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Methods of Anesthesia > Preexcitation & SVT > Flashcards

Preexcitation & SVT Flashcards

1
Q

2 possible pathways to the ventricles

A
  1. Normal AV node pathway

2. “abnormal” accessory pathway

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2
Q

What is the alpha pathway?

A

The normal AV node pathway

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3
Q

What is the beta pathway?

A

The abnormal conduction pathways in the AV node or myocardium

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4
Q

Other names for beta pathways

A
  1. Accessory pathways
  2. Bypass tracts
  3. Preexcitation pathways
  4. Aberrant pathways
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5
Q

What happens if a beta pathway is activated?

A

The pt is at risk for developing arrhythmias

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6
Q

Possible triggers that can activate beta pathways

A
  1. Stress, catecholamine surges
  2. Caffeine, tobacco, street drugs
  3. Electrolyte abnormalities
  4. Acid-base imbalance
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7
Q

In normal conduction, if a beta pathway is activated, where does the current go?

A

In both the alpha and beta pathways

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8
Q

What kind of conduction and refractory period does the alpha pathway have?

A
  1. Slow conduction

2. Short refractory period (fast reset)

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9
Q

What kind of conduction and refractory period does the beta pathway have?

A
  1. Rapid conduction

2. Long refractory period (slow reset)

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10
Q

What will the PR interval look like if the accessory pathway in the AV node is activated?

A

Short

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11
Q

What will the QRS complex look like if an accessory pathway in the AV node is activated?

A

Normal

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12
Q

What will the PR interval look like if an accessory pathway in the myocardium is activated?

A

Short

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13
Q

What will the QRS complex look like if an accessory pathway in the myocardium is activated?

A

Wide

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14
Q

What occurs anytime current travels down a beta pathway?

A

Preexcitation

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15
Q

What is the clinical significance of preexcitation?

A

Not a big deal unless associated with tachycardia

-can lead to arrhythmias such as SVT

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16
Q

From a PAC with an activated beta pathway, which path will the current travel through to get to the ventricles?

A

Alpha pathway only bc the beta pathway is still in refractory

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17
Q

After the PAC impulse gets to the ventricles, what pathway does it travel?

A

The rapid beta pathway

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18
Q

If the reentrant tachycardic loop occurs in the myocardium, what would you expect to see on the EKG?

A

A delta wave and wide QRS complex

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19
Q

What accessory path is activated in Wolff Parkinson White syndrome?

A

The Kent bundle in the myocardium that forms a direct connection between the atria and ventricle

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20
Q

What does the EKG of WPW have?

A
  1. Short PR interval

2. Delta wave

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21
Q

When is WPW symptomatic?

A

With tachycardia

22
Q

Anesthetic management of symptomatic WPW w/tachycardia

A

Avoid/limit sympathetic stimulation (ketamine, pain, hypovolemia, anxiety)

23
Q

What can WPW with tachycardia be confused with on the EKG?

A

Vtach due to the wide QRS

24
Q

Treatment for symptomatic WPW

A
  1. Transvenous catheter ablation
  2. Antiarrhythmic drugs (beta blockers, amiodarone)
  3. Synchronized cardioversion (if tachycardic and unstable)
25
Q

Most effective and permanent solution to treat WPW

A

Transvenous catheter ablation

26
Q

What antiarrhytmics should be avoided in WPW patients?

A

Drugs that block conduction through the AV node (adenosine, CCBs, digoxin)

27
Q

What accessory pathway is activated in Lown Ganong Levine syndrome (LGL)?

A

James bundle in the myocardium, forms a direct connection between the atria and Bundle of His (bypasses the AV node)

28
Q

EKG of LGL

A
  1. Short PR interval

2. No delta wave

29
Q

Treatment of LGL syndrome

A

Usually asymptomatic and requires no treatment

30
Q

What is the activated accessory path of Mahaim preexcitation?

A

Mahaim fibers that connect the AV node and R ventricle by bypassing the Bundle of His

31
Q

EKG of Mahaim preexcitation

A
  1. Normal PR interval

2. Widened QRS complex with or without a delta wave

32
Q

Clinical definition of SVT

A
  1. Tachycardia greater than 150 bpm caused by reentry.
  2. QRS is normal width.
  3. P waves may or may not be present
33
Q

Reentry tachycardia/SVT resembles what rhythm?

A

Junctional tachycardia

34
Q

What does paroxysmal SVT resemble on the EKG?

A

Afib, but you can see the P waves, especially when the heart slows down

35
Q

Most common type of reentry

A

AV nodal reentrant tachycardia (AVNRT)

36
Q

EKG for AVNRT

A
  1. Narrow QRS

2. May or may not have P wave

37
Q

AVNRT treatment to slow conduction through AV node

A
  1. Vagal maneuvers
  2. Adenosine
  3. CCBs
  4. Sotalol
  5. Digoxin
38
Q

Duration of action of adenosine

A

5-10 seconds

39
Q

Dose of adenosine for SVT

A

initial 6mg bolus, NS flush

Up to 2 additional doses of 12 mg

40
Q

Mechanism of action of Sotalol

A

Beta blocker, decreases conduction/increases refractoriness in AV node

41
Q

ACLS dose of Sotalol

A

100mg or 1.5mg/kg

42
Q

When should Sotalol be avoided?

A

In patients with prolonged QT syndrome

43
Q

Treatment for SVT AVNRT

A
  1. Slow AV node conduction
  2. Antiarrhythmics
  3. Beta blockers
  4. Synchronized cardioversion
  5. Transvenous catheter ablation
44
Q

EKG for SVT within myocardium

A

Delta wave or wide QRS complex

45
Q

AVRT treatment

A
  1. Antiarrhythmics
  2. Beta blocker
  3. Synchronized cardioversion
  4. Transvenous catheter ablation
46
Q

Why do you want to avoid treatments that block AV node conduction in SVT AVRT?

A

Blocking antegrade conduction through the AV node may promote very rapid, even life-threatening vtach or vfib response

47
Q

What patients are at highest risk for a life-threatening response with AV node conduction blocking in AVRT?

A

Pts who develop afib or flutter with a bypass tract

48
Q

Purpose of Maze procedure

A

To treat afib

49
Q

How does the Maze procedure treat afib?

A

Inflicting scar tissue through incisions, cold temperatures/cryomaze, ablation lines to disrupt abnormal conduction pathways

50
Q

When are Maze procedures commonly done?

A

With another heart operation while the chest is open via sternotomy or thoracotomy

51
Q

What is the purpose of closing the L atrial appendage?

A

To prevent clot release from the L atrium in pts with a history of afib

52
Q

What are options for L atrial appendage closure?

A
  1. Ligation of the L atrial appendage (open heart)

2. Insertion of the “watchman” device (endovascular)

Methods of Anesthesia (20 decks)

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