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Cardiovascular Pathophysiology > Treatment of Cardiac Arrhythmias > Flashcards

Treatment of Cardiac Arrhythmias Flashcards

1
Q

what are the basic mechanisms of arrhythmogenesis?

A

altered automaticity
triggered activity
re-entry

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2
Q

what arrhythmias are associated with altered automaticity?

A

slow atrial, junctional, and ventricular escape rhythms
idioventricular rhythms
some atrial tachycardias

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3
Q

what is triggered activity associated with?

A

sympathetic stimulation
drugs
bradycardia

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4
Q

what are the criteria for a re-entrant circuit?

A

unidirectional conduction block
multiple conduction pathways
critical slowing of propagation to allow impulse conduction to previously refractory area

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5
Q

when should you treat an arrhythmia?

A

clinical signs
sustained ectopy
short coupling interval
multifocal complexes
natural history with known risk of sudden death

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6
Q

what is the vaughan-williams classification based on?

A

electrophysiologic mechanisms of action

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7
Q

what are some class Ia drugs?

A

procainamide
quinidine
disopyramide

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8
Q

what are some class Ib drugs?

A

lidocaine
mexiletine
tocainide

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9
Q

what is quinidine used for?

A

conversion of atrial fibrillation in horses

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10
Q

how can quinidine increase the heart rate?

A

vagolytic effect

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11
Q

what is procainamide used for?

A

ventricular and supraventricular arrhythmias

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12
Q

what are some side effects of quinidine?

A

proarrhythmia, torsade de pointes
horses: colic, hypersensitivity, urticaria, sweating
tachycardia
GI signs, skin rash, hypotension, cardiovascular collapse

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13
Q

what tissue do class Ib drugs work on?

A

diseased/ischemic myocardium

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14
Q

what is lidocaine used for?

A

first line emergency drug for ventricular tachycardia
some supraventricular arrhythmias may also respond

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15
Q

what are the side effects of class Ib drugs?

A

vomiting, seizures, ataxia, CNS depression especially in cats/horses
increased defibrillation threshold
suppression of escape rhythms

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16
Q

what type of drugs are the class II antiarrhythmic drugs?

A

beta blockers

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17
Q

what are the class II drugs?

A

atenolol
carvediliol
metoprolol
bisoprolol
esmolol
propanolol

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18
Q

when are class II drugs useful?

A

ventricular or supraventricular arrhythmias
cardiomyopathy
subaortic stenosis
pulmonic stenosis
left ventricular outflow tract obstruction
hyperthyroidism
intoxication with certain compounds

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19
Q

what are the side effects of class II antiarrhythmic drugs?

A

negative chronotropism
negative inotropism
hypotension
bronchospasm
hypoglycemia

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20
Q

what type of drugs are the class III antiarrhythmics?

A

K channel blockers

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21
Q

what are the class III antiarrhythmics?

A

sotalol
amiodarone

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22
Q

what are the effects of class III antiarrhythmics?

A

prolong action potential duration
beta-blockade
depress AV nodal conduction
increase atrial refractory period
increase fibrillation threshold

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23
Q

in what is sotalol especially effective?

A

boxer cardiomyopathy

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24
Q

what is sotalol used for?

A

ventricular and supraventricular arrhythmias

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25
Q

what is the most common side effect of amiodarone?

A

hepatopathy

26
Q

what are the side effects of class IV antiarrhythmics?

A

excessive negative chronotropism
negative inotropism
excessive vasodilation

27
Q

what are the main effects of digoxin?

A

potent inhibitor of Na/K ATPase pump
parasympathomimetic
improved baroreceptor function

28
Q

what are the main clinical uses of digitalis glycosides?

A

treat supraventricular tachyarrythmias
+/- treat congestive heart failure

29
Q

what are the side effects of digitalis?

A

lethargy, anorexia, vomiting, diarrhea, malaise
arrhythmias associated with digitalis toxicity
increased with concurrent hypokalemia, azotemia

30
Q

what are the consequences of cardiac arrhythmias?

A

reduced cardiac output
syncope
weakness
decompensation of CHF
death

31
Q

what is the decision to treat an arrhythmia based on?

A

hemodynamic compromise
natural history of arrhythmia, breed
potential for further electrical instability and sudden death
potential for tachycardiomyopathy or CHF
risk benefit analysis

32
Q

what is sinus arrhythmia?

A

cyclic/rhythmic variation in P-P intervals
can be respiratory origin

33
Q

when should you treat sinus bradycardia?

A

is hemodynamic status is not okay

34
Q

what do you treat in sinus tachycardia?

A

underlying cause: shock, hypovolemia, fever

35
Q

what are the two types of supraventricular premature depolarizations?

A

atrial premature depolarization: from atria
junctional premature depolarization: from AV junctional tissue

36
Q

what is supraventricular tachycardia?

A

runs or paroxysms of ectopic complexes from atria or AV junctional tissue
more than 3 in number

37
Q

what is the preferred drug for emergent therapy of rapid supraventricular tachycardia?

A

IV diltiazem

38
Q

what is the most likely underlying cause of supraventricular tachycardia in a lab or boxer puppy?

A

orthodromic atrioventricular reciprocating tachycardia

39
Q

what is the hallmark of atrial fibrillation?

A

irregularly irregular R-R intervals

40
Q

what drugs can be used to slow AV conduction?

A

amiodarone
beta blocker
calcium channel blocker
digoxin

41
Q

what are the treatment options for atrial fibrillation with no significant heart disease?

A

goal often conversion to sinus rhythm
quinidine
diltiazem, sotalol, class I
other drugs
cardioversion: ECG synchronized

42
Q

what are some options if lidocaine does not work for ventricular tachycardia?

A

procainamide
esmolol
sotalol
amiodarone
synchronized cardioversion

43
Q

does accelerated idioventricular rhythm usually require treatment?

A

not usually

44
Q

what is sick sinus syndrome?

A

periods of sinus arrest often followed by paroxysm of supraventricular tachycardia
syndrome often characterized by bradycardia and tachycardia

45
Q

who is predisposed to sick sinus syndrome?

A

older female schnauzers, westies, pugs

46
Q

what are the general options for sick sinus syndrome treatment?

A

atropine response test
medical management
cardiac pacing

47
Q

what is atrial standstill?

A

atrial activity is totally absent

48
Q

what are some causes of atrial standstill?

A

atrial muscular dystrophy
hyperkalemia
hypothermia
terminal event

49
Q

what do the class Ia drugs do?

A

prolong action potential and effective refractory period

50
Q

what do the class Ib drugs do?

A

short action potential duration and effective refractory period

51
Q

what do the class Ic drugs do?

A

marked depression in phase 0 upstroke
no change in action potential or effective refractory period

52
Q

does procainamide significantly depress ventricular function?

A

no

53
Q

what are some side effects of procainamide?

A

sympatholytic: hypotension
proarrhythmia, AV block
GI upset
coat color changes

54
Q

what is mexiletine used for?

A

ventricular arrhythmias
often in combination with class II and III

55
Q

when are class II antiarrhythmics useful with cardiomyopathy?

A

if CHF absent/well controlled

56
Q

what is amiodarone used for?

A

ventricular and supraventricular arrhythmias

57
Q

what are the side effects of amiodarone?

A

hepatopathy
thyroid dysfunction
pulmonary fibrosis
blood dyscrasias
neuropathy
angioedema, collapse, hypotension

58
Q

do the dihydropyridines or non-dihydropyridines of the class IV antiarrhythmics have nodal effects?

A

non-dihydropyridines

59
Q

is sick sinus syndrome usually life-threatening?

A

not unless under anesthesia

60
Q

what are some options for bradycardias?

A

sympathomimetics
vagolytics
temporary transvenous pacing lead
transthoracic pacing
permanent pacemaker

61
Q

in what percentage of dogs do complications from pacemakers occur?

A

20%

62
Q

which cats with third degree AV block need treatment?

A

those with symptomatic third degree AV block: transdiaphragmatic epicardiac pacemaker

Cardiovascular Pathophysiology (35 decks)

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