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SAM 2 > Most Common arrhythmias in smalls > Flashcards

Most Common arrhythmias in smalls Flashcards

1
Q

Ventricular Extrasystoles (VPC)

A
  1. HR: normal, low or high i.e irregular!
  2. Rhythm: irregular due to the premature beat
  3. P-waves: not associated with P waves (except fusion beat). The normal sinus P-waves may distort the ST segment or T-wave of extrasystole!
  4. QRS: WIDER AND LARGER
  5. ST-segment: abnormal
  6. T waves: abnormal, OPPOSITE POLARITY TO THE QRS
  7. Pause: fully compensated, no resting
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2
Q

VPC left ventricular origin

A

**look at direction of QRS complexes

Large (-) deflection

Large (+) P waves

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3
Q

VPC right ventricular origin

A

Producing (+) waves that are wider and larger than simus waves

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4
Q

Ventricular tachycardia (many extrasystoles)

A

Sustained vs non-sustained

Uniform vs multiform

Accelerated idioventricular rhythm

Torsade de pointes

Flutter, fibrillation

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5
Q

What 2 features are ALWAYS seen with ventric tachycard?

A
  1. A captured sinus beat- when you see the sinus firing at the correct moment
  2. Fusion beat- combo of sinus and the ventric originating ectopic beat. The depol is coming from 2 direstions

May have to wait some time before you eill see the 2- but you will always see the 2

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6
Q

Accelerated idioventricular ryhthm

A

Most commonly the HR<160bpm with this

Therefore often known as slow ventric tachycard

The slow HR is convenient as it allows us to see the sinus beats and fusion beats

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7
Q

Torsade de pointes

A

Means “changing of the points”

from (+) to (-)

Multiform, v. fast ventric tachycard

Emergency situation

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8
Q

Ventricular flutter, fibrillation

A

Flutter= reentry

Fibrillation=disorganised beats

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9
Q

Causes of ventric arr

A

Cardiac

Extracardiac

Drugs/toxins

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10
Q

Cardiac causes of ventric arr

A

Myocardial injury

Myocarditis

Cardiomyopathy

Pericarditis/ haemocarditis

Endocardosis/itis

Congenital HD

Base and myocardial tumours

Amyloidosis

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11
Q

Extracardiac causes of ventric arr

A

Same as for causes of arr in general discussed prev

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12
Q

Drugs/toxins causing ventric arr

A

DADADDEC

Digitalis

Anaesth

Doxorubicin

Atropine

Dobutamine

Dopamine

Epi

Chocolate…

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13
Q

Extra steps to be included in the new arr protocol if it suspected of being ventric

A

BP- however hyperT usually does not cause!

Inflamm markers: c- Tr-1: IC in myocytes, is heart specific and could indicate myocarditis!

CRP and SAA

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14
Q

Congenital Ventric arr

A

ARVC in BOXERS, bulldogs and cats

DCM: in dobermans and great danes

Ventric tachycard: german shepherds

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15
Q

ARVC in boxers

A

Autosomal dominant

All with the mutation are sick, but with different phenotypes because varying penetration

Signs when older than 6 although after no clinical signs (rxcept PCV)

Maye see extrasystoles in eCG

Syncope during stress/exercise

Maybe sudden death

Fibrous/fatty degen of the RV

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16
Q

ARVC in boxers- waht you must treat

A

The syncope- only if fainting due to the disease and not acc to another systemic illness eg insulinoma or SAS

Bradyarrhythmias=vasovagal syncope

the ventric tachycard: on an ECG can see up to 1000 VPC’s per day! pairs, triplets, tachycard, R on the T wave.

For this give Mexiletin or Sotalol (PO) or Atenolol

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17
Q

Diagnosis of ARVC in boxers *

A

Holter: Bradyarr and syncope!!

Bradyarr: after the syncope there are only a few VPCs because there is a compensatory incr in vagal activity after a symp surge! e.g when the dog is stressed/happy

This leads to vasoD… decr BP… dog faints

Try to avoid triggers and can tell the owner to elevate the HL’s when there is a fainting episode!

*eCG readings: the QRS complex is positive because the VPC is originating from the R ventricle

18
Q

DCM in Dobermans

A

Holter for screening and treatment.

Should do US and eCG also

Often sudden death

19
Q

Treatment of DCM in Dobermans

A
  1. HF and sinus ryhthm/ atrial fibrillation: diuretics and pimobendan. Beta blockers when no congestion and low dose digoxin
  2. HF and ventric arr: Mexiletine and Sotalol
  3. Syncope without HF: must screen with Holter to exclude bradyarr! beta blockers (sotalol) and Na channel blockers
  4. No clinical signs but VPCs on Holter: sotalol and pimobendan if the heart is enlarged
20
Q

Supraventricular Extrasystoles

A

Causes:

  1. HD- atrial stretch and hypoxia
  2. Extracardiac
  3. Sometimes in healthy animals witha. high vagal tone

Checkand treat underlying cause ONLY!!

If symptoms: Digoxin, beta blockers, Ca channel blockers and Amiodarone

21
Q

Supraventricular Extrasystoles appearance on eCG

A

Supraventric premature beats but usually cannot see origin

No preceeding P-wave

Junctional

22
Q

Narrow QRS complex tachycradia

A

Narrow QRS always indicates SUPRAVENTRIC!! dogs<70ms cats<60ms

*wide QRS indiactes VENTRIC (sometimes supraventric)

Sinus tachycard

Supraventric tachycard:

  • FAT: focal atrial tachycard
  • Junctional tachycard
  • OAVRT= bypass tachycard
  • Atrial flutter

Atrial fibrillation

23
Q

Sinus Tachycardia

A
  1. HR: fast but usually not above 200 bpm
  2. Rhythm:P–P distances and R—R distances only vary slightly (<10%)but have paroxysmal form i.e gradual acceleration and deceleration
  3. P waves: positive II or avF, there is a P for every QRS complex but it may be lost in prev ST segment or T wave. Could be higher in tachycard
  4. PQ distances: normal but could shorten when HR incr
  5. QRS complex: regular or abnormal if intraventricular conduction disorder
24
Q

Causes of sinus tachycard

A

Mainly extracardiac e.g pain, fever, gastric dilation

25
Q

Atrial fibrillation

A

Disorganised atrial activity

  1. HR>180-200 bpm but this may be normal in giant breeds e.g in the case of lone fibrillation
  2. Rhythm: is irregular thereofore it is an absolute arr
  3. P-waves: missing or f-waves
  4. QRS complex: usually normal (maybe abnormal)
26
Q

Atrial fibrillation- appearance on eCGs

A

chaotic electric depol waves

Unudlations of membranes

Flatlines btw QRS complexes

27
Q

Lone atrial fibrillation

A

physio in large breed dogs

HR is normal

28
Q

Treatment of atrial fibrillation

A
  1. treat the HD: treat the HF and if the ventric rate still high, slow with digoxin, diltiazem or beta blockers e.g amiodarone
  2. If caused by extracardiac then find and treat! e.g if high symp or comp parasym tone. Or post anaesth/induction of high vagal tone– wait and see, maybe give lidocaine IV
  3. Lone fibrillation- try and find the casye e.g hypothryroidism? do US and look for DCM

Overall- danger of thrombosis is low because of contraction of the atria therefore no need for anticoag therapy

**atrial fibrillation in cats- suspect enlarged atrium- then prescribe antithrombitic medication

29
Q

Junctional tachycard

A

P waves move in and out of QRS complexes

30
Q

OAVRT

A

(-) P waves

Depol begins at the AV and then moves up to the atria!

31
Q

Treatment of Supraventric arr

A

Dont treat: nonfrequent atrial or junctional extrasytoles or lone fibrillation

Goal 1: restore sinus rhythm!! the phys methods! however only chest thump when you have excluded VT from SVT with wide QRS

Give Diltiazem or Esmolol IV- these drugs impact the AV node- will delay the conduction so the flutter slows down but doesn’t stop

32
Q

What is bradycardia?

A

Dogs: >60-70 bpm

Cats: <140 bpm

Caused by SA dysfunction or conduction disorders

33
Q

Sinus bradycardia

A

Usually occurs in a relaxed animal

Incr intracranial/IOP

HyperT

Hperkalaemia

Hypothyreoisis

Hyptglucaemia

Hypothermia

SSS

Check and treat the possible causes

Conduct atropine reaction test- could diagnose high vagal tone bradycard and (SSS)

34
Q

Canine Sinus Node dysfunction (SND) and SSS

A

Sinus bradycard

Sinus arrest— AV block (therefore it is often accompanied by AV blocks or BBBs)

Tachycard- bradycard syndrome

Escape rhythms

Female>make

Mini schnauzer, westie, springers, cockers, labs, pugs, daschunds

SND +/- signs but SSS always signs

Many of the dogs reaxt to atropine which is misleading- should be used to diagnose parasymp diseases but this is a nodal problem

35
Q

Treatment of SND and SSS

A

If reacted to atropine then likely to react to theophylline, terbutaline and propantheline bromide

Sympto- pacemaker

Often diagnosed during anaesth

36
Q

Atrial standstill/ silent atrium

A

Hyperkalaemia induced bradyarr!!!

NO atrial conduction!! therefore sinoventricular conduction must take place through internodal tracts

Slow escape rhythm– this is what is keeping the animal alive!!!!

37
Q

Causes of atrial standstill/ silent atrium

A

Renal failure

Urinary tract obstruction

Leakage

Addisons

Reperfusion syndrome

38
Q

AV blocks

A

1st-3rd degree

Can be functional or physio

Causes:

  • Drugs/toxins
  • High vagal tone therefore reacts to atropine
  • Hyperkalaemia
  • Hypothyreoisis (1st)
  • Inflamm, neoplasia, amyloidossi and fibrosis– autoimmune e.g Lyme!
39
Q

Different degrees of AV blocks appearance on eCG

A

1st: prolonged PQ interval
2nd: Mobitz-1-Wenkebach phenomenon due to high vagal activity therefore responds to atropine
3rd: many non-conductive PQ therefore requires pacemaker

40
Q

Bradyarrhythmias

A
  1. Sinus bradycardia
  2. sinus arrest
  3. SA/AV block
  • if sinus nodal origin then give terbualine or theophylline ]Atropine test
  • Check electrolytes- maybe hyperkalameia?
  • bloods: kindey function (e.g lower excretion of K)
  • Biomarkers e.g cTR-1 for myocarditis
  • Immune/autoimmune-Lyme, AHA- gove doxycycline or preds
  • Echo
41
Q

Treatment of bradyarr

A

Stops Drug treatment- eliminate toxins!!!

All antiarr and digoxin are contra!!!

Pacemaker: for high degree AV block or SSS

SAM 2 (12 decks)

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