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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
Q

Fast & wide arrhythmias are ___ most of the time.
Rate?

A

Vtach
150-200

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26
Q

What is wide?
QRS >___?

A

0.14sec

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27
Q

When Vtach is >30sec, called what?

A

Sustained Vtach

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28
Q

What is Vtach almost always due to?

A

Ischemia

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29
Q

It is difficult to discriminate Vtach from __?

A

SVT with aberrancy (ie BBB)

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30
Q

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

A

Amiodarone

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31
Q

Vfib tx?

A

chest compressions early then shock until rhythm established.
Meds:
M- Mg
A-Amiodarone
V- Vasopressin
E- Epi

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32
Q

3 Types of Brady arrhythmias

A
  1. sinus brady
  2. SA block
  3. AV block
  4. SSS
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33
Q

AV Blocks that arent scary

A 
1st degree 
Type 2 (Mobits 1)
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34
Q

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
A

Both

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35
Q

T/F: 2nd degree block Type 2 is a structural abnormality that can go to complete heart block

A

True

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36
Q

Tx for 2nd degree block Type 2 (Mobitz) & complete heart block (3rd degree)?

A

•Unstable=transcutaneous pacing (TCP)

…most will move toward TCP

•dopamine great choronotrop

**epinephrine!!!

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37
Q

T/F: we treat 2nd degree block Type 2 (Mobitz) with atropine?

A

False

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38
Q

T/F: narrow bradycardias are more stable than wide bradycardias?

A

True

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39
Q

What is a very scary lab finding in bradycardias?

What do you give to stabilize membrane?

A

HyperK

Ca2+

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40
Q

T/F: Wide bradycardias are more likely to progress to asystole than narrow?

A

True

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41
Q

T/F: Wide bradycardia is sensitive to atropine?

42
Q

Where is the block found in wide bradycardias?

A

Below the AV node

43
Q

Is 3rd degree block narrow or wide?

44
Q

Are 1st degree blocks & 2nd degree type 1 narrow or wide?

45
Q

Are Mobits 2 (2nd degree) wide or narrow?

does the pr stay the same?

46
Q

T/F: Narrow bradycardia is sensitive to atropine?

47
Q

BLS Mantra

A

C: Circulation
A: Head tilt/chin lift or jaw thrust
B: Assist ventilation
D: Defibrillation or Differential Diagnosis

48
Q

Universal Steps for Unconscious/Pulseless

A
  • 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
Q

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
A
  1. get a defibrillator
50
Q

6 sec equals how many boxes on EKG?

51
Q

what method do we use for reading rate on EKG?

A

Dubin
measure R to R

52
Q

4 narrow complex tachycardias

A
  • AVNRT
  • AVRT
  • Afib
  • MAT
53
Q

Name the rhythm using steps

A

Fast

Stable

Narrow

Irregular

No P waves

54
Q

What are p waves after the QRS called?

What rhytm does this indicate?

A

“retrograde”

SVT

55
Q
A

unstable

Fast

wide

regular

P waves? no

v tach

56
Q

Is there a p wave in afib?

57
Q
A

mantra
don’t know if stable
too fast (>150)
narrow
regular
NO P waves

=SVT

58
Q
A

stable

narrow

regular

p waves? yes

= sinus tach

59
Q
A

Unstable

Fast

wide <12sec (3 boxes)

Regular

60
Q
A
  • 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
Q

what does aberrancy mean?

A

Conduction problem

62
Q

Regular narrow tachycardias?

A
  1. Sinus tach
  2. Atrial tach
  3. AVRT
  4. AVNRT
  5. Junctional tach
  6. Atrial flutter
63
Q

Where is the reentrant circuit in AVNRT

A

Within the AV node

64
Q

Where is the reentrant circuit in AVRT?

A

Down AV node

Retrograde up an accessory bypass tract

65
Q
A

Stable

Fast (210bpm)

Narrow

Regular

P wave? no

AVNRT

66
Q

Name this reentry

A

Macroreentry

Aflutter 2:1

67
Q
A

Fast

Narrow

Regular

No P waves

Rate 3:1

68
Q
A

Stable

Fast

Narrow

Regular

Pwave? no

A flutter 2:1

Clue is rate of 150

69
Q
A

Stable

Fast

Narrow

Regular

P wave? no

A flutter 2:1

(150)

70
Q

Is AVNRT seen with heart dz?

71
Q

WPW is a form of which tachyarrhythmia

72
Q

What do you think when you see rates >200 in young, healthy pts?

A

WPW (AVRT)

73
Q

Name of the acessory path in WPW

A

Bundle of Kent

74
Q
A

Short PR

Delta Wave

WPW

75
Q

What does orthodromic mean?

A

P wave seen after QRS, impulse goes down AV node and a retrograde P wave is seen

77
Q

Tx for AVRT or orthodromic avnrt tx same

fast, wide unstable arrhythmia

A

•don’t block the av node

use procainamide or shock

78
Q

Tx for fast, narrow & unstable Arrhythmias?

A

Shock (50J)

79
Q
A

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
Q

Name the arrhythmia

A

•multiple foci of discharge, irregular, narrow complex, no p waves are seen

82
Q
A

Stable

fast

Narrow

Irregular

Pwaves? no

afib

83
Q
A

Stable

normal

Narrow

Irregular

Pwaves? no

afib

84
Q

Tx for Afib/Flutter

outpatient

A

•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
Q

Tx afib/flutter

inpt

A
  • 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

87
Q

Tx for unstable narrow, irregular

A
  • afib: really hard to manage
  • Shock first

what if first-line shock fails?

•treat with amiodarone

88
Q

T/F: WCT (wide complex tachycardia) is Vtach most of the time?

89
Q

V tach is a ________ almost always due to _____________.

A

a life threatening arrhythmia almost always due to ischemic heart disease

90
Q
A

Unstable

Fast

wide

regular

Pwaves? no

Vtach

91
Q

Key points for fast, wide arrhythmias

A

•If in doubt treat for VTACH

•unstable=shock (200J)

•stable runs of vtach (monomorphic)= amiodarone then cardioversion

•(polymorphic) think torsades=mag

92
Q

Sedation prior to shock?

A

Ketamine or propofol

94
Q

T/F; Vtach mimickers are usually irregular

95
Q

3 types of wide, irregular tachycardias?

When in doubt?

A
  1. afib
  2. aflutter with a BBB
  3. wpw with a block

Shock it out

96
Q
A

fast

wide

irregular

no p waves

So afib with BBB?

Afib with avrt antidromic

97
Q

4 Characteristics of PVCs

A
  • no p wave
  • wide QRS that is premature
  • st & t wave segment are in opposite direction of QRs
  • found in health and ischemia
98
Q

which 2 av blocks are ischemia related?

A
  • second degree mobitz 2 (infranodal)
  • third degree av disassociation
100
Q

2 addtional rhythms from AV node not working

A
  • idioventricular rhythm
  • atrioventricular junctional rhythm
102
Q

T/F: third degree or complete heart block is life threatening rhythm, av node does not conduct

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