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Cardio Exam 1 > Mechanism of Arrythmias - Quiz 2 > Flashcards

Mechanism of Arrythmias - Quiz 2 Flashcards

1
Q

three mechanisms of arrhythmia

A
  • abnormal automaticity
  • abnormal triggered activity
  • re-entry
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2
Q

types of abnormal triggered activity

A
  • early afterdepolarizations
  • late afterdepolarizations
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3
Q

abnormal automaticity due to

A
  • abnormal phase 4 depolarization
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4
Q

exclusivity of mechanisms of arrhythmia

A
  • not mutually exclusive
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5
Q

abnormal phase 4 depolarization due to which conditions

A
  • degeneration/fibrosis
  • ischemia
  • stretch
  • hypokalemia
  • sympathetic stimulation

DISH S

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6
Q

stretch due to

A
  • people with CHF
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7
Q

EAD inciters

A
  • QT prolonging drugs
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8
Q

EADs exaggerated by

A
  • slow heart rate
  • hypokalemia
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9
Q

EADs blunted by

A
  • rapid heart rates
  • K+, Mg2+
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10
Q

EADs mechanisms

A
  • net increase inward
  • plateau current
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11
Q

EADs putative clinical rhythm

A
  • torsades
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12
Q
A

early afterdepolarizations

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13
Q
A

delayed afterdepolarizations

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14
Q

DADs inciters

A
  • digitalis
  • catecholamines
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15
Q

DADs exaggerated by

A
  • rapid rates
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16
Q

DADs blunted by

A
  • Ca2+ channel block
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17
Q

DADs mechanism

A
  • intracellular Ca2+ overload
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18
Q

DADs putative clinical rhythm

A
  • dig tox
  • ischemia
  • outflow tract VT
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19
Q

most common mechanism for abnormal rhythms

A
  • reentry
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20
Q

what will favor re-rentry

A

2 heterogenous pathways

Transient or permanent unidirectional block

dispersion of refractoriness

slow conduction velocity in the normal unblocked pathway

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21
Q

what can result from a transient or unidirectional block

A

one electrical pathway has either a prolonged refractory period or a prolonged repolarization time

producing a wave which only travels down the remaining pathway.

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22
Q

importance of slow conduction in regions of less refractoriness

A

must be slow enough relative to the refractoriness of the blocked pathway to allow recovery of the previously blocked pathway.

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23
Q

WPW AV rentry tachycardia structural physiology

A
  • AV bypass tracts found along muscular portion of mitral and tricuspid annulus’
  • THESE ARE THE ACCESSORY TRACTS
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24
Q

WPW sinus rhythm due to

A
  • fusion of bypass and AV nodal conduction to ventricle
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25
Q

WPW re-entry tachycardia due to

A
  • there is a block in the bypass tract
  • re-entry of impulse from AV node over bypass tract that now depolarizes backwards
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26
Q

how can an accessory tract depolarize again?

A
  • the slow conduction of the AV node allows the bypass tract to recover its excitability
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27
Q

premature impulse in AV re-entry tachycardia due to

A
  • unidrectional block in the bypass tract only
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28
Q

where would you see this signal?

A

AV re-entry tachycardia

in WPW

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29
Q

strategy of antiarrhythmic agents

A
  • alter automaticity
  • alter conduction velocity
  • alter refractory period
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30
Q

antiarrythmic drugs - how we alter automaticity

A

ALL WAYS TO SLOW DOWN HEART RATE

  • decrease slope of phase 4 depolarization
  • increase threshold potential
  • decrease resting membrane potential
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31
Q

antiarrythmic drugs - ways to alter conduction velocity

A
  • decrease rate of rise of phase 0
  • decrease resting membrane potenail and responsiveness
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32
Q

antiarrythmic drugs - ways to alter refractory period

A
  • increase phase 2 plateau
  • increase phase 3 repolarization
  • increase action potenial duration
33
Q

strategy of catheter ablation

A
  • eliminate pathway of reentry circuit
  • create barrier of conduction to disrupt reentry circuit
  • eliminate source of abnormal automaticity or triggered activity
34
Q

bradyarrythmias defined as

A
  • heart rate less than 60 bpm
35
Q

bradyarrythmias due to

A
  • abnormal automaticity
  • degeneration of the normal conduction system
36
Q

diagnosis based on EKG

A
  • sinus bradycardia
37
Q

p wave in sinus bradycardia

A
  • normal p wave
38
Q

conditions that can cause sinus bradycardia

A
  • high vagal tone
  • ischemia
  • degenerative disease
  • drugs
  • hypothyroidism

HDIDH

39
Q

treatment of sinus bradycardia

A
  • no treatment unless symptomatic
  • then pacemaker
40
Q

diagnosis based on EKG

A
  • sinus pause
41
Q

sinus pause cause

A
  • degenerative disease in or around SA node
42
Q

sinus pause treatment

A
  • pacemaker if symptomatic
43
Q

symptoms of sinus pause

A
  • syncope generally greater than 3 seconds
44
Q

diagnosis based on EKG

A
  • tachy-brady syndrome
45
Q

what you see in tachy-brady syndrome

due to

A
  • pauses occur at termination of tachyarrythmias
  • due to overdrive suppression of SA node
46
Q

diagnosis based on EKG

A
  • junctional escape rhythm
47
Q

junctional escape rhythm due to

A
  • AV nodal cells acting as subsidiary pacemaker due to slower phase 4 depolarization
48
Q

hallmark of junctional escape rhythm

A
  • no P before QRS
49
Q

what you see in first degree heart block

A
  • every P makes a QRS
  • but long PR
50
Q

what you see in second degree heart block

A
  • regular P waves
  • some but not all P waves makes QRS complexes
51
Q

what you see in third degree heart blocks

A
  • constant and independent atrial and ventricular rates
  • no P conducts to a QRS
52
Q

diagnosis based off EKG

A
  • 1st degree AV block
53
Q

causes of first degree AV block

A
  • high vagal tone
  • degenerative disease
  • drugs
54
Q

treatment of first degree AV block

A
  • nothing
55
Q

which secondary AV block is most common

A
  • mobitz 1
56
Q

refractoriness of mobitz 1

A

varies

57
Q

PR of mobitz 1

A

long, prolongs

58
Q

usual site of block mobitz 1

A
  • within AV node
59
Q

QRS duration mobitz 1

A
  • any
60
Q

causes mobitz 1

A
  • AV nodal blocking drugs
  • inferior MI
  • vagal tone
  • degenerative disease
61
Q

carotid massage mobitz 1

A
  • worsens
62
Q

exercise mobitz 1

A
  • improves
63
Q

permanent pacing (mobitz 1)

A
  • not usually
64
Q

refractoriness of mobitz 2

A
  • fixed
65
Q

PR of mobitz 2

A
  • short, constant
66
Q

usual site of block mobitz 2

A
  • below the AV node
67
Q

QRS duration mobitz 2

A
  • usually wide
  • usually associted with BBB
68
Q

causes of mobitz 2

A
  • Na+ channel blocking drugs
  • anterior MI
  • degenerative disease
69
Q

carotid massage mobitz 2

A
  • no change or improves
70
Q

exercise, atropine mobitz 2

A
  • no change or worsens
71
Q

permanent pacing for mobitz 2

A
  • yes
72
Q

diagnosis based on EKG

A
  • mobitz 1 block
  • look for P without QRS
  • wide QRS
  • longer PR
73
Q

diagnosis based on EKG

A

mobitz II

  • look for P without QRS then short PR
74
Q

diagnosis based on EKG

A
  • 3rd degree AV block
  • no relationship between P and QRS
  • more P’s than QRS’s. QRS’s are regular
75
Q

treatment of 3rd degree AV block

A
  • reverse with treatment of underlying cause
  • may need pacemaker
76
Q

cause of 3rd degree AV block

A
  • ischemia/infarct
  • degenerative disease
77
Q

diagnosis based on EKG

A

3rd degree AV block

  • due to inferior MI
78
Q

diagnosis based on EKG

A
  • sinus bradycardia - atrial pacing
  • pacemaker spike followed by P wave
79
Q

diagnosis based on EKG

A
  • ventricular pacing
  • can see the spike of the current depolarizing the ventricle

Cardio Exam 1 (25 decks)

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