Lecture 20: Approach to Dysrhythmias Flashcards

1
Q

What are the 3 groups of dysrhythmias?

A
  1. Premature/Ectopic/Escape beats/rhythms
  2. Bradyarrhythmias
  3. Tachyarrhythmias
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2
Q

What are the 4 possible causes of palpitations?

A
  1. Minor/transient arrhythmia
  2. Significant CVD
  3. Cardiac manifestation of a systemic condition (thyrotoxicosis)
  4. Benign somatic symptom of psychosocial origin
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3
Q

What are the risk factors that suggest a CV origin for palpitations?

A
  • 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)
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4
Q

What should all patients get when evaluating for palpitations?

A

EKG

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5
Q

What is a holter monitor?

A
  1. 24-48 hour monitor placed on the chest to record cardiac rhythms.
  2. Holter monitors include a diary for the patient.
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6
Q

What is different about a loop recorder vs a holter monitor?

A
  • 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
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7
Q

What would suggest stress test vs echo for palpitation evaluation?

A
  • Stress test: Exercise-induced palps or CAD
  • Echo: structural abnormalities via EKG or decreased ventricular function
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8
Q

When is cardioversion indicated?

A
  • Unstable tachys: SVT, AF, VT, VF
  • Afib/flutter
  • SVT
  • Vtach
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9
Q

What is the joule range for cardioversion?

A

50-360 joules

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10
Q

What kind of sedation is used in cardioversion?

A

Procedural sedation

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11
Q

What is catheter ablation typically used for?

A

Reentrant circuits, specifically
1. AVNRT
2. PAT
3. AFlutter

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12
Q

What gets ablated generally in afib?

A

Pulmonary veins

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13
Q

What are the potential complications of catheter ablation?

A
  • Major vascular damage
  • Perforation leading to tamponade
  • AV node damage
  • Atrio-esophageal fistula (if posterior LA is being ablated)
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14
Q

What is the difference between an ICD and a pacemaker?

A

ICDs are for sudden death and include pacemakers.

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15
Q

When are pacemakers indicated?

A
  • Symptomatic bradycardia
  • High-grade AV block
  • Sinus pauses or afib pauses with symptoms
  • No reversible cause identified
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16
Q

When is an ICD indicated?

A
  • Primary prevention of SCD (VT/VF)
  • EF <= 35% or at-risk (Long QT, Brugada, HOCM)
  • Secondary prevention of SCD
17
Q

What are most pacemakers placed in?

A

RA and RV (RV lead is always present)

Sometimes LV

18
Q

What is the main consideration with pacemakers/ICDs?

A

They are metal, and older ones are MRI-incompatible and set off metal detectors.

19
Q

If a patient has ventricular pacing, what EKG pattern will they have?

A

LBBB with a wide complex QRS

Since the RV is being paced, and then the signal goes to the left.