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Clin Med II > tachyarrhythmias, afib and aflutter > Flashcards

tachyarrhythmias, afib and aflutter Flashcards

1
Q

common causes of sinus tachycardia

A
  • exercise
  • anxiety
  • pain
  • stimulants
  • volume depletion
  • anemia
  • hypoxia
  • PE
  • pericarditis
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2
Q

treatment for tachycardia

A
  • treat underlying cause
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3
Q

AVNRT

A
  • AV nodal reentry tachycardia

- electrical conduction gets trapped in a loop around AV node

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4
Q

AVRT

A
  • av reciprocating tachycardia
  • wider circuit
  • accessory pathway through AV node into atria and ventricles
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5
Q

junctional tachycardia

A
  • originates in AV node
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6
Q

main symptom of SVT

A
  • sudden onset and offset
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7
Q

management of stable SVT

A
  • first line= vagal maneuvers* or carotid massage
  • adenosine 6 mg IVP, 12 mg IVP, 12 mg IVP
  • BB or CCB
  • frequent attacks require ablation
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8
Q

management of unstable SVT

A
  • vagal maneuvers first line

- DC cardioversion if unsuccessful

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9
Q

sx of vtach

A
  • heart palpitations
  • near syncope or syncope
  • chest pain, SOB, diaphoresis
  • sustained LOC
  • death
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10
Q

treatment for vtach with pulse

A
  • stable- amiodarone IV bolus then cont infusion, ICD

- unstable- DC cardioversion

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11
Q

treatment vtach without pulse

A
  • CPR
  • defibrillation
  • epi
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12
Q

torsades de pointes triggers

A
  • hypoK
  • hypoMg
  • drugs that prolong QTc:
  • antiarrhythmic drugs
  • antipsychotics
  • abx
  • antidepressants
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13
Q

antiarrhythmics that prolong QTc

A
  • amiodarone
  • flecainide
  • sotalol
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14
Q

antipsychotics that prolong QTc

A
  • chlorpromazine
  • haloperidol
  • olanzapine
  • quetiapine
  • risperidone
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15
Q

abx that prolong QTc

A
  • azithromycin
  • levofloxacin
  • ciprofloxacin
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16
Q

antidepressants that prolong QTc

A
  • citalopram

- TCAs

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17
Q

treatment for torsades

A
  • IV mg firstline
  • temp transvenous overdrive pacing if no response to Mg
  • if unstable requires defibrillation
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18
Q

causes of vfib

A
  • MI most common
  • HF
  • hypoxemia or hypercapnia
  • hypotension/ shock
  • electrolyte abnormalities
  • stimulates
  • often preceded by vtach
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19
Q

assoc conditions with vfib

A
  • LVH
  • HOCM
  • CHF
  • aortic stenosis
  • brugada syndrome
20
Q

treatment for vfib

A
  • CPR
  • defibrillation
  • if pulse regained consider cardiac cath and ICD
21
Q

afib

A
  • rapid irregular atrial contraction
  • no p waves
  • usually assoc with HR of 120-160
  • high stroke risk
  • more common in elderly, males, and whites
22
Q

etiology of afib

A
  • hyperthyroidism*
  • acute vagotonic episode
  • alcohol
  • post op
  • atrial enlargement
  • disruption of electrical conduction sys
23
Q

where does ablation occur for afib

A
  • ostial portion of pulmonary veins
24
Q

risk factors for afib

A
  • age > 64
  • male
  • HTN
  • obese
  • prolonged PR interval
  • valve disease*
  • CHF
25
Q

paroxysmal afib

A
  • intermittent
26
Q

persistent afib

A
  • fails to terminate within 7 days

- requires intervention

27
Q

permanent afib

A
  • lasts > 12 mo

- no longer pursue rhythm control

28
Q

sx of afib

A
  • may be asymptomatic
  • heart palpitations
  • presyncope or syncope
  • SOB and exs intolerance
  • chest pain
  • fatigue
29
Q

triggers of afib

A
  • sleep deprivation
  • physical illness
  • post op
  • stress
  • hyperthryoidism
  • physical exertion
  • stimulant meds
  • alcohol, caffeine
  • dehydration
30
Q

what should every person with afib have during work up>

A
  • TTE to assess for valve disease

- TSH levels

31
Q

what is the best method for detecting atrial thrombus

A
  • TEE

- very invasive

32
Q

goals of afib tx

A
  • rhythm control- always tried first
  • rate control to prevent tachy CMP or ischemia
  • decrease stroke risk with anticoags
  • alleviate sx
33
Q

who requires urgent DC cardioversion for afib

A
  • unstable hemodynamics
  • evidence of hypoperfusion
  • severe manifestations of HF
  • WPW
34
Q

non-urgent DC cardioversion

A
  • new onset/ dx afib
  • persistent afib who are limited by sx
  • before cardiversion control ventricular rate and provide IV heparin
35
Q

tx prior to DC cardioversion for afib

A
  • anticoag tx X 3 weeks OR TEE to determine if thrombus present
36
Q

c/i to cardioversion for afib

A
  • known afib with minimal sx
  • multiple comorbidities
  • unlikely to maintain NSR
  • benefits decrease after 80
  • paroxysmal afib
  • known clot or sx > 48 hours without anticoag tx X 3 weeks
37
Q

complications of afib

A
  • ischemia
  • pulmonary edema
  • tachycardia induced CMP
  • stroke
38
Q

treatment for rate control in afib

A
  • BB or CCB first line (IV then PO)
  • digoxin added to BB or CCB
  • amiodarone last line
39
Q

side effects of amiodarone

A
  • abnormal LFTs

- pulmonary toxicity- chronic interstitial pneumonitis

40
Q

how do you determine stroke risk for afib pts

A
  • CHADS2 score

- CHADS2-VASc score which is more specific if pt falls into intermed risk

41
Q

anticoag tx options for afib

A
  • warfarin
  • dabigatran
  • rivaroxaban
  • apixaban
42
Q

warfarin

A
  • competitively depletes vit K
  • 5-7 days for full therapeutic effect
  • goal INR of 2-3
  • CYP2C9 interactions
  • no bridging for afib
43
Q

indications for hospitalizations with afib

A
  • ablation of accessory- WPW
  • treat assoc medical problems that are trigger
  • manage rate or sick sinus syndrome
44
Q

treatment of aflutter

A
  • rate control more difficult than afib
  • usually respond well to ablation
  • anticoag tx prior to abalation X 1 month or if recurrent
45
Q

where does ablation occur for aflutter

A
  • large macroreentrant pathway of RA

Clin Med II (16 decks)

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