Dysrhythmias Management Flashcards
Think of this big picture stuff?
–IDENTIFY AND TREAT ANY PRIMARY CAUSE
–Is the dysrhythmia causing a problem?
•MAY need to manage it
–Antidysrhythmic medication is NOT benign!
•Proarrhythmia – DIGOXIN!
–BE SYSTEMATIC
Consider the causes of dysrhythmias?
Consider
–Structural heart disease
•Supraventricular rhythms – atrial stretch
–Metabolic disease
–Electrolyte disorders
–Trauma
–Drugs and toxins
–Sepsis, neoplasia (esp ventricular)
How can we document dysrhythmia during episodes?
Paper trace ECG – 30 seconds?
Ambulatory (Holter) ECG – 48hours?
5 minute ECG picks up most rhythm disturbances found on Holter
Antidysrhythmic medication is indicated if?
Treatment of the dysrhythmia is likely to improve patient survival or if the patient is showing clinical signs related to the occurrence of a dysrhythmia.
The significance of a dysrhythmia, and therefore any decision to implement therapy, is determined by:
- The heart rate and the frequency of the abnormal event.
- The timing of the abnormal event with respect to the preceding PQRST complex
e. g. long pause and ventricular escape – DON’T SUPPRESS IT!
e. g. Very early VPC lands on top of preceding T wave – VERY BAD!
Antidysrhythmic drugs are?
“…toxins with occasional beneficial side effects!”
Other mechanisms of dysrhythmia control:
•Specialist procedures
–Pacing
–Ablation with catheters.
–Implantable cardiovertors.
Discuss Bradydysrhythmias?
–Variations on sinus arrhythmia – not usually clinically significant
–Sinus arrest, 2nd/3rd degree AV block – usually are clinically significant
Discuss Tachydysrhythmias?
–Supraventricular – arise in or above AVN, USUALLY narrow and upright in lead II
–Ventricular – arise from ventricles – wide and bizarre in lead II
Clinically significant bradydysrhythmias?
- High grade 2nd degree AV block
- 3rd degree AV block
- Sinus arrest
- Sick sinus syndrome
- Atrial standstill
Bradydysrhythmias clinical signs?
Clinical signs:
- weakness
- lethargy
- syncope
- sudden death - rare
Bradydysrhythmias must rule out primary cause?
MUST rule out primary causes
- cardiomyopathy
- digitalis/drug toxicity/effect
- AV node fibrosis
- endocarditis
- electrolyte imbalance
Think about this for bradysysrhythmias?
- Is it vagal?
- Usually sinus pause/block/arrest
- Abolished by atropine/exercise
- Rarely produce clinical signs
- Rule out if exercise intolerant/collapsing
What is this?
Persistent atrial standstill
What is the treatment for bradydysrhythmias?
Treatment
- Primary cause – especially electrolyte disorders
- Pacemaker implantation
- Parasympatholytic drugs (e.g. atropine) – rules out “sinus” rhythms
What is the cardiac action potential?
Discuss Fast supraventricular tachycardia?
- Frequent in heart failure (big atria) ESP atrial fib!
- Treat the failure – rate may drop
- If out of HF but still fast
–Use diltiazem and/or digoxin
Primary SVT causing clinical signs. Give what?
–diltazem +/- sotalol
Tachydysrhythmia management?
