Primer 10 - Arrhythmias Flashcards
Which ECG is irregularly irregular?
Atrial fibrillation
Which is the Arrhytmia that is associated with hypertension, rheumatic fever heart disease, valvular disease and hypertiroidism?
Atrial fibrillation
What is the complication for atrial fibrillation ?
It can result in atrial stasis and lead to cardioembolic events.
Patient presents a new (less than 48hours) atrial fibrillation which is the treatment?
Synchronized cardioversion
Which is the treatment for a chronic atrial fibrillation ?
- Antithrombotic therapy (e.g. Heparin, warfarin, enoxaparin).
- Coumadin
- Rate control (beta-blockers, non-dihydropyridine calcium channel blocker, Digoxin).
- Rhythm control (sotalol, Amiodarone, class IC or III antiarrhythmics)
Which are the two types of treatments for atrial fibrillation
1)Rate control. 2)Rhythm control.
Chaotic and erratic baseline whit no discrete P waves, these characterized belong to what type of fibirillation?
Atrial fibrillation.
“Sawtooth pattern” is belong to what type of fibirillation?
Atrial flutter.
What is an atrial flutter?
It’s an Arrhytmia with a rapid succession of identical, back-to-back atrial depolarization waves.
Which is the management for atrial flutter?
Similar to atrial fibrillation (rate control, anticoagulation, cardioversion).
Which is the definitive treatment for atrial flutter?
It is catheter ablation.
Which components belong to sinus bradycardia?
Normal P waves, Normal QRS complexes, however BMP is lower than 60.
Which is the only Arrhythmia that is fatal without immediate CPR and defibrillation?
Ventricular fibrillation: A completely erratic rhythm with no identifiable waves.
What is the 1st degree AV block ?
It is the PR interval is prolonged (>200msec.), also is benign and asymptomatic and no treatment required.
What bacterial infection caused AV node block?
Borrelia burgdorferi, and it is the organisms that causes Lyme disease.
How many types of the 2nd degree AV blocks exists?
There are 2 kind of 2nd degree blocks, Mobitz type 1 (also called Wenckebach) and Mobitz type 2.
What does the Mobitz type 1?
Progressive lengthening of PR interval until a beat is “drooped”(a P wave not followed by QRS complex.
Dropped beats that are not preceded by a change in the length of the PR interval (as a type 1). May progress to third degree block. Often treated with pacemaker.
Mobitz type II.
What happened in the Mobitz type II?
There is a P wave and absent QRS.
What is a 3rd degree (complete)?
The atria and ventricles beat independently of each other. P waves bear no relation to the QRS complex.
Which rate is faster atrial or ventricular?
Atrial rate is faster than ventricular rate.
Which is the treatment for 3rd degree av block?
Usually treated with pacemaker.
Which disease can result in 3rd degree heart block?
Lyme disease.
Which is the most common type of ventricular preexcitation syndrome?
Wolff-Parkinson-White Syndrome.
Which is the accessory conduction pathway in Wolff-Parkinson-White syndrome ?
Bundle of Kent
What is the syndrome characterized by Delta wave?
Wolff-Parkinson-White Syndrome, also there are widened QRS complex and shortened PR interval.
What kind of tachycardia may can result in WPW syndrome?
Supraventricular tachycardia.
Which is the Junctional escape rhythm ?
It is a delayed heart beat, it is not originated from atrium or SA node, the signals coming from somewhere in the AV junction, also is the protective mechanism of the heart when the AV node does not work.
What is the Ventricular Premature Contractions (PVC)?
There are early acquiring waves QRS complexes. Signals come from the Purkinje fibers.
What is the ventricular escape rhythm ?
It is a failure of the sinus in AV nodes at do generate an impulse, also there is an absent of P wave activity and long pause greater than the normal sinus.
How many of Ventricular Tachycardia exists?
1)Ventricular tachycardia (vt). 2)Nonsustained VT. 3)Stained VT.
3 or more successive ventricular complexes
Ventricular tachycardia.
Series of repetitive ventricular beats, duration of less than 30 seconds belong to
Nonsustained VT.
Series of repetitive ventricular beats duration of more than 30 seconds.
Sustained VT.
What is the polymorphic ventricular tachycardia, characterized by shifting sinusoidal waveforms on ECG?
Torsades de pointes.
orsades de pointes can progress to…
Ventricular fibrillation
Which are the drugs that prolong the QT interval?
AntiArrhytmics (class IA, III). AntiBiotics (Macrolides). Anti"C"ychotics (Haloperidol). AntiDepressents (TCAs). AntiEmetics(ondansetron). *drug-induced long QT (ABCDE).
Which are the causes for torsades de pointes?
Caused by hypokalemia and hypomagnesemia.
What is the treatment for torsades de pointes?
Treatments includes magnesium sulfate.
Increase PR until dropped beat.
Mobitz type 1
Undulating amplitude of QRS?
Torsades de pointes
In what cardiac pathology do we see Delta waves in EKG?
Wolf Parkinson White.
In what cardiac pathology do we see Sawtooth pattern in EKG?
Atria flutter.
Wide QRS after long pause
Ventricular escape
PR >200 ms
First degree heart block
No warning dropped beat
Mobitz type II
Irregularly irregular
Atrial Fibrillation
Atria and ventricles beat independently
3rd degree heart block
Erratic rhythm
Ventricular fibrillation
Wide QRS and tachycardia
Ventricular tachycardia
What is the initial treatment for ventricular fibrillation?
Shock monophasic 360 Jouls and begin CPR at 30:2
What is the initial treatment for ventricular tachycardia when there is no pulse?
Shock monophasic 360 Jouls and begin CPR at 30:2
What is the hallmark of a third degree heart block?
No coordination between P-waves and QRS segments
What drugs are known to prolong the QT interval, increasing the likelihood of torsades de pointes?
AntiArrhytmics, antiBiotics, antipsychotics, antidepressant, AntiEmetics.
What are the two different types of second degree AV block? And how do they differ?
Mobitz I: progressively lengthening of PR internal until dropped (P wave not followed QRS complex”. Mobitz II: dropped with out progressively lengthening prolongation.
Why is warfarin anticoagulant important in patients with chronic atrial fibrillation?
Reduce the risk of thrombotic stroke or PE.
