Rate & Rhythm Disturbances Flashcards
Sinus arrhythmia-
- Cyclic increase in normal HR with inspiration, decrease with expiration
- Reflex changes in vagal influence on pacemaker
- Young & elderly
Sinus arrhythmia- Sx
- Disappears with breath holding, increased HR
Sinus arrhythmia- Dx/ Tx
No clinical significance
Sinus Bradycardia- Eti
< 60 BPM- increased vagal influence in pacemaker, SA node disease
Sinus Bradycardia-Sx
- weakness, confusion, syncope
- may cause article, junctional or ventricular ectopic rhythms
Sinus Bradycardia- Dx
Rate increases with exercise or atropine
Sinus Bradycardia- Tx
Atropine & pacing
Sinus Tachycardia- Eti
> 100 BPM
- Rapid impulse formation of SA node
Sinus Tachycardia- Sx
- Fever, exercise, emotion, pain, anemia, HF, shock, drugs
- Alchohol withdrawal
Sinus Tachycardia- Dx
- Gradual onset & termination
- infrequently exceeds 160 BPM
- Regular rhythm, may change with position, breaths, sedation
Sinus Tachycardia- Tx
- Beta blockers
- Modification of SA node
Paroxysmal supraventricular tachycardia- Eti
- AV nodal reentry tachycardia
- AV accessory pathway
- No structural heart disease
Paroxysmal supraventricular tachycardia- Sx
- 140-240 BPM, regular
- Episodes begin & end abruptly- seconds to hours
- Angina, dizzy, SOB,
Paroxysmal supraventricular tachycardia- Dx
- ECG: regular rhythm, increased rate
- P-wave differs in contour
Paroxysmal supraventricular tachycardia- Tx
- Terminate episode
- valsalva, carotid sinus massage
- Adenosine to block conduction of AV node
Wolffe-Parkinson-White syndrome- Eti
Superventricular tachycardia due to accessory connection between atrium & ventricle through Kent Bundles
Wolffe-Parkinson-White syndrome- Sx
- Syncope
- Rapid, regular rhythm
- Palpations
- Loss of pre excitation during exercise
Wolffe-Parkinson-White syndrome- Tx
- Catheter ablation
Atrial fibrillation- Eti
- Most common
- Increases in 7th decade
- 60% revert to sinus rhythm within 24 hrs
- HTN, MI, stroke
Atrial fibrillation- Sx
- Irregularly irregular pulse
- palpitations or fatigue
Atrial fibrillation- Dx
- ECG- ambulatory
Atrial fibrillation- Tx
> 1 wk = anticoagulants & rate control with beta blockers, CCB
Atrial premature contraction- Eti
- Ectopic focus of atria fires before SA node
- Common
Atrial premature contraction- Sx
- Premature heart beat, abolished by increase in HR
- Asymptomatic & benign
- Varied p wave morphology
Atrial premature contraction- Tx
None- discontinue coffee, tobacco
Atrial flutter- Eti
- Assoc with COPD
- Less common that fibrillation
Atrial flutter- Sx
- Regular pulse with atrial rate btw 250-350
- Palpitations, fatigue, tachycardia
- COPD or HF
Atrial flutter- Dx
Sawtooth ECG
Atrial flutter- Tx
- Beta blocker or CCB- rate control
- Electrical cardioversion
Premature ventricular contraction- Eti
- Isolated beats originating from ventricular tissue
Premature ventricular contraction- Sx
- Pts may not sense
- Exercise abolishes
- No p-wave
- Arrhythmia- every 2nd/3rd beat premature
Premature ventricular contraction- Dx
Ambulatory ECG
Premature ventricular contraction- Tx
- Asymptomatic= no tx
- Freq- lytes, tsh, HD
- Beta blockers
- Catheter ablation
V-tach- Eti
- 3+ premature beats
- Sudden death with sig. LV dysfunction
V-tach- Sx
- Syncope, impaired cerebral fxn
- Structural heart defects/ disease, myopathy
V-tach- Dx
ECG- Torasades de pointes
V-tach- Tx
- Mg sulfate
- beta blockers
V-fib- Eti
- Proceeded by V-fib
- Severe CAD
V-fib- Sx
- Sudden death
- Prior MI
V-fib- Tx
- Cardioverter- defibrilatoer
Long QT syndrome- Eti
Congenital or acquired
Long QT syndrome- Sx
- Congenital: Primary elec. disorder, no evidence of HD, deafness
- Acquired: secondary to MI, abn lytes, antiarrythmics
Long QT syndrome- Tx
Beta blockers