L20 Flashcards
What are the 3 options for wide QRS complex tachycardia?
VTach - monomorphic or polymorphic
VFib
SVT w/ aberration
What does VTach look like?
Tachycardia
3+ consecutive premature ventricular contractions
Concordance of QRS - all pointing down
Atrial ventricular dissociation - any P waves (might see some in 3) are separated from QRS - ventricle and atrial depolarizations separated
What does VFib look like?
No discernible rhythm
Doesn’t even look like QRSs
What does Torsades de Pointes look like on EKG? What could it progress to?
EAD –> long QT –> polymorphic ventricular tachycardia
String of high amp QRS followed by low amp QRS
May progress to VFib
What is the shared mechanism of Class 1 anti-arrhythmics?
Na blockers
Changes to AP for class 1a vs 1b vs 1c
1a - longer AP = longer QT
1b = shorter AP
1c = no change to AP
What are class 2, 3, 4, 5 anti-arrhythimcs?
2 = BBs 3 = K blockers 4 = Ca CB 5 = Digoxin
Med to treat acute wide complex tachy
Amiodarone
2md = procainamide
Others: lidocaine, Mg, BBs
Amiodarone
- Toxicity
Tox:
- Bradycardia
- Pneumonitis
- Hypo/hyperthyrodism
- Transaminitis (liver enzymes)
- Peripheral neuropathy
What causes the BP drop seen with amiodarone
Drug detergent
Amiodarone drug ints
↑activity Digoxin, quinidine, warfarin
Worsens bradycardia due to BB, Ca CBs
Long term treat wide complex tachy w/o structural heart disease
Ablation
Long term treat wide complex tachy w/ structural heart disease
Implantable cardioverter defibrillator
What is Brugada’s syndrome
Defective Na channel in heart - less Na current
= structural heart disease –> ventricular tachy
“Channelopathy”
What is long QT syndrome
Na or K channel structural abnormalities that lead to ↑risk VTach
