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Cardiology (inpatient) > ventricular arrhythmias > Flashcards

ventricular arrhythmias Flashcards

1
Q

premature ventricular contraction

A

premature firing of a ventricular cell

  • initiated by purkinje fibers
  • causes ventricles to be in a refractory state-so when the normal pacers fire, the ventricles won’t contract at the normal time
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2
Q

what is a compensatory pause>

A

pause- pause in the heart beat following an extrasystole that is long enough to compensate for the prematurity of the extrasystole

*seen in PVC so the next beat will arrive on time

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3
Q

what are some features of PVCs

A

Often benign
Frequent PVCs can depress ventricular function
Precursor to ischemia or structural disease
Substantial day to day variation
Affected by stress, medications, caffeine

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4
Q

sx of PVC

A

palpitations, dizzy, strong Heart beat, pause

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5
Q

what is something to look for during a stress test? (what happens to PVC?)

A

want PVC to go away- if they increase it may indicate ischemia

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6
Q

EKG findings on a PVC

A

Rate: Depends on underlying rhythm

Rhythm: Irregular
P wave: Not present on PVC

P:QRS ratio: No P waves on the PVC

PR interval: None
QRS: Wide >0.12 seconds

Grouping: Bigeminy, Trigeminy possible

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7
Q

classifying PVC: 1?

A

PVC

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8
Q

classifying PCV: 2 in a row?

A

couplet

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9
Q

classifing PCS: 3 + in a row but lasting less than 30 sec

A

nonsustained ventricular tachycardia (Vtach)

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10
Q

patter of PVCs: every other beat?

A

bigeminy

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11
Q

pattern of PVCs: every 3rd beat

A

trigeminy

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12
Q

ventricular escape beate

A

occurs when SA node fails to fire and next available pacemaker cell is in the ventricle

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13
Q

what happens to the normal rhythm in a ventricular escape beat?

A

origianl pacemaker doesn’t fire, so the next beat doesn’t arrive on time

*noncompensatory pause

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14
Q

sx of ventricular escape beat

A

paplitations, dizzy, presycope, syncope

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15
Q

tx of ventricular escape beat?

A

electrolye corrections, pacemaker if become rhythm

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16
Q

EKG findings in ventricular escape beat

A

Rate: Depends on underlying rhythm
Rhythm: Irregular

P wave: Not present on PVC

P:QRS ration: No P waves on the PVC

PR interval: None

QRS: Wide >0.12 seconds
Grouping: None

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17
Q

Idioventricular rhythm

A

occurs when ventricular foci act as primary pacemakre for the heart

(20-40 bpms)

*can also have accelerated idoventricular rhythm (40-100 bpm)

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18
Q

sx of idioventricular rhythm

A

dzzy, pre-syncope, syncope

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19
Q

tx of idioventricular rhythm

A

underlying causes,

BB with CAD

atrial overdrive pacemkater

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20
Q

EKG finding ins idioventriculare rhythm

A 
Rate: 20-40 or 40-100
Rhythm: Regular
P wave: None
P:QRS ration: None
PR interval: None 
QRS: Wide >0.12 seconds
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21
Q

ventricular tachycardia

A

very fast ventricular rate that is dissocaited from underlying atrial rate

*no marriage of P and QRS

22
Q

nonsustained VT?

A

Runs of three or more ventricular beats lasting <30 seconds and terminating spontaneously

Increased mortality (SCD) in patient’s with heart disease

23
Q

sustained VT?

A

Ventricular beats lasting >30 seconds, intervention often required to terminate

High risk of reoccurrence
With LV dysfunction SCD high

24
Q

monomorphic VT

A

The appearance of all the beats match each other in each lead (same QRS configuration)

Can deteriorate to VF

BAD NEWS

25
Q

POLYMOrphic VT

A

Beat to beat variations is morphology

Torsades de pointes- polymorphic VT in the context of prolonged QT interval

Think ischemia

26
Q

sx of VT

A

NST asx

palpitations, CP, SOB, presyncope, syncope, hemodymaiclly compromised

27
Q

tx of vtach (if NSVT or premature beats)

A

BB or CCB if pt is symptomatic

28
Q

tx of VTach if pt has hypotension, loss of consiousness,

A

synchronized cardioversion

29
Q

pulseless vtach tx?

A

immediate defibrillation along with CPR

30
Q

acute Vtach pharmacological tx

A

amiodarone
lidocaine
procainamide

31
Q

what is brugadad syndrome?

A

genetic disorder that causes syncope, ventricular fibrillation and sudden death, often during sleep

32
Q

torsades de pointes

A

Occurs with underlying prolonged QT interval:
Congenital
Drugs
Electrolyte imbalances

Can convert to a normal or ventricular rhythm

QRS morphology twist around baseline like a party streamer

Very serious: Harbinger for death, Ventricular Fibrillation

33
Q

tx of torsades

A

Treatment: IV Magnesium, Potassium, Defibrillation

34
Q

ventricular flutter

A

very fast vtach

  • can no longer tell QRS, Twave, ST segments
  • sinosoidal pattern

tx same as V tach

35
Q

ventricular fibrillation

A

cardiac chaos

different ares of ventricles firing all at their own pace w/ no coordination or organization

36
Q

what is the main cause of sudden cardiac death?

A

vfib

37
Q

causes of v fib

A

myocardial infraction

hypokalemia

drug toxicity

38
Q

tx of v fib

A

nonsynchronized defibrilattion; biphasic 120-200 J

(don’t have to synch bc there is nothing tto synch up with)

amiodarone for 24-48 hours

39
Q

pulseless electrical activity

A

can be any rhythms at all w/o a pulse

CPR

40
Q

AV blocks

A

Delay or interruption in the transmission of an impulse from the atria to the ventricles
Conduction blocks between sinus node and purkinje fibers
Occurs at AV node, Bundle of His and below
Key determining factor is the PR interval

41
Q

first degree heart block

A

prolonged block in the AV node, ery impulse is conducted

42
Q

what can cause a first degree heart block

A

meds, vagal stimulation, dz,

43
Q

what will the PR interval look like?

A

> .20 sc

44
Q

first degree sx

A

asx

dizzy, presyncope, syncope

45
Q

tx of first degree

A

reverse cause, nothing, pacemaker

46
Q

Mobitz I second degree

A

Wenckenback

Caused by a diseased AV node with a long refractory period

Progressive delay between atrial and ventricular contraction and the eventual failure of a QRS following a P wave (dropped beat)

47
Q

causes of Mobitz I

A

Normal in individuals with high vagal tone (young, athlete)
Heart disease- RCA, inferior MI
Post mitral valve surgery
Lyme disease

48
Q

Mobitz 1 sx

A

asx,
bradycardia
palpiations

49
Q

tx of mobitz 1

A

unstable: atropine,pacing
stable: pacing pads in lace, revascularization, remove toxin

50
Q

EGK Mobitz 1

A

PR interval gets larger and larger until the bieat drops

51
Q

Mobtiz II

A

Occurs due to a diseased AV node
Block usually occurs in the Bundle of His
May lead to complete heart block

Distinguishing factor: presence of non-conducted beat without progressive lengthening of PR interval,

**pt can have bothe a I and II degree block-can be in different places

52
Q

what is a third degree heart block

A

Complete block of the AV node
Atria and Ventricles are firing separately each to its own drum
2 pacemaker sites, atrial 60-100 bpm and ventricles 30-50 bpm, both will be regular but independent

Medical emergency, typically requires a pacemaker

Cardiology (inpatient) (14 decks)

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