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Cardiology and Respiratory SA Med > ECG Rhythm Disturbance > Flashcards

ECG Rhythm Disturbance Flashcards

1
Q

Bradyarrhythmia origins

A
  • SA node

- AV node

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2
Q

How to know if a bradyarrhythmia is from a sinus node?

A
  • Decreased rate of P waves or absent P waves
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3
Q

How to know if a bradyarrhythmia is from AV node?

A
  • Slow/absent conduction through the AV nodes

- P waves without QRS

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4
Q

Characteristics of sinus bradycardia or bradyarrhythmia

A
  • Normal P wave for every QRS but P and QRS occur at a slow rate
  • Normal PR interval
  • Normal QRS
  • QRS may be variably spaced if sinus arrhythmia
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5
Q

Treatment for sinus bradycardia

A
  • Generally a response to other systemic issues
  • High vagal tone (disease of GIT, pulmonary organ, brain, or eyes)
  • Anesthesia/sedation
  • Medications
  • ID and address underlying cause
  • In situations such as anesthesia complications, atropine may be given
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6
Q

Sick sinus syndrome

A
  • Abnormal rhythm disturbance in older small breed dogs (schnauzer, dachshund, west highland white terrier, cocker spaniel)
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7
Q

Characteristics of sick sinus syndrome

A
  • Sinus bradycardia
  • Sinus arrest (pause without P or QRS)
  • AV block
  • Supraventricular tachycardia (especially after a long pause)
  • See the example
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8
Q

What can happen during sinus arrest?

A
  • Collapse due to absence of cardiac contraction

- Usually 6 second break is enough

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9
Q

AV node disease characteristics

A
  • Normal or elevated P wave rate
  • Decreased rate of conduction from P to QRS (long PR interval)
  • Complete block of conduction through the AV node (AV block)
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10
Q

How many different types of AV block are there?

A
  • Three types
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11
Q

First degree AV block characteristics

A
  • Usually high vagal tone
  • Normal HR
  • Prolonged PR interval
  • Most often a PHYSIOLOGIC process
  • No symptoms
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12
Q

Second degree AV block characteristics

A
  • P wave without a QRS
  • Intermittent failure of conduction through the AV node
  • Normal to slow HR
  • Often irregular
  • Symptoms are variable
  • Normal in the horse
  • Seen in dogs with high vagal tone or AV node disease
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13
Q

How do you differentiate vagal tone vs AV node disease with second degree AV block?

A
  • Atropine

- Block resolves if vagally mediated

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14
Q

Third degree AV block characteristics

A
  • Ps and QRSs are regular but not related
  • Ventricular (QRS) activity is from escape foci in AV node or ventricle (wide/bizarre)
  • Slow HR
  • Often regular beats
  • Symptoms are weakness, exercise intolerance, collapse
  • Cause is AV node disease
  • 99% of the time is pathologic; structural problem
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15
Q

Treatment of third degree or complete AV block

A
  • Requires pacemaker implantation
  • Generally not responsive to medical treatment
  • Can be insignificant in very geriatric cats if they aren’t symptomatic
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16
Q

Which diseases can you use a pacemaker for?

A
  • Sick sinus syndrome and complete AV block
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17
Q

Pacemaker overview

A

$3000-5000

  • Lifespan of a generator is ~7 years
  • Prognosis is good if no other major diseases
18
Q

What are the three types of tachycardia?

A
  • Sinus (normal)
  • Supraventricular
  • Ventricular
19
Q

Characteristics of sinus tachycardia

QRS shape
Regularity
Onset
P wave

A

QRS shape: Normal
Regularity: Regular
Onset: Gradual
P wave: Normal

20
Q

Characteristics of supraventricular tachycardia

QRS shape
Regularity
Onset
P wave

A

QRS shape: normal
Regularity: Irregular (often)
Onset: Abrupt
P wave: Abnormal

21
Q

Characteristics of ventricular tachycardia

QRS shape
Regularity
Onset
P wave

A

QRS shape: Wide/bizarre
Regularity: Regular (often)
Onset: Abrupt
P wave: Not associated

22
Q

Sinus tachycardia definition

A
  • Increased heart rate that originates in the sinus node
23
Q

Causes of sinus tach

A
  • Response to systemic issues (pain, excitement, hypotension)
24
Q

Treatment of sinus tach

A
  • Address the primary cause
25
Q

Supraventricular tach definition

A
  • 3+ supraventricular beats in a row
  • Abrupt and irregular, starts suddenly, ends suddenly
  • QRS is the same
  • P wave may be abnormal
26
Q

Causes of supraventricular tachycardia

A
  • Atrial enlargement*** (most common)
  • Enlarged hilar lymph nodes
  • Thoracic masses
  • Pulmonary inflammation
  • Electrolyte disturbances
  • Horses can have SV tachycardia without structural heart disease
27
Q

Atrial fibrillation characteristics

A
  • Type of SV tachycardia
  • Rapid heart rate
  • Irregularly irregular R-R intervals
  • No obvious P waves
  • +/- f waves
28
Q

Causes of atrial fibrillation in small animals

A
  • Most commonly observed with severe atrial enlargement
  • Dilated cardiomyopathy
  • Chronic valvular disease
  • Other causes possible (as for SVT)
  • Fairly uncommon in cats
29
Q

Treatment of canine supraventricular tachycardia and atrial fibrillation

A
  • Goal to decrease HR to normal range by decreasing ventricular response rate of conduction through the AV node
  • Do NOT expect a return to normal rhythm, especially in atrial fibrillation
  • Consider one of the following:
    1. ) Calcium channel blocker (Diltiazem, negative chronotrope)
  1. ) Digoxin (negative chronotrope; positive inotrope)
  2. ) Beta blockers (Atenolol, sotalol)
  3. ) Combinations (digoxin + diltiazem)
30
Q

Equine atrial fibrillation

A
  • QRS is normally negative
  • Sawtooth jaggedy baseline with a negative QRS
  • Irregularly irregular and faster than normal rate
31
Q

Equine (lone) atrial fibrillation

A
  • Lone = no evidence of structural heart disease and successful treatment often converts rhythm to normal sinus rhythm
  • Atrial fibrillation can have a negative impact on horses, so they should be treated
32
Q

Atrial fibrillation treatments for horses (yes this is SA med….)

A
  • Quinidine (+ Digoxin) or amiodarone
  • Treat as soon as possible after fibrillation begins to increase likelihood of good response
  • relapses are common
33
Q

Bovine atrial fibrillation causes

A
  • Most often associated with 1° GI disease
34
Q

Treatment for bovine Afib

A
  • Treatment may not be indicated - once primary disease is addressed, arrhythmia usually resolves
35
Q

Ventricular tachycardia definition

A
  • 3 or more ventricular premature beats (VPC) in a row
  • Sustained
  • Paroxysmal (means intermittent)
36
Q

Things to consider when treating ventricular tachycardia

A
  • Sudden death can result from Vtach
  • Antiarrhythmics decrease risk of VT but sudden death avoidance not guaranteed
  • Many anti-arrhythmics are pro-arrhythmic and can make arrhythmia worse or better
  • Make sure you have indications to treat
37
Q

8 indications to treat Vtach****

A
  1. Paroxysms or sustained Ventricular tachycardia >140-160 BPM
  2. > 20 VPCs per minute
  3. Multiform VPCs
  4. Arrhythmias with myocardial failure present
  5. Breeds at risk for sudden death (boxers/Dobermans)
  6. Clinical signs of hypotension
  7. VPCs close to the T wave of the preceding complex (R on T phenomenon
  8. Critically ill patients
38
Q

Emergency treatment for Ventricular Tachycardia

A
  • IV lidocaine bolus
  • If response is noted can switch to a CRI
  • Side effects of lidocaine are CNS (seizures), vomiting
  • Caution in cats
39
Q

Chronic therapy for ventricular tachycardia (oral medications)

A
  • Mexilitine (like lidocaine)
  • Sotalol (beta blocker/class 3)
  • Atenolol (beta-blocker)
  • Other options available but less common
40
Q

Ventricular fibrillation definition

A
  • Disorganized ventricular activity, end result of Vtach
  • No pulses generated, leads to death
  • Only effective treatment is electrical defibrillation
  • Anti-arrhythmics are not effective

Cardiology and Respiratory SA Med (15 decks)

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