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Ross Arrhythmias Flashcards

1
Q

5 step EKG management

A

Step 1: mantra
(IV, O2, Monitor)
Step 2: stable or unstable
Step 3: too fast too slow
Step 4: wide or narrow
Step 5: regular or irregular
Step 6: P waves

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2
Q

How to determine whether a pt is unstable?

A
  1. **Vitals: esp. hypotension
  2. Evidence of hypoperfusion
    - appearance
    - mental status: altered
    - CP
    - Dyspnea
  3. Hx
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3
Q

4 MC tachy arrhythmias

A
  1. sinus tach
  2. atrial fib or atrial flutter
  3. supraventricular tachycardias: AVNRT and AVRT
  4. vtach
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4
Q

Tachy narrow means?
caused by?
QRS?

A

SVT
Blocks AV node
<0.12sec

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5
Q

Tachy wide arrhythmia can indicate what? (3)

A

“DIE”

  • Drug Toxicity
  • Ischemia
  • Electrolyte abnormality
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6
Q

Are wide tachy arrhythmias good or bad?

A

BAD

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7
Q

Wide tachy arrhythmias are ___ until proven otherwise

A

Vtach

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8
Q

Check P waves in which leads?

A

Lead 2 and AVR

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9
Q

P wave should be ___ in lead 2
and __ in AVR

A

Up
Down

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10
Q

Is Vtach regular or irregular?

A

Regular

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11
Q

Tx for Vtach (fast, wide, regular)

A

Shock

+/- amidarone/procanamiede

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12
Q

Tachyarrhythmias

  1. Narrow, regular= ______
  2. Narow, irregular= _______
  3. Wide, regular= ________
  4. Wide, irregular = ______/______
A
  1. sinus tach
  2. Afib/Flutter
  3. Vtach
  4. Aberancy/blocks
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13
Q

4 Types of Narrow, normal arrhythmias & Rates.

A
  1. AVNRT (180-200)
  2. AVRT (>200)
  3. Narrow Complex VT
  4. Macro reentry: (HR of 150)
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14
Q

Macro reentry also called ___?
Characteristics

A

Aflutter w/consistent blockHR 150; 2:1 block

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15
Q

Classic type of AVRT?
Classic findings?

A

WPW
Short PR interval
>200

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16
Q

How to distinguish b/w AVNRT and Macro reentry?

A

Macro reentry slower (150)

Try vagal maneuver- will help AVNRT

Try adenosine- will unmask flutter waves

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17
Q

Tx for AVNRT?

A

Vagal maneuver

Procainamide

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18
Q

Tx for Macroreentry (aflutter 2:1)?

A

Adenosine

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19
Q

Name the arrhythmia:
Tachy, Narrow, Regula, No P waves

A

AVNRT

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20
Q

AVNRT is assoc with?

A

Ahcohol, caffeine, stimulants
young, healthy women

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21
Q

Tx for AVRT-WPW?

A

Procainamide (AV node block)

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22
Q

Tx for fast, narrow & stable Arrhythmias?

A

Block AV node; try vagal

  1. adenosine-converts blocks the av node and breaks the re-entrant circuit
  2. CCB’s, BBs or amiodarone (for CHF)- controls rate
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23
Q

How to treat fast, narrow arrhythmias:
Stable?
Unstable?

A

stable-procainamide
Unstable- shock (50J)

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24
Q

If its fast, wide, & You’re in doubt- ___?

A

Shock it out

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25
Fast & wide arrhythmias are ___ most of the time. Rate?
Vtach 150-200
26
What is wide? QRS \>\_\_\_?
0.14sec
27
When Vtach is \>30sec, called what?
Sustained Vtach
28
What is Vtach almost always due to?
Ischemia
29
It is difficult to discriminate Vtach from \_\_?
SVT with aberrancy (ie BBB)
30
Question: A 74 year old male presents with chest pain, he is awake and alert and has the following ekg. What is your treatment? Lidocaine Amiodarone Kitchen sink Magnesium
Amiodarone
31
Vfib tx?
chest compressions early then shock until rhythm established. Meds: M- Mg A-Amiodarone V- Vasopressin E- Epi
32
3 Types of Brady arrhythmias
1. sinus brady 2. SA block 3. AV block 4. SSS
33
AV Blocks that arent scary
``` 1st degree Type 2 (Mobits 1) ```
34
Which of these pts need admission: - Pt with 60bpm but if they feel symptoms (***relative brady)*** - Pt w/HR 50 feeling light-headed, dizzy, and may be a cause of syncope or near syncope
Both
35
T/F: 2nd degree block Type 2 is a structural abnormality that can go to complete heart block
True
36
Tx for 2nd degree block Type 2 (Mobitz) & complete heart block (3rd degree)?
•**Unstable=**transcutaneous pacing (TCP) ...most will move toward TCP •**dopamine** great choronotrop \*\***epinephrine!!!**
37
T/F: we treat 2nd degree block Type 2 (Mobitz) with atropine?
False
38
T/F: narrow bradycardias are more stable than wide bradycardias?
True
39
What is a very scary lab finding in bradycardias? What do you give to stabilize membrane?
HyperK Ca2+
40
T/F: Wide bradycardias are more likely to progress to asystole than narrow?
True
41
T/F: Wide bradycardia is sensitive to atropine?
False
42
Where is the block found in wide bradycardias?
Below the AV node
43
Is 3rd degree block narrow or wide?
Wide
44
Are 1st degree blocks & 2nd degree type 1 narrow or wide?
Narrow
45
Are Mobits 2 (2nd degree) wide or narrow? does the pr stay the same?
Wide yes
46
T/F: Narrow bradycardia is sensitive to atropine?
True
47
BLS Mantra
C: Circulation A: Head tilt/chin lift or jaw thrust B: Assist ventilation D: Defibrillation or Differential Diagnosis
48
Universal Steps for Unconscious/Pulseless
- Assess responsiveness, open/position airway - Obtain assistance (phone first, unless Peds) - Ask for defibrillator/AED - Assess circulation check pulse - Start compressions 30/2: 15/2 - 2 breaths - Compression five rounds - AED/defibrillator
49
You are volunteering in the medical tent at a local marathon. You are seeing a 65 year-old who just finished the race who says they are dizzy. They are awake and alert, sweaty and you have difficulty finding the radial pulse. What is the first thing you do? 1. do your mantra 2. get a defibrillator 3. call Ems over to take person to the hospital 4. get him a drink of water
2. get a defibrillator
50
6 sec equals how many boxes on EKG?
30
51
what method do we use for reading rate on EKG?
Dubin measure R to R
52
4 narrow complex tachycardias
- AVNRT - AVRT - Afib - MAT
53
Name the rhythm using steps
Fast Stable Narrow Irregular No P waves
54
What are p waves after the QRS called? What rhytm does this indicate?
"retrograde" SVT
55
unstable Fast wide regular P waves? **no** **v tach**
56
Is there a p wave in afib?
NO
57
mantra don't know if stable **too fast (\>150)** **narrow** **regular** **NO** P waves =**SVT**
58
stable narrow regular p waves? **yes** **= sinus tach**
59
Unstable Fast wide \<12sec (3 boxes) Regular
60
* AV dissociation:* * P waves (arrowed) appear at a different rate to the ventricles* **too fast** **unstable** **wide** **regular** p waves? : **yes** *wide with p waves not associated with QRS:* **v tach**
61
what does aberrancy mean?
Conduction problem
62
Regular narrow tachycardias?
1. Sinus tach 2. Atrial tach 3. AVRT 4. AVNRT 5. Junctional tach 6. Atrial flutter
63
Where is the reentrant circuit in AVNRT
Within the AV node
64
Where is the reentrant circuit in AVRT?
Down AV node Retrograde up an accessory bypass tract
65
Stable Fast (210bpm) Narrow Regular P wave? **no** **AVNRT**
66
Name this reentry
Macroreentry Aflutter 2:1
67
Fast Narrow Regular **No** P waves Rate 3:1
68
Stable Fast Narrow Regular Pwave? **no** **A flutter 2:1** **Clue is rate of 150**
69
Stable Fast Narrow Regular P wave? **no** **A flutter 2:1** **(150)**
70
Is AVNRT seen with heart dz?
NO
71
WPW is a form of which tachyarrhythmia
AVRT
72
What do you think when you see rates \>200 in young, healthy pts?
WPW (AVRT)
73
Name of the acessory path in WPW
Bundle of Kent
74
Short PR Delta Wave WPW
75
What does orthodromic mean?
P wave seen after QRS, impulse goes down AV node and a retrograde P wave is seen
76
WPW
77
Tx for AVRT or orthodromic avnrt tx same fast, wide unstable arrhythmia
•don’t block the av node use **_procainamide_** or **_shock_**
78
Tx for fast, **narrow** & **_unstable_** Arrhythmias?
Shock (50J)
79
Fast Narrow Regular P waves? **no** 225 bpm. **•AVRT** * The QRS complexes are narrow because impulses are being transmitted in an orthodromic direction (A -\> V) via the AV node. * This rhythm is indistinguishable from AV-nodal re-entry tachycardia (AVNRT)
80
Name the arrhythmia
•multiple foci of discharge, irregular, narrow complex, no p waves are seen
81
82
Stable fast Narrow Irregular Pwaves? **no** **afib**
83
Stable normal Narrow Irregular Pwaves? **no** **afib**
84
Tx for Afib/Flutter outpatient
•treat underlying cause **•rate control** or rhythm conversion and **anticoagulation** * rate control by decreasing conduction blocking a/v node * b blockade * calcium channel blockers: Diltiazem * amiodarone * Digoxin takes forever Have patient on monitor
85
Tx afib/flutter inpt
* ER Goals: conversion versus **_conduction (rate) control_** * if hypotensive and unstable then shock @ 200j and then heparinize * in the ER we strive for rate (conduction) control especially if afib greater than 48 hours because not anti coagulated get CHADS2 score
86
87
Tx for unstable narrow, irregular
* afib: really hard to manage * Shock first what if first-line shock fails? •treat with amiodarone
88
T/F: WCT (wide complex tachycardia) is Vtach most of the time?
True
89
V tach is a ________ almost always due to \_\_\_\_\_\_\_\_\_\_\_\_\_.
a life threatening arrhythmia almost always due to ischemic heart disease
90
Unstable Fast **wide** **regular** Pwaves? **no** **Vtach**
91
Key points for **fast, wide** arrhythmias
•If in doubt treat for VTACH **•unstable=shock** (200J) **•stable** runs of vtach (monomorphic)= **amiodarone then cardioversion** •(polymorphic) think **torsades=mag**
92
Sedation prior to shock?
Ketamine or propofol
93
94
T/F; Vtach mimickers are usually **irregular**
true
95
3 types of wide, irregular tachycardias? When in doubt?
1. afib 2. aflutter with a BBB 3. wpw with a block **Shock it out**
96
fast ## Footnote **wide** **irregular** **no p waves** **So afib with BBB?** **Afib with avrt antidromic**
97
4 Characteristics of PVCs
* no p wave * wide QRS that is premature * st & t wave segment are in **opposite direction** of QRs * found in health and ischemia
98
which 2 av blocks are ischemia related?
* second degree mobitz 2 (infranodal) * third degree av disassociation
99
100
2 addtional rhythms from AV node not working
* idioventricular rhythm * atrioventricular junctional rhythm
101
102
T/F: third degree or complete heart block is life threatening rhythm, av node does not conduct
true

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