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Cardiology (SP23) > Module 3: Other Cs > Flashcards

Module 3: Other Cs Flashcards

1
Q

Definition:
Disorders of rate, rhythm, and/or conduction

A

Arrhythmias
- Rate: tachyarrhythmias, bradyarrhythmias
- Location of foci: sinus, atrial, junctional (AV junction), ventricular

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2
Q

List the consequences of arrhythmias:

A
  • Hemodynamic compromise
  • Cardiac compromise
  • Electrical instability
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3
Q

List the causes of arrhythmias:

A
  1. Structural Heart Disease
  2. Metabolic & Endocrine disorders
  3. Autonomic imbalance (stress in class)
  4. Drugs & Toxins
  5. Usual Suspects
    - non-cardiac diseases that cause transient arrhythmias
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4
Q
  • A pause that is > 2 P-P intervals
  • Associated conditions:
    - High vagal tone (Brachycephalic dogs with upper airway obstruction)
    - Pathology affecting the sinus node (Neoplastic infiltration, electrolyte imbalances, drug toxicities)
    - Sinus node dysfunction (When symptomatic = Sick Sinus Syndrome)
A

Sinus arrest

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5
Q
  • Sinus node dysfunction that has resulted in clinical signs (syncope)
  • Fibrotic changes to the SA node
  • Older terrier breeds most common
    - Miniature Schnauzers and Westies
    - Females over-represented
A

Sick Sinus Syndrome (Fainting)
- Bradycardia with sinus arrest
- “Tachycardia-Bradycardia Syndrome”
- Periods of supraventricular tachycardia (atrial tachycardia) with periods of sinus arrest (this is usually when they faint)
- May also have some atrioventricular (AV) block
- conduction system can be diffusely affected

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6
Q

Treatment of choice for Sick Sinus Syndrome?

A

Artificial pacemaker

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7
Q

Management of sinus rhythm disturbances:
- Find cause & treat accordingly
- Pain, stress, hypovolemia, hypotension

A

Sinus tachycardia

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8
Q

Management of sinus rhythm disturbances:
- Find cause (high vagal tone, drug related) & treat accordingly
- Atropine/glycopyrrolate

A

Sinus bradycardia

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9
Q

Management of sinus rhythm disturbances:
- Atropine/glycopyrrolate
- SSS- pacemaker

A

Symptomatic sinus arrest

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10
Q

Vaughan-Williams:
Class 1:
Class 2:
Class 3:
Class 4:

A

Class 1: Na+ channel blockers
Class 2: Beta-adrenergic blockers
Class 3: K+ channel blockers
Class 4: Ca2+ channel blockers
(no beta kids in the car)

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11
Q

(T/F) All antiarrhythmic drugs can potentially be pro-arrhythmic

A

True

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12
Q

** Filler Card **

A

C9

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13
Q
  • Sinus rhythms
  • Sinus arrhythmias
  • 2degree AV block (some species)
    These are …
A

Normal Rhythms

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14
Q
  • Supraventricular (atrial arrhythmias)
  • Junctional rhythms
  • Ventricular arrhythmias
    These are …
A

Tachyarrhythmias

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15
Q
  • High-grade 2nd-degree AV block
  • 3rd-degree AV block
  • Atrial standstill
  • Sinus arrest
    These are …
A

Bradyarrhythmias

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16
Q

(T/F) AV nodal conduction influences the ventricular rate but not the origin of the SVT

A

True
- Atrioventricular (AV) node = Gatekeeper

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17
Q

With any supraventricular rhythm, the rate is determined by the _____________

A

AV node

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18
Q

When the supraventricular signal doesn’t pass down to ventricles = AV node is ______

A

Blocked
- is considered a “physiological block” (AV node is healthy, the signals are just coming in too fast)

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19
Q
  • Normal (or consistent with sinus) QRS morphology
  • P’ waves vary and are usually different than sinus P waves
    - Can be buried in preceding T wave
  • Often seen with structural heart disease (atrial enlargement)
    - But can see with the other “causes of arrhythmias”
A

APC

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20
Q

(T/F) Treatment is necessary for APCs

A

False, No treatment necessary for APCs
- no clinical signs

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21
Q
  • Ectopic rhythm originating from an atrial focus outside of the SA node
    – “A Run of APCs”
  • May see some physiological AV block (P waves without QRS complexes)
  • Start and stop abruptly
  • Often rapid and the P wave is buried in the preceding T wave
  • Look for P’ waves
A

Focal atrial tachycardia = FAT

22
Q
  • Large, rapid, organized circuit traveling around the atria
  • Rapid, regular “saw-tooth” flutter waves
  • Rate may be regular or irregular
    - Variable conduction through the AV node
  • AV nodal conduction = determines the HR
A

Atrial flutter= A-Flutter

23
Q
  • Much more common
  • Irregular, no P waves, the ventricular rate is usually rapid (can be normal), may have undulating baseline (but not always present)
  • AV conduction determines the ventricular rate
A

Atrial fibrillation = A-Fib = AF

24
Q

Treatment of Atrial Arrhythmias:
(Persistent/frequent atrial tachycardias, Atrial flutter, Atrial fibrillation)

A
25
Q

Atrial Arrhythmias: Heart Control
Arrhythmia is sustained, but HR is slower (more physiologic) to improve CO

A

Heart RATE Control

26
Q

Atrial Arrhythmias: Heart RATE Control
- sensitizes baroreceptors -> increases vagal tone

A

Digoxin

27
Q

Atrial Arrhythmias: Heart RATE Control
Blocks Ca2+channels in the AV node

A

Diltiazem
- Class 4
- Most used/safer

28
Q

Atrial Arrhythmias: Heart RATE Control
Decreases sympathetic tone; indirectly blocks Ca2+entry
- Each has pros and cons
- Digoxin is the only one that is not a negative inotrope (actually digoxin is a positive inotrope) therefore it is the drug of choice with CHF
- Often have to use multiple drugs together

A

Beta-blockers
- Safe to use, sometimes

29
Q

Atrial Arrhythmias: Heart Control
Arrhythmia is converted to a normal sinus rhythm

A

Heart RHYTHM Control

30
Q

Drugs that suppress automaticity or modify
conduction:

A
  • Quinidine
31
Q

What is the most common example of rhythm control?

A

It is with Atrial Fibrillation
- Medical Conversion
- Electrical Conversion

32
Q

What is the drug of choice for acute, life-threatening ventricular arrhythmias?

A

Lidocaine

33
Q

Use for:
- Lidocaine
- Procainamide
- Mexiletine

A

ventricular arrhythmias

34
Q

Use for:
Quinidine

A

Atrial Fibrillation in horses

35
Q

A 12 YO dog presents a 3-day history of diarrhea,
vomiting, and anorexia. An ECG was recorded. What is the treatment for the following rhythm?

A

Fluid Bolus

36
Q

(T/F) Digoxin is the only one that is not a negative inotrope (actually digoxin is a positive inotrope) therefore it is the drug of choice with CHF

A

True

37
Q

** FILLER CARD **

A

C10

38
Q

Ventricular Arrhythmias:
- Beats coming in prematurely
- Morphology wide and bizarre (unlike the sinus beats)
- P waves present (but not associated with VPCs)

A

Ventricular premature complexes= VPCs = PVCs

39
Q

Ventricular Arrhythmias:
- Life-saving beats originating from the ventricle, therefore still wide & bizarre
- Unlike, VPCs, these are coming in late (after a pause)

A

Ventricular escape beats

40
Q

Ventricular Arrhythmias:
- > 3 ventricular premature beats in a row
- Heart rate is fast (tachycardia)

A

Ventricular tachycardia = V-tach = VT

41
Q

Ventricular Arrhythmias:
Considered a type of polymorphic Ventricular Tachycardia
Treatment: Magnesium Sulfate IV

A

Torsade de pointes
(Turning around a point)

42
Q

Ventricular Arrhythmias:
- Irregular, chaotic, deformed deflections of varying amplitude, width, and shape
- No organized activity
- No cardiac output
- Treatment: Defibrillation STAT!!

A

Ventricular Fibrillation

43
Q

Therapy for Ventricular Arrhythmias:
What is the drug of choice (intravenous) for acute therapy of ventricular arrhythmias?

A

Lidocaine (IV)

44
Q

Therapy for Ventricular Arrhythmias:
What is the drug(s) of choice (oral) for chronic therapy of ventricular arrhythmias?

A
  • Sotalol (go to)
  • Procainamide (also can be used IV)
  • Amiodarone (also can be used IV)
  • Atenolol
  • Mexiletine (also a go-to)
    (SPAAM)
45
Q
  • Rhythm coming from the ventricles
  • Not fast (usually less than 170bpm in dogs)
  • “Accelerated” as compared to an escape rhythm but not tachycardic
  • Usually related to non-cardiac causes
  • Sick animals in the ICU
    Treat underlying cause
A

Accelerated Idioventricular Rhythm= AIVR = “Slow V-Tach”

46
Q
  • QRS wide (More than just LV enlargement)
    - Dog: > 80 ms
    - Cat: > 60 ms
  • Normal MEA or left-axis deviation
A

Left Bundle Branch Block (LBBB)
- This is similar QRS morphology as a VPC originating from the right ventricle
- Sinus rhythm with “right-sided” VPC doesn’t have a “P wave” before it

47
Q
  • QRS wide:
    - Dog: > 80 ms
    - Cat: > 60 ms
  • Right axis deviation
    - deep (negative) S wave in I & II
    - Positive QRS in avR
A

Right Bundle Branch Block (RBBB)
- This is similar QRS morphology as a VPC originating from the left ventricle

48
Q

What is the difference between RBBB vs RV enlargement?

A

Both have a right axis deviation, BUT the QRS with RBBB is wider than with RV enlargement alone (you can poke your finger with it)

49
Q
  • Slowed or blocked conduction through the AV node
  • Varying degrees of AV block possible
A

Atrioventricular Block = AV block

50
Q

What has a high vagal tone and is a common finding & normal rhythm in horses?

A

2nd degree AV Block (Type I)

51
Q

Do the PowerPoint questions?

A

Cardiology (SP23) (8 decks)

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