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CV Test 4 > Electrophysiology > Flashcards

Electrophysiology Flashcards

1
Q

What is syncytium?

A

A functional unit of contraction

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2
Q

Why does current conduct easily though originating syncytium?

A

Tight intracellular junctions

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3
Q

What is between the atrial syncyctium and the ventricular syncyctium?

A

A fibrous non-conductive layer

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4
Q

What predicts/shows automaticity?

A

Phase 4

-spontaneous upward drift

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5
Q

Why is there a delay at the AV node?

A

Allows atria to empty before ventricular contraction

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6
Q

What is the connective tissue that allows the signal to pass the fibrous non-conductive layer?

A

Atrioventricular bundle

AKA Bundle of His

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7
Q

What is absolute refractory period?

A

When no stimulus, no matter the size will excite muscle

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8
Q

What time does absolute refractory correspond with?

A

Depolarization

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9
Q

What is relative refractory?

A

Time when muscle does not respond to normal stimulus, but will to a strong stimulus

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10
Q

What causes refractory times?

A

Conformation changes in the Na+ channel to inactivated state

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11
Q

Which electrical therapy has less joules, cardioversion or defibrillation?

A

Cardioversion

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12
Q

When does cardioversion deliver shock?

A

During QRS

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13
Q

What rhythms respond to cardioversion?

A

Afib
A flutter
V tach

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14
Q

Why is cardioversion delivered on QRS?

A

Less chance of inducing more lethal dysrhythmia

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15
Q

With what other treatment does cardioversion carry an increase risk of producing worse dysrhythmia?

A

Digoxin toxicity

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16
Q

What risk does cardioversion of atrial fibrillation carry?

A

Embolization of atrial thrombi

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17
Q

What is usually done to prevent atrial thrombi embolization for cardioversion of Afib?

A

Heparinization

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18
Q

When is heparinzation for cardioversion of Afib not needed?

A

New onset

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19
Q

What medication(s) are usually used for cardioversion?

A

Methohexital

Propofol

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20
Q

What rhythms is defibrillation used for?

A

V fib

Pulseless V tach

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21
Q

First degree HB treatment?

A

Rarely needs treatment

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22
Q

Second degree type I HB treatment?

A

Usually transient, rarely needs treatment

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23
Q

Second degree type II HB treatment?

A

Greater risk of progression to completely HB

-consider prophylaxis pacemaker

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24
Q

What is the output of a pacemaker, and it’s units?

A

The strength coming from the device

Measured in mili-amps (MA)

25
Q

What is the sensitivity of a pacemaker?

A

The sensing of intrinsic (patient’s) activity

26
Q

What rhythms is a permanent pacemaker used for?

A

Bradycardia
Heart block
Sick Sinus Syndrome

27
Q

What does a magnet do to a permanent pacemaker?

A

Converts pacemaker to an asynchronous pace

-paces at a set pace no matter what

28
Q

What is a (minor) concern with Succinylcholine and a pacemaker?

A

Muscle fasiculations may be sensed as cardiac activity

29
Q

What is done to help minimize interference with electrocautery and pacemakers?

A

Grounding pad placed far from heart
Use low setting and short bursts
Bipolar bovie is preferred

30
Q

What is the pacemaker code?

A

Chamber paced
Chamber sensed
Response of device

31
Q

What is asynchronous mode?

A

Devices paces at set rate no matter what

VOO

32
Q

What is demand mode?

A

Devices senses intrinsic activity and responds appropriately
VVI

33
Q

What is AV sequential pacing?

A

Dual chamber pacing

35
Q

What is meant by output on pacemaker?

A

MA

Causes the spike

36
Q

What is meant by output failure? Fix?

A

No pacing spike seen
Turn up MA
Reposition lead

37
Q

What is meant by sensitivity with pacemaker?

A

The ability to detect patient’s intrinsic cardiac activity

38
Q

What is meant by capture with a pacemaker?

A

Capture is the appropriate waveform after a pacing spike?

39
Q

What is meant by failure to capture? Fix?

A

Pacing spike seen, but no waveform follows (MA is less than threshold)
Turn up MA
Reposition lead

40
Q

What is meant by failure to sense? Fix?

A

Pacemaker fires when it should not
-not detecting intrinsic activity when it occurs
Need to increase sensitivity

41
Q

How is sensitivity increased on a pacemaker?

A

Setting changed to a lower number (this increases sensitivity)

42
Q

What is an AICD?

A

Automatic implantable cardiac device

-defibrillator

43
Q

Who is an AICD used on?

A

Patients with repeated ventricular dysrhythmia that is unresponsive to drug therapy

44
Q

What does an AICD do?

A

Diagnoses rhythm and delivers shock if/when needed

45
Q

What are the precautions with an AICD?

A

Same as pacemaker

46
Q

During implantation of an AICD, what should anesthesia avoid giving to the patient?

A

Meds that will inhibit induction of lethal dysrhythmias to test AICD function
-lidocaine

47
Q

What is done during surgery when patient has an AICD?

A

Rep will/can turn off device

Magnets don’t deactivate them all

48
Q

What is sick sinus syndrome?

A

Aging and wearing out of the SA node

49
Q

What s/sx are often seen with SSS?

A 
Bradycardia is common
Tachycardia is possible
Syncope
Palpitations
Can be asymptomatic
50
Q

What is the treatment for SSS?

A

Permanent pacemaker

May need SVT suppression meds as well

51
Q

What is pre-excitation syndrome?

A

An abnormal accessory pathway that bypasses the AV node

52
Q

What occurs do to this bypass of the AV node?

A

Signal arrives to the ventricle without delay
Refractory times occur in different areas
Dysrhythmias in the ventricle

53
Q

What is the most common pre-excitation syndrome?

A

Wolf Parkinson White

54
Q

What is the name of the accessory pathway in Wolf Parkinson White?

A

Kent’s bundle

55
Q

What kind of symptoms with patient’s with Wolf Parkinson White have?

A

Paroxysmal supraventricular tachycardia
-sudden on set of high HR
Sudden death

56
Q

What is the treatment for Wolf Parkinson White?

A

Cardioversion
Procainamide
Surgical ablation

57
Q

What should NOT be given to patients with Wolf Parkinson White? Why?

A

Verapamil
Digoxin
Dysrhythmia made worse

58
Q

What is the goal with patients with pre-excitation syndrome?

A 
Avoid dysrhythmia 
Reduce SNS stimulation 
-SNS stimulation increases conduction
-adequate depth
-avoid ketamine
-CV stable NMB use
59
Q

It is okay to use anticholinergics to reverse NMB when patient has pre-excitation syndrome?

A

Yes in appropriate dose

60
Q

What is maintained with AV sequential pacing?

A

Atrial kick

CV Test 4 (2 decks)

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