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Cardio > Supraventricular arrhythmias > Flashcards

Supraventricular arrhythmias Flashcards

1
Q

What is a supra ventricular tachycardia (SVT)

A
  • an abnormally fast heart rhythm arising from improper electrical activity in the atria
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2
Q

List the different types of SVT

A
  • Sinus tachycardia
  • Innapropriate sinus tachycardia
  • Sinus nodal re-entrat tachycardia
  • Atrial tachycardia
  • A flutter
  • Paroxysmal Supraventricular Tachycardia (PSVT)
  • A-fib
  • WPW syndrome
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3
Q

Sinus tachycardia: HR, types

A
  • when there’s a sinus rhythm with an elevated rate of impulses, defined as a rate greater than 100 beats/min (bpm)
  • 2 types:
    .Physiologic: during exercise
    .Pathologic: anaemia, drugs, hyperthyroidism, hypoxia, hypovolemia, pheochromocytoma
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4
Q

Inappropriate sinus tachycardia

A
  • the underlying cause is not found, give BB
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5
Q

Sinus nodal re-entrant tachycardia: def, ECG, T

A
  • narrow complex tachycardia due to micro re-entrant circuit in SA
  • ECG: normal p waves
  • T: BB and Calcium Channel Blockers are the first line treatment. Radiofrequency ablation is second
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6
Q

Atrial tachycardia: HR, ECG, T

A
  • regular rhythm > 100 bpm
  • ECG: different P wave morphology
  • found in normal as well as cardiac diseases (metabolic disarray, digitalis toxicity, pulmonary disease), short PR
  • T: BB, Calcium channel blocker, propafenone, amiodarone, stall, IV adenosine
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7
Q

Atrial flutter: what is it

A
  • a supraventricular arrhythmia, that results from a re-entrant mechanism, from either the right or left atrium
  • re-entrant signals loop back on themselves, overriding the sinus node and making an endless cycle, causing the atria to contract again and again at a very fast rate
  • > 300bpm
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8
Q

What are the different types of A-flutter

A
  • type 1

- type 2

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9
Q

A-flutter: type 1

A
  • caused by a single reentrant circuit that moves around the annulus: the ring of the tricuspid valve of the right atrium
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10
Q

A-flutter: type 2

A
  • a re-entrant circuit develops in the right or left atrium, but the exact location is not known
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11
Q

A-flutter: Causes

A
  • everyone has a cavotricuspid isthmus, but not everyone has a-flutter causing a re-entrant circuit, so an underlying cause must create it
  • Ischemia: makes the heart cells more irritable
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12
Q

A-flutter: ECG

A
  • ECG: toothed like shape, + narrowed QRS complexes

Ratio of Atrial contractions : Ventricular contractions will depend on the delay at the AV node

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13
Q

A-flutter: symptoms

A
  • shortness of breath
  • nausea
  • chest pain
  • dizziness
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14
Q

A-flutter: complications

A
  • overtime, the ventricles can tire out and decompensated and people can develop HF
  • Blood clot formation in the atrium -> stroke. Because the blood stagnate/ pool in the atrium
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15
Q

A-flutter: T

A
  • anticoagulants/ blood thinners: to reduce chances of clot formation
  • BB, CCB to control HR
  • Cardioversion, to stop the episode of flutter: it depolarizes all the atrial tissue at once and let the sinus node take control again
  • Radiofrequency catheter ablation: depending on which type of A-flutter it is
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16
Q

What happens in AVRT and AVNRT

A
  • Atrioventricular Reentrant Tachycardia
  • the electrical signal uses a separate accessory pathway to get back up from the ventricles to the atria, causing the atria to contract before the SA node sends out another signal
  • signal moves back down the AV node to the ventricles and contracts the ventricles, and goes back up the accessory pathway -> cycle repeats
  • HR: 200-300 bpm
17
Q

What is the most common type of AVRT

A
  • Woll-Parkinson-white syndrome
  • uses the bundle of Kent as accessory pathway
  • this type of re-entry is known as an anatomical re-entrant circuit, because the accessory pathway is a fixed anatomically defined pathway
18
Q

AVNRT- what happens there, what’s the difference with AVRT

A
  • AVNRT: Atrioventricular nodal re-entrant tachycardia
  • here, the accessory pathway is located in or near the AV node, whereas for AVRT, it was located in the ventricles. Both going to the atria.
19
Q

AVRT and AVNRT symptoms

A
  • usually doesn’t last long
  • both rarely life-threatening
  • Palpitations, shortness of breath, feeling of dizziness, syncope or fainting in rare cases
20
Q

AVRT: ECG

A
  • tachycardia

- P wave might or might not be buried, depending on where the accessory pathway is located

21
Q

AVNRT: ECG

A
  • tachycardia
  • P mostly not visible. Because the signal’s getting to the atria and ventricles at almost the same time, so the P wave starts essentially where the QRS starts and when you add them together
22
Q

AVRT and AVNRT Treatment

A
  • Radio catheter ablation: to destroy the accessory pathways
  • Vagal maneuvers for AVNRT, to activate the vagus nerve, which tends to block the AV node temporarily, and potentially stopping the episode
  • Carotid sinus massage
  • Valsalva maneuver
  • medications to slow AV node conduction
  • Cardioversion: when other treatments are not effective

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