normal: 40-60 BPM (normal AV node)
2. Accelerated : 60-100 BPM
3. Junctional Tachycardia : 100 + BPM
EKG
- inverted or absent P waves
- will have a regulat rhythm
Atrial Fibrillation
- causes
- patho
- types
- EKG findings
What: the atria are beating chaotically (300+ beats) but the ventricles are okay irreglarly irregular
Pathology
- there is some increase in atrial pressure (from mitral or tricuspid disaese, Left ventricle issue, systemic HTN, pulm HTN)
- triggers the atria to stretch (because increased pressure and fluid) –> damages them!
- electrical remodeling because of stretch
- hyperexcitable etopic foci overwhelm sinus node & they all fire
Types
- paroxysmal: selt-limiting within 7 days (24hrs. commonly)
- persistant: more than 7 days
- perminent: more than 1 year
- lone: afib but theres not evidence of underlying conditions
Causes
- P: PE, COPD, pericarditis
- I: iatrogenic (touch with central line palcement)
- R: rheumatic heart disease – regurg and stenosis of mitral
- A: atherosclerosis
- T: thyroid disease
- E: endocarditis/elevated BP
- S: sick sinus syndrome/sleep apnea
Atrial Fibrillation
- signs and symptoms of pt.
- diagnosis & treatment
treatment for hemodynamically stable v unstable
Symptoms: depend on udnerlying conditions and range
- asymptomatic
- mild: fatigue, decreased exercise capacity, palpatations, dizzy
- Moderate/severe: SOB, chest pain, syncope, sweating
Diagnosis and Treatment
- EKG: no discerable P waves – just F waves at baseline, narrow QRS mostly tachy, irregularly iregular
- get labs for full clinical picture
- chest xray, TTE/TEE, CT, etc. for underlying
Treatment
- control the rate (in ventricles), send to normal sinus, maintain normal, prevent clot
hemodynamically stable
- #1: Rate Control + anticoag.
use Beta Blocker ( cardioselective -olol metoprolol, propranolo, esmolol) use BB if the afib is coming from a cardiac issue or SNS issue
or CCB (non-dyhydropridine to get cardio effects - ditiazem, verapimil) (use CCB if COPD/astham without heart failure)
or antiarrythmics (amiodarone)
- # 2: Rhythm Control (if they dont go back to sinus on own)direct cardioversion > over medications (amioderone, sotalol, flecainide)hemodynamically unstable
- need to get them out of the afib ASAP = synchronized cardioversion – sync machine to give shock not when repolarizing
- alwasy consider risk of throwing a clot first!
Anti-coag. considerations
unstable:
- afib < 48 hours = IV heparin, DOAC, etc. asap before or after cardiovert
- afib <>48 hours = give anticaog and continue that for 4 weeks
stable:
- afib > 48 hours = give coumadin/DOAC for 3 weeks prior to cardiovert & 4 weeks after
- in pt. can send for a TEE prior to cardioversion to r/o clot
what is the complications of afib
- conditions
- most severe?!`
with this complications — determine anticoag needs
chad score?
- hypotensions
- MI
- tachycardia cardiomyopathy
STOKE OR TIA is biggest risk!!!
Anticoag?
- know why it happened? no need for lifelong
- mechanial heart valve? — need warfarin 2.5-3.5
- new stable afib with no valve disease? CHA2DS2VASc score — greater than 2? anticaog.
Meds
- DOACs preferred (dabigatran, riveroxiban, apixaban)
- warfarin
Atrial Flutter
- what
- patho
- types
- EKG
what: a SVT where there is a reentry circuit in the right atrium –> Saw-Tooth Waves
Patho
- a tract within the r. atrium of excitable tissue exisits (cavo-tricuspid isthmus)
- a SINGLE area of foci of irritable tissue creating the single – hence why it is REGULAR
Types
- Typical: the IVC and the cavo-tricuspid isthmus reentry
anticlockwise (most common) or clockwise
- leads II, II avF inverted or not of the flutter
- Atypical: not the isthmus – just scar tissue that gets irritable
EKG: REGULARRLY IRREGULAR
- rapid and regular rhythm
- tachycardic 130-170
- “saw-tooth” flutter pattern in II, III, avF
- ventricular rate will be less (av node still working)
Atrial Flutter
- risk factors
- complications
- signs
Risk Factors
- underlying valvuar disease
- underlying volume overload (HTN)
- underlying cornary artery disease
- thyroid disease
- can be after afib ablation!! (scarring)
Complications
- less risk of stroke as afib, but still a risk becuase throwing clots
- MI
- dizzy
- hypotension (because tachy)
Signs and Symptoms
- palpatations
- anxiety
- dizzy//lightheaded
…if severe to impact cardiac output
- dyspnea
- edema
- angina
- hypotension
- syncope
