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SEM 5: SAM 1 > End of Part 2 + part 3 arrhythmias > Flashcards

End of Part 2 + part 3 arrhythmias Flashcards

1
Q

ECG criteria for 3rd degree AV block

A
  1. P waves with no QRS
  2. Inconsistent PR intervals (AV dissociation)
  3. Ventricular or Junctional escape beats
  4. Low HR

Ventricular escape beat = wide QRS
Junctional escape beat = narrow QRS

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2
Q

Main cause of Mobitz Type I 2nd degree AV block?

A

High vagal tone (PNS)

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3
Q

Main cause of Mobitz Type II 2nd degree AV block?

A
  • Structural heart disease of the AV node
    Ex: Hyperkalemia, myocarditis, fibrosis
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4
Q

Main cause of 3rd degree AV block?

A
  • Structural heart disease of the AV node
    Ex: Hyperkalemia, myocarditis, fibrosis
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5
Q

ECG criteria for BBB (bundle branch blocks)?

A
  • Wide QRS
  • Every P has a QRS (sinus rhythm)

(Looks like AIVR and V-TACH, difference is these exhibit AV dissociation and BBB do not)

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6
Q

Main cause of left sided BBB?

A

Cardiomyopathy / structural heart disease

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7
Q

ECG criteria for Atrial standstill?

A
  • No P waves at all (straight line before QRS)
  • Normal QRS
  • Usually bradycardia
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8
Q

Causes of atrial standstill?

A
  • Hyperkalemia (urinary obstruction, Addisons)
  • Neuromyopathy in springer spaniels
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9
Q

What breeds are predisposed to sick sinus syndrome?

A
  • Mini schnauzer
  • West highland terrier
  • Dachshund
  • Cocker spaniel
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10
Q

What is Sick sinus syndrome?

A

Complex disturbance of impulse conduction resulting in sinus bradycardia and/or sinus arrest (prolonged sinus pause)

  • SA node cells become fibrotic
  • Can cause SVPCs or VPCs
  • Can cause 1st or 2nd degree AV block
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11
Q

Effects of hypokalemia?

A
  • Prolongs repolarization
  • Causes excitability due to K+ imbalance, resulting in ectopic complexes like SVPCs and VPCs
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12
Q

Mild, Moderate, and Severe effects of hyperkalemia?

A

Mild: Shortened repol and Tented T waves (tall and pointy)

Mod: Wide QRS complexes (ventricles messed up)

Severe: Prolonged PR intervals or absent P waves, v-fib, death

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13
Q

Hyperkalemia ___________ the time of repolarization, while hypokalemia _________ the time of repolarization

A

shortens, prolongs

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14
Q

What arrhythmias can be seen with hypokalemia?

A
  • Ectopic complexes like SVPCs and VPCs
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15
Q

What electrolyte imbalance can result in atrial standstill?

A

Hyperkalemia

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16
Q

What device records ECG continuously for 24-48 hours?

A

Holter monitor

17
Q

When is an arrhythmia considered hemodynamically significant?

A

If it results in low CO, low BP, and hypoperfusion

18
Q

4 indications for anti-arrhythmic therapy:

A
  1. Hemodynamically significant
  2. Causing CS
  3. Potential to deteriorate into fatal arrhythmia (Ex: VPC or VT turning into V-fib)
  4. Negatively impacting cardiac function
19
Q

List the drugs belonging to Class I anti-arrhythmics and their MOA

A

MOA: Na+ channel blocker

  1. Lidocaine
  2. Mexiletine (PO)
  3. Procainamide
  4. Quinidine
20
Q

List the drugs belonging to Class II anti-arrhythmics and their MOA

A

MOA: Beta blockers

  1. Atenolol
  2. Esmolol
  3. Propanolol
  4. Metoprolol
21
Q

List the drugs belonging to Class III anti-arrhythmics and their MOA

A

MOA: K+ channel blocker

  1. Sotalol
  2. Amiodarone
22
Q

List the drugs belonging to Class IV anti-arrhythmics and their MOA

A

MOA: Ca+ channel blocker

  1. Diltiazem
  2. Verapamil
23
Q

Effects of digoxin on the heart?

A

Increases vagal tone (PNS) in the SA and AV nodes

(Neg chronotropy, slows down HR)

24
Q

Treatment for sinus tachycardia?

A
  • No antiarrhythmic therapy needed (physiological response, treat underlying cause)

Exception: ST due to toxicity/drugs - Use Esmolol (slows down HR)

25
Q

Drug treatment protocol for supraventricular tachycardia?

A

Goal: Slow down HR

  • Diltiazem is first choice for SVT
  • Second choices: Beta blockers, Digoxin, Sotalol
26
Q

________ is the first line DOC for treatment of supraventricular tachycardia

A

Diltiazem

  • Ca+ channel blocker, Class IV anti-arrhythmic
27
Q

Drug treatment protocol for atrial fibrillation?

A

Goal: control rate and rhythm

Rate:
- Diltiazem is first choice for A fib, slows down AV conduction
- +/- Digoxin

Rhythm:
- Electrical cardioversion (defibrillation shock), restores AV synchrony

28
Q

Drug treatment protocol for SVPCs?

A
  • Not necessary unless frequent or sustained bigeminy, in that case use Diltiazem
29
Q

When is anti-arrhythmic therapy for VPCs indicated?

A
  • > 1000 single VPCs/24 hrs
  • Frequent or sustained ventricular bi or trigeminy
    OR
  • R or T phenomenon (T wave goes into QRS complex without finishing repol)
30
Q

Any frequency or duration of _________ warrants anti-arrhythmic treatment

A

Ventricular tachycardia

31
Q

Drug treatment protocol for V-tach?

A

Lidocaine!!! - first choice

Second choices: Procainamide, amiodorone, magnesium

If VT is not sustained and patient is not hemodynamically unstable start with PO Mexiletine or Sotalol

32
Q

Positive atropine response test

A
  • Bradycardia turns into tachycardia, meaning bradyarrhythmia was due to high vagal tone
33
Q
A
34
Q

Negatice atropine response test

A
  • HR stays the same after inj
  • Bradyarrhythmia likely due to structural heart disease and not high vagal tone (Ex: SSS vs sinus bradycardia due to PNS)
34
Q

Which arrhythmias require a pacemaker?

A
  1. High grade Mobitz type II 2nd degree AVB (Ps without QRSs)
  2. 3rd degree AV block/ Complete AV block (Ps with no normal QRS, only escape beats)
  3. Sick sinus syndrome (sinus bradycardia or sinus arrest) - only if symptomatic
  4. Atrial standstill (must rule out hyperkalemia first)
34
Q

Drug treatment protocol for 1st, 2nd, and 3rd degree AV block

A

Only High grade Mobitz type II 2nd degree AVB and 3rd degree AV block require anti-arrhythmic therapy
- Requires pacemaker, high risk of sudden death if not
- Dopamine, dobutamine, atropine while waiting

No tx needed, look for underlying cause of high vagal tone
1. 1st degree AVB
2. Mobitz type I 2nd degree AVB
3. Low grade Mobitz type II 2nd degree AVB

35
Q

True or False: Sick sinus syndrome is associated with high risk or sudden death

A

False

36
Q

What drugs can be given in an emergency setting while awaiting pacemaker implantation?

A
  • Dopamine, dobutamine, isoproteronol (sympathomimetics)
37
Q

Sinus tachycardia vs supraventricular tachycardia?

A

Sinus tachycardia
- every P has a QRS, normal rhythm, consistent RR intervals
- Everything normal just high HR
- Due to high sympathetic tone

Supraventricular tachycardia
- > 3 SVPCs
- pre-mature QRS complexes close together
- Regular irregular rhythm
- Due to atrial dilation

SEM 5: SAM 1 (35 decks)

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