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Internal Medicine I > tachyarrhythmias > Flashcards

tachyarrhythmias Flashcards

1
Q

Paroxysmal tacycardias - what are they? What causes them

A

Rapid heart beats that come and go in bursts, 3 or more > 100 bpm. Mostly due to reenrty

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2
Q

Causes of Tachyarrhytmias

A

1.) Reentry 2.) Abnormal Impulse formation (enhanced automaticity or triggered activity)

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3
Q

enhanced automaticity causes

A

due to increased catecholamines, electrolyte abnormality (hypkalemia), hypoxia/ischemia, mechanical stretch, drugs (digoxin)

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4
Q

Triggered activity

A

early or delayed depolarization due to increased intracellular calcium, digoxin toxiciy, accelerated idioventricular rhythm in acute myocardial infraction and exercise induced VT

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5
Q

Management of premature atrial contractions

A

Asymptomatic = no treatment needed treatment of annoying palpations = betablocker (takes away the feeling but you still have the premature beat)

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6
Q

management of AV junctional beats

A

no treatment needed

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7
Q

management of premature ventricular contractions in the absence of left ventricular dysfunction

A

no treatment needed

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8
Q

management of symptomatic premature ventricular contractions

A

Beta blokers

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9
Q

management of symptomatic premature ventricular contractions in presence of heart disease

A

treat underlying cause - Automatic Implantable Cardiac Defibrillator (AICD) or amiodarone if high risk

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10
Q

Antiarrythmics and premature ventricular contractions

A

antiarrhythmics increase mortality risk

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11
Q

Causes of sinus tachycardia

A

fever, hypovolemia, anxiety, exercise, thyrotoxicosi, hypoxia, hypotenion, CHF, acidosis

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12
Q

Most common abnormal arrhythmia

A

atrial fibrillation (60% of population at some point)

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13
Q

Paroxysmal Atrial fibrillation

A

duration less than 7 days and terminates spontaneously. Causes - emotional, post op, exercise, alcohol, vasovagal, hypoxia, metabolic)

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14
Q

Persistent Atrial Fibrillation

A

Duration greater than 7 days and would last indefinitely unless cardioverted. Causes- rheumatic fever, non rheumatic valve disease, hypertensive cardiovascular disease, chronic lung disease

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15
Q

Permanent Atrial fibrillation

A

duration greater than 7 days and sinus rhythm not possible

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16
Q

management of Paroxysmal A Fib

A

1.) focus on cause: HTN, hyperthyroidism, pericarditis, alcohol. 2.) Focus on prevention - class IC and/or Class III (amioderone most effective)

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17
Q

management of Persistent A Fib

A

1.) Termination with electric cardioversion 2.) Prevention - class IC or III drugs

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18
Q

management of Permanent A Fib

A

Rate control- Digoxin, B-Blocker, Verapamil, Diliazem, anticoagulants

19
Q

what is the importance of giving and anticoagulant before cardioversion

A

prevents clot- blood is stagnant in the left atrium

20
Q

when do we do cardioversion in A fib

A

when LA <4.5 cm ( if higher it wont sustain the cardioversion)

21
Q

CHAD2 Score

A

1 point for each of the following: 1.) Congestive heart failure 2.) Hypertension 3.) Age >75 4.) Diabetes 5.) Stroke/transient ischemic attack - Score >2 = warfarin or diabigatran (Pradaxa) indicated

22
Q

Heparin

A

fast action IV or injection for immediate anticoagulation - peaks after 2-4 hours

23
Q

problems with warfarin

A

1.) food and drug interations 2.) Genetic variation in metabolism 3.) Narrow theraputic window 4.) slow onset of action (2-3 days to get a person anticoagulated)

24
Q

Atrial remodeling

A

if sustained distention and stretch it remains that way and will become permanently enlarged

25
Q

Is it better to control rate or rhythm in A Fib?

A

Overall better to control rate but in younger patients its probably better to try and control the rhythm

26
Q

Atrial flutter causes

A

oragnic heart disease (pericarditis, respiratory failure, post op)

27
Q

Management of Atrial flutter

A

1.) ALWAYS electrocardioversion - DO NOT RESPOND TO MEDS 2.) Ablation is curative

28
Q

Prevention in Atrial Flutter

A

Prevention and rate control with beta blockers , calcium channel blockers and digoxin

29
Q

Treatment of SVT

A

Vagal stimulation (carotid sinus massage), Adenosine (12 mg IV), pacing, ablation

30
Q

SVT prevention

A

beta blockers, calium channel blockers and digoxin

31
Q

causes of multifocal atrial tachycardia (MAT)

A

COPD, hypokalemia, or adrenergic drugs

32
Q

MAT treatment

A

correct hypoxia and acidosis (a result of lung disease)

33
Q

treatment of pre-excitation tachyarrythmias (ex: WPW)

A

localize and ablate tracts

34
Q

Treatment of nonparoxysmal junctional tachycardia

A

DO NOT CARDIOVERT (can cause cardiac arrest) - override pacing and treat cause

35
Q

causes of nonparoxysmal junctional tachycardia

A

dig toxicity, myocarditis, acute rheumatic fever, catecholamines

36
Q

causes of ventricular tachycardia

A

ischemia, prior MI, cardiomyopathy, metabolic abnormality, drug toxicity, prolonged QT

37
Q

treatment of ventricular tachycardia

A

cardioversion, beta blockers, verapamil, amiodarone, overdrive pacing (ex: thump on chest)

38
Q

causes of Torsade de pointe

A

Hypokalemia, hypomagnesmia, and quinidine

39
Q

treatment of Torsades de pointe

A

beta blockers, sympathectomy, magnesium pacing

40
Q

managemet of accelerated idioventricular tachycardia

A

DO NOT TREAT THIS!!!

41
Q

management of Ventricular flutter and fibrillation

A

defibrillation

42
Q

Arrythmogenic RV Dysplasia

A

associated with plantopalmar kerotosis and wooly hair, right ventricle fibrofatty myocardial degeneration, syncope and sudden death

43
Q

Which cases require Ablative therapy

A

WPW, A fib, A flutter, AV nodal SVT

Internal Medicine I (4 decks)

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