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MDT > Sinus and Atrial Rhythms > Flashcards

Sinus and Atrial Rhythms Flashcards

1
Q

what are the causes of sinus brady (7)

A
  • inf/post/RV MI
  • vagal stimulation
  • hypoxia
  • increased ICP
  • meds
  • sa node pathology
  • athletes
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2
Q

causes of sinus tachy (8)

A
  • sns stimulation
  • hypoxia
  • pain
  • CHF
  • AMI
  • meds
  • exercise
  • fear/XIT
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3
Q

what is the main cause of sinus arrhythmias?

A

often due to respirations where the heart rate speeds up during inspiration and slows down during expiration

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4
Q

what are other causes for sinus arythmias?

A
  • psns stimulation of baroreceptors
  • increased vagal tone
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5
Q

what is sino atrial block?

A

occurs when the SA node initiates a beat but the signal is blocked which prevents the contraction of the atria. this will cause a brief pause in the rythm

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6
Q

what is the key feature for SA block?

A

between two p waves the pause is an exact multiple of the distance that p wave should have been

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7
Q

what could cause SA block? (5)

A
  • hypoxia
  • SA node damage from MI,CAD,myocarditis
  • vagal tone on SA node
  • carotid sinus sensitivity
  • meds
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8
Q

what is sinus arrest?

A

this is when the SA node fails to fire altogether for 1 or more beats

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9
Q

how does sinus arrest differ from SA block

A

this is different because the SA node fails to fire where as in SA block the SA node does fire however the impulse is blocked and does not cause the atria to contract

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10
Q

what is a key feature for sinus arrest

A

the timming for the next beat is unpredictable in contrast to SA block. the pause can be filled by a secondary pace maker aka junctional escape beat

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11
Q

causes for sinus arrest (6)

A
  • SA node damage (MI, CAD, Myocarditis)
  • sudden increase in vagal tone
  • carotid sinus pressure
  • obstructive sleep apnea
  • hypothermia
  • meds
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12
Q

more often than not there usually isnt a treatment done for sinus arrest but if there are serious signs and symptoms what treatments could be implimented?

A

a treatment with atropin, pacing, and possibility of a permanent pacemaker

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13
Q

true or false: premature atrial complexes (PAC’s) dont affect the overall heart rate!

A

true! unless there is an underlying rhythm

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14
Q

why is PAC’s an irregular rhythm

A

becaus of the premature/ early beat

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15
Q

what shape should we expect the p wave to be in a PAC?

A

it could vary because the PAC could come from a different part of the atria. it could be flattened, notched, pointed, biphasic, or event lost in the preceding T wave

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16
Q

what should you know about the PR interval /QRS during a PAC

A

they could be prolonged or wide respectivly but rare

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17
Q

what could cause PAC’s (10)

A
  • stimulants
  • emotional stress
  • metal and physical fatigue
  • atrial enlargment
  • digitalis
  • valvular heart disease
  • elctrolyte imbalance
  • hyperthyriodism
  • CHF
  • ACS
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18
Q

PAC’s can sometimes initiate ….

A

A-fib, A flutter, or paroxysmal SVT

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19
Q

what will happen to the RR distance when a PAC occurs

A

the distance will be shorter

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20
Q

what is a Aberrantly conducted PAC?

A

the PAC takes an abnormal pathway through the ventricles leading to a wide QRS complex

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21
Q

how does the depolarization pathway to the ventricles occur during a PAC?

A

the depolarization occurs sequentially first the left bundle banch and then the right which creates the wider QRS

22
Q

what is a non conductive PAC

A

a PAC is so early that it enteres a refractory period so the impulse does not reach the ventricles so there is not a QRS complex

23
Q

how would a non conductive PAC appear as on an ECG

A

it may appear as a P wave with no QRS and could be mistaken for sinus arrest

24
Q

what is multiform atrial rhythm formerly known as wandering atrial pacemaker

A

the impulse from the atria originates from at least 3 different sites above the bundle of his

25
Q

what is the characteristics of multiform atrial rhythm on an ECG

A

the size ,shape, and direction of the P waves are different because they orriginate fromm different sites

26
Q

what is multiform atrial tachycardia

A

similar to the multiform atrial rhythm but with a rate of >100bpm

27
Q

what could cause multiform atrial rhytms (4)

A
  • COPD
  • ACS
  • Valvular disease
  • Hypomagnesemia
28
Q

what is atrial flutter?

A

a re entry rhythm caused by an irritable site within the atria firing at a rapid rate

29
Q

what clinical presontation would a pt with atrial flutter show

A
  • palpations, difficulty breathing, fatigue, and chest discomfort
30
Q

what could cause atrial flutter (5)

A
  • hypoxia
  • ischemic heart disease
  • various cardiac pathologies
  • CAD
  • cardiomyopathies
    -MI complications
31
Q

what would a treatment be fora a pt that has a rapid ventricular rate and atrial flutter with serious S/S

A

synchronized cardioversion

32
Q

what is atrial fibrillation

A

its when the electrical signals in the atria are disorganised and firing in multiple locations

33
Q

where do the lectrical signals in a fib often originate?

A

from the pulmonary veins

34
Q

what is the definiton of SVT?

A

tachycardias that originate above the bundle of his

35
Q

what are the three types of narrow complex SVTs?

A
  1. Atrial tachycardia
  2. AV Nodal Reentrant Tachycardia (AVNRT)
  3. AV reentrant Tachycardia (AVRT)
36
Q

what are characteristics of AVNRT?

A

rate: 150 - 250 , typically 180 to 200
rhythm: regular
waves: p wave is often hidden in QRS, PR intervals is not measurable, QRS gennerally narrow

37
Q

how does a PAC cause re-entry resulting in SVT?

A

while the fast pathway is in refractory, the PAC may enter the AV node through the slow pathway which can lead to reentry

38
Q

what are retrograde p waves in AVNRT

A

a small sip or inversion before the T wave on an ECG

39
Q

what is AVRT?

A

AVRT involves a accesory pathway that by passes the AV node

40
Q

true or false, accesory pathways in AVRT are typically congenital and present at birth?

A

true!

41
Q

anterograde conduction

A

impulses travel from the atria to the ventricles through an accessory pathway

42
Q

retrograde conduction

A

impulses travel back up through the accessory pathway

43
Q

bidirectional conduction

A

accesory pathway can conduct impulses in both directions

44
Q

true or false: the accesory pathways conduct impulses faster than the AV node.

A

TRUE

45
Q

what is wold parkinson white syndrome (WPW)

A

A type of svt where an accesory pathway known as the bundle of kent allows impulses to bypass the AV nide

46
Q

what are characteristics of WPW

A
  • delta wave in the QRS
  • shorter PR interval
  • possible wodened QRS
  • ST and T wave abnormalities
47
Q

WPW with SVT

A

the impulse circulates through the accesoray pathway and av node creating a re entry circuit

48
Q

what are the two types of AVRT

A

orthodromic AVRT and Antidromic AVRT

49
Q

orthodromic AVRT + characteristic

A

conduction antegrades through the AV node then up through the accesory pathway

Rate: 200- 300
ECG : narrow qrs with hidden p wave

50
Q

Antidromic AVRT + characterisitic

A

the conduction proceeds down the accessory pathway then retrogrades up the av node

rate: 200-300
ECG: wide QRS like V tach

51
Q
A

MDT (20 decks)

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