Lecture 20: Approach to Dysrhythmias Flashcards
What are the 3 groups of dysrhythmias?
- Premature/Ectopic/Escape beats/rhythms
- Bradyarrhythmias
- Tachyarrhythmias
What are the 4 possible causes of palpitations?
- Minor/transient arrhythmia
- Significant CVD
- Cardiac manifestation of a systemic condition (thyrotoxicosis)
- Benign somatic symptom of psychosocial origin
What are the risk factors that suggest a CV origin for palpitations?
- FMHx of arrhythmias
- FMHx of syncope or sudden death
- Hx of MI
- Structural HD
- Valvular diseases
- EKG abnormalities (prolonged QT, bradycardia, 2/3 degree HB, sustained vent arrhythmias)
What should all patients get when evaluating for palpitations?
EKG
What is a holter monitor?
- 24-48 hour monitor placed on the chest to record cardiac rhythms.
- Holter monitors include a diary for the patient.
What is different about a loop recorder vs a holter monitor?
- Loop recorders are implantable but require no anesthesia or anything.
- Lasts 3-4 years
- Usually used if someone still has episodes but 30 day monitors were inconclusive
- Used for cryptogenic strokes
What would suggest stress test vs echo for palpitation evaluation?
- Stress test: Exercise-induced palps or CAD
- Echo: structural abnormalities via EKG or decreased ventricular function
When is cardioversion indicated?
- Unstable tachys: SVT, AF, VT, VF
- Afib/flutter
- SVT
- Vtach
What is the joule range for cardioversion?
50-360 joules
What kind of sedation is used in cardioversion?
Procedural sedation
What is catheter ablation typically used for?
Reentrant circuits, specifically
1. AVNRT
2. PAT
3. AFlutter
What gets ablated generally in afib?
Pulmonary veins
What are the potential complications of catheter ablation?
- Major vascular damage
- Perforation leading to tamponade
- AV node damage
- Atrio-esophageal fistula (if posterior LA is being ablated)
What is the difference between an ICD and a pacemaker?
ICDs are for sudden death and include pacemakers.
When are pacemakers indicated?
- Symptomatic bradycardia
- High-grade AV block
- Sinus pauses or afib pauses with symptoms
- No reversible cause identified