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Cardiology > Dysrhythmias > Flashcards

Dysrhythmias Flashcards

1
Q

Sinus Pause/Arrest

A

May occur from increased vagal tone, myocarditis, MI and digitalis toxicity
Typically lasts 2 seconds - 2 minutes
Atropine may be given if hemodynamically unstable

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2
Q

What med should be given to a patient with symptomatic Sinus bradycardia?

A

Atropine 1mg IV

Temporary Pacemaker

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3
Q

Where does SVT originate?

A

Above the His bundle.

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4
Q

What might cause SVT?

A

digitalis, asthma meds, caffeine, ephedra, cocaine, meth Stimulants

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5
Q

What does SVT generally start with?

A

A PAC or PVC

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6
Q

S/S of SVT

A 
Palpitations
Dizziness
SOB
Anxiety
CP/tightness
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7
Q

SVT Tx

A 
Vagal maneuvers
Carotid Massage
Adenosine 6mg IV fast push.
or of unsuccessful...
Cardioversion, IV Beta blocker/CCB
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8
Q

SVT prevention

A

Beta Blockers
CCB’s
Digoxin
SVT ablation (permanent)

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9
Q

Wolff-Parkinson-White Syndrome (WPW)

A

Congenital defect - any age. Men > Women
Form of SVT where an accessory pathway bypasses the AV node.
AKA AV reciprocating arrhythmia
Bypassing AV node can cause re-entry tachycardia

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10
Q

WPW S/S

A 
Palpitations
Tachycardia
DIzziness
Dyspnea
Anxiety
Syncope
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11
Q

WPW EKG symptoms

A 
PR interval < .12ms
Delta wave (slurred QRS uptake)
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12
Q

WPW Long-term Tx

A

Depends on frequency and symptoms
Radiofrequency ablation
Beta blockers, CCB’s, Flecainide

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13
Q

WPW Acute Tx

A

Vagal maneuvers
IV adenosine (6-12 mg fast push)
OR
IV diltiazem or verapimil

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14
Q

Paroxysmal Atrial Tachycardia (PAT)

A

Atrial rate 150 - 250
P wave morphology varies
Usually requires no tx
Usually terminated with vagal maneuvers

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15
Q

Premature Atrial Contractions (PAC’s)

A

Discharge from non-sinus atrial pacemaker
P’ wave marks PAC
May be precursor to Afib

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16
Q

PAC Tx

A

Asymptomatic (avoid triggers (stimulants))

Symptomatic: Beta blockers

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17
Q

Wandering Atrial Pacemaker

A

Seen in normal hearts and diseased hearts
Variable rate
More than 3 different P wave morphologies
Usually no tx required
May lead to multifocal atrial tachycardia

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18
Q

Multifocal Atrial Tachycardia

A

Wandering atrial pacemaker with a rate over 100 bpm

Usually doesnt cause hemodynamic instability

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19
Q

Causes of multifocal atrial tachycardia

A 
Lung dz, COPD
AMI
Sepsis
Hypokalemia
Low magnesium
Ma be a precursor to Afib
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20
Q

Multifocal atrial tachycardia tx

A

Tx underlying medical problem

Suppress rate with BB, or CCB

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21
Q

Atrial Fibrillation

A 
Most common arrhythmia
Micro re-entry circuit
Atrial rate is 350 - 450
No distinguishable P waves
Irregularly irregular
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22
Q

Causes of Afib

A 
Underlying cardiac dz
Valvular dz, Heart failure, IHD
Pericarditis
Thyrotoxicosis
PE
Pneumonia
Alcohol OD
Post-op thoracic surgery
Sleep Apnea
HTN
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23
Q

Afib may result in?

A

Decreased Cardiac Output

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24
Q

INR goals for Afib?

A

2.0 - 3.0

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25
Q

Rate goals for Afib?

A

between 60 and 110
Diltiazem
Beta Blockers
Digoxin

26
Q

When is it safe to cardiovert without anticoagulation in Afib?

A

Less than 48 - 72 hours of Afib

27
Q

Atrial Flutter

A 
Macro re-entry circuit 
Atrial rate 250 - 350
Ventricular rate 150
2:1 3:1 4:1 pattern
regularly irregular
Classic sawtooth on EKG
28
Q

A flutter is indicative of?

A

Diseased hearts (CHF)
Precursor to Afib
Tx depends on level of hemodynamic compromise

29
Q

Aflutter Tx

A

Cardioversion
Class 1A antiarrhythmics
BB, CCB, Digoxin

30
Q

Junctional Tachycardia

A

Junctional rhythm with a rate of 150 - 250
More common in women
Usually initiated by PAC

31
Q

Junctional Tach tx

A

Vagal maneuvers
Adenosine* DOC
Long-term: BB, CCB

32
Q

1st degree AV block

A

PR interval > .20
Occurs in healthy and sick hearts
Usually don’t need tx

33
Q

2nd Degree AV Block Type 1

A

Wenchebach
Occurs in the AV node, above His bundle
often transient
Often asymptomatic - no tx

34
Q

Wenchebach EKG

A

Variable rate

PR grows wider and wider until the QRS is blocked completely, then it resets.

35
Q

2nd Degree AB block Type 2

A

Mobitz
Usually occurs below His bundle
May progress into higher degree AV block

36
Q

Type 2 block EKG findings

A

Variable rate
normal P wave
Widened QRS associated w/ BBB
PR may be normal until dropped QRS

37
Q

Type 2 block Tx

A

More serious than Type 1
Artificial pacing
Usually requires permanent pacemaker

38
Q

3rd Degree Block

A

AV dissociation

Sinus impulses are completely blocked upstream of the ventricles

39
Q

3rd Degree block causes

A

digitalis toxicity
Acute infxn
MI
Degeneration of tissue

40
Q

3rd Degree block EKG findings

A

Normal atrial rate
Ventricular rate usually less than 70
QRS may be normal or widened

41
Q

3rd degree block tx

A

External pacing and atropine for acute episodes.

Permanent pacing for chronic complete block

42
Q

Premature Ventricular Contractions (PVC)

A 
Increasing circulating catecholamines
Coronary ischemia
Hypokalemia
Low magnesium
Drug toxicities
43
Q

PVC EKG findings

A

Variable rate
P wave usually obscured by QRS
Wide QRS
May occur in singles, couplets, or triplets

44
Q

Bigeminal PVC’s

A

one normal beat and one PVC repeated

45
Q

Trigeminal PVC’s

A

two normal beats and one PVC

46
Q

Ventricular Tachycardia causes

A

Triggered by ischemia, electrolyte abnormalities
Hypokalemia is also an important trigger
MI
Cardiomyopathy

47
Q

Pulse Vtach Tx

A

Cardioversion

Amiodarone

48
Q

Pulseless Vtach

A

Defibrillation

Amiodarone

49
Q

Torsades de Pointes

A

Twisting about the points

Upward and downward deflection of QRS

50
Q

Torsades de Pointes causes

A

Long QT drugs
electrolyte imbalances
Myocardial ischemia

51
Q

Torsades de Pointes Tx

A

Synchronized cardioversion
IV magnesium, potassium
Overdrive pacing

52
Q

Ventricular Fibrillation

A

AKA sudden cardiac death
ABsence of cardiac output
Occurs with AMI

53
Q

Vfib Tx

A

ACLS protocol
Immediate defib
Treat underlying cause
Implantation of ICD

54
Q

Idioventricular Rhythm

A

Widened WRS
dying heart rhythm
Pacemaker most likely needed
Caused by myocardial ischemia, infarction

55
Q

Asystole

A

In the presence of AMI is almost always fatal

Complete cessation of any electrical or mechanical activity

56
Q

Asystole Tx

A 
CPR, O2
IV, Intubate
Transcutaneous pacing
Epi 1mg IV push q3-5m
Atropine
57
Q

Pulseless Electrical Activity (PEA)

A

Electromechanical dissociation
There is electrical activity, but no mechanical response
EKG shows sinus, but NO pulse

58
Q

PEA 6 H’s

A 
Hypoxia
Hypovolemia
Hypoglycemia
Hydrogen Ions (Acidosis)
Hypothermia
Hypo/Hyperkalemia
59
Q

PEA 6 T’s

A 
Toxins
Tamponade
Trauma
Tension pneumothorax
Thrombosis (cardiac)
Thrombosis (pulmonary)
60
Q

PEA Tx

A

Correct underlying cause
Epi, Atropine
CPR

61
Q

Which pathway do electrical impulses take in WPW?

A

Through the kent bundles

You will see delta waves and short PR

Cardiology (14 decks)

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