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Clin Med - Cardio Exam #2 > Tachycardia > Flashcards

Tachycardia Flashcards

1
Q

physical exam for tachycardia

A
  • general: respiratory distress, pain, sweating
  • vitals: fever common
  • CV: rhythm, murmurs/sounds, JVD
  • pulm: auscultate for crackles/wheezes
  • Abd: distended or tender
  • lymph: enlarged LN
  • extremities: clubbing, cyanosis, edem
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2
Q

examples of narrow complex tachycardia

A
  • sinus tach
  • AV node re-entrant (AVNRT/SVT)
  • AV reciprocating (AVRT) - orthodromic
  • multifocal atrial tachycardia (MAT)
  • a.fib/flutter
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3
Q

examples od wide complex tachycardia

A
  • AVRT - antidromic (i.e. WPW)

- v tach/fib –> Torsade de Pointe

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4
Q

etiology of sinus tach

A
  • exercise
  • pain
  • stimulants
  • anemia
  • anxiety
  • vol. depletion
  • hypoxia
  • hyperthyroidism
  • PE
  • pericarditis
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5
Q

symptoms of sinus tach

A
  • asx
  • heart palpitations
  • SOB
  • In pts w heart dz: palpitations, SOB, chest discomfort, lightheadedness, fatigue
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6
Q

treatment of sinus tach

A
  • IV fluids
  • pain rx
  • anticoags
  • tx septic source
  • anxiolytics
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7
Q

define SVT

A
  • regular, rapid rhythm
  • narrow QRS
  • no p waves*
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8
Q

examples of SVT

A
  • AVNRT
  • AVRT
  • junctional tachycardia
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9
Q

etiologies of SVT

A
  • conduction abnormalities
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10
Q

symptoms of SVT

A
  • sudden onset palpitations w/ abrupt cessation
  • syncope
  • SOB
  • anxiety
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11
Q

management of stable SVT

A
  • vagal maneuvers
  • carotid massage
  • adenosine
  • CCB or BB
  • ablation for frequent attacks
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12
Q

management of unstable SVT

A
  • vagal maneuvers

- immediate DC cardioversion

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13
Q

MC cause of SVT

A

AVNRT

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14
Q

describe AVNRT

A

re-entrant circuit around AV node

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15
Q

What triggers AVNRT?

A
  • exertion
  • ETOH
  • caffine
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16
Q

describe the HR in AVNRT

A
  • 140-280 bpm

- regular

17
Q

differentiate the types of AVRT

A
  • narrow QRS = orthodromic; through AV
  • wide QRS = antidromic; not through AV ==> ddx w/ vtach

i.e. WPW

18
Q

tx of stable orthodromic narrow AVRT

A
  • vagal maneuvers
  • adenosine
  • CCB
  • BB
19
Q

tx of unstable orthodromic AVRT

A

DC cardioversion

20
Q

tx of antidromic AVRT

A
  • unstable = DC cardioversion
  • stable = procainamide
    ^^ both subsequently get ablation
21
Q

tx of antiromic AVRT in a conscious patient

A

tx like stable vtach

- amiodarone

22
Q

describe WPW

A
  • pre-excitation syndrome with accessory pathway
  • symptomatic
  • most commonly PSVT
  • w/ a.fib –> rapid ventricular respiration –> v. fib –> death
  • delta waves w/ decr PR interval
23
Q

management of normal rate and stable WPW

A
  • ablation

- BB, adenosine, procainmide, amiodarone

24
Q

management of fast rate WPW

A
  • unstable = DC cardioversion
  • stable = procainamide
    ^^ both eventually get ablation
25
Q

describe MAT

A
  • 3+ different p wave morphologies
  • 100-150bpm

ddx:

26
Q

treatment of MAT

A
  • CCB

- flecainide or propafenone

27
Q

describe sustained vtach

A
  • fast, wide complex rhythm
  • > 30s duration
  • with structural heart disease
  • syncope
  • 3+ consecutive ventricular premature beats
  • 160-240bpm, moderately regular
  • frequent complication of MI & dilated cardiomyopathy
28
Q

symptoms of vtach

A
  • asx (rare)
  • palpitations
  • sense of impending doom
  • chest discomfort
  • SOB, diaphoresis, syncope
  • LOC
29
Q

treatment of vtach

A
  • w/pulse = DC cardioversion, amiodarone, implantable cardioverter-defibrillator (ICD)
  • w/o pulse = ACLS
30
Q

describe NSVT

A
  • 3+ consecutive ventricular beats
  • ## rate > 120bpm
31
Q

treatment of NSVT

A
  • infrequent = optimize electrolytes, BB, manage underlying

- frequent = amiodarone

32
Q

describe Torsades de Pointe

A
  • triggered by hypoK, hypoMg, + drugs that prolong QTc (i.e. antiarrhythmics, abx, antipsychotics, antidepressants
33
Q

treatment of Torsades de Pointe

A
  • unstable = DC cardioversion

- stable = IV Mg

34
Q

describe v.fib

A
  • low amplitude on EKG
  • associated w/ CAD and MI
  • sudden death may be initial (and only!) manifestation of coronary dz
  • pulseless and unresponsive
35
Q

treatment of v.fib

A
  • CPR
  • defibrillation
  • arteriography
  • ICD

Clin Med - Cardio Exam #2 (12 decks)

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