Tachyarrhythmias

Question 1

What does the QRS width look like in a generalized tachyarrhythmia?

Answer 1

Narrow, less than or equal to 120 ms, and it is due to a rapid activation of ventricles via intact H-P system –> Supraventricular

OR

Wide, greater than 120 ms, due to ventricular activation outside normal conduction system –> due to bundle branch block, non-specific aberration, preexcitation or a ventricular origin.

Question 2

What do the following have in common?

1. Sinus Tachycardia
2. AVNRT (AV Node Reentry Tachycardia)
3. AVRT (AV Reentry Tachycardia)
4. Atrial Tachycardia
5. Atrial Flutter

Answer 2

Narrow QRS (Regular)

Question 3

What do the following have in common?

1. Atrial Fibrillation/Flutter
2. MAT (Multifocal atrial tachycardia)

Answer 3

Narrow QRS (Irregular)

Question 4

What do the following have in common?

1. Ventricular Tachycardia
2. SVT with aberrancy
3. Preexcitation (WPW)

Answer 4

Wide QRS

Question 5

This is an irregular Narrow QRS that is irregular. It is more common with other heart disease(s) present in the patient, and commonly increases in frequency with age.

Answer 5

Atrial Fibrillation

Question 6

What heart diseases can cause A.Fib to occur?

Answer 6

1. CAD
2. CHF
3. CM
4. Valvular Dz
5. Pericardial Dz
6. Left Ventricular Hypertrophy

Question 7

What other conditions can cause A.Fib to occur?

Answer 7

1. Age
2. HTN
3. Stress (post-op or personal)
4. ETOH, esp withdrawal “Holiday Heart”
5. Thyroid Dz
6. Electrolyte Disorder
7. Pulmonary Dz and/or PE

Question 8

On an EKG for A. Fib, what will you not see? Why?

Answer 8

No P waves present because of no sinoatrial node conduction.

Question 9

This classification of A. Fib can be described as recurrent self-terminating episodes, generally less than 24 hours.

Answer 9

Paroxysmal

Question 10

This classification of A. Fib can be described as lasting more than 1 year. Cardioversion may have either been not attempted or failed.

Answer 10

Longstanding Persistent

Question 11

This classification of A. Fib can be described as attempts at rhythm control have been abandoned if favor of rate control and anticoagulation.

Answer 11

Permanent

Question 12

This classification of A. Fib can be described as a failure to self-terminate, greater than 7 days. This requires cardiversion!

Answer 12

Persistent

Question 13

This is an irregular Narrow QRS that is irregular. It is defined by at least 3 different P wave morphologies.

Answer 13

MAT (Multifocal Atrial Tachycardia)

Question 14

What dz is MAT usually assc with?

Answer 14

COPD Exacerbations

Question 15

This is a regular Narrow QRS. It is usually assc with an underlying cause such as fever, infection, pain, anemia, thyrotoxicosis, alcohol/drug withdrawal, heart failure, or shock.

Answer 15

Sinus Tachycardia

Question 16

This is a regular (and sometimes irregular) Narrow QRS. It is usually assc with intra-atrial reentrant pathways classically in the right atrium crossing the cavo-tricuspid isthmus.

Answer 16

Atrial Flutter

Question 17

This type of tachyarrhythmia is commonly seen with A. Fib or with the same situations.

Answer 17

Atrial Flutter

Question 18

A variable AV block leading to irregular heart beat may most commonly cause this kind of tachyarrhythmia.

Answer 18

Atrial Flutter

Question 19

This is a regular Narrow QRS. It is most common in younger patients and mediated by slow and fast conduction pathways within the AV nodal region.

Answer 19

AVNRT (AV Node Reentrant Tachycardia)

Question 20

This is the most common regular narrow tachyarrhythmia

Answer 20

AVNRT (AV Node Reentrant Tachycardia)

Question 21

Are there any discernible P waves in this Narrow QRS tachyarrhythmia?

Answer 21

NO!

Question 22

How do you determine between AVNRT and AFib?

Answer 22

Both are narrowed QRS, but A. Fib has no pattern and haphazard distribution. Whereas AVNRT had a pattern.