Clin Med III: Cardio - Arrhythmias
this is a short circuit that uses the AV node as part of the arrhythmias
reentrant arrhythmias
what should be done first for A-fib management: Rate or Rhythm control?
rhythm
what are the symptoms in WPW related to?
short circuit fast arrhythmias
this condition is rare, is mostly asymptomatic, and may be brady, tachy, or alt. brady-tachy
sick sinus syndrome
this type of arrhythmia is normal in YOUNG ppl
sinus arrhythmia
condition with sinus brady w/ a HR < 60
sinus node disease
type of rhythm where every P has a QRS , but is just fast - occurs with exercise
sinus tachycardia
what may a pt complain of with a mobitz II heart block
that their chest does not feel right and feel like they are going to pass out
never use these drugs with WPW why?
the ABCD! 1. Adenosine 2. BB 3. CCB 4. Digoxin ** may accelerate conduction through the accessory pathway and lead to V-fib
this is a COMPLETE HEART BLOCK
third degree
this type of block needs EMERGENCY TX. what is it?
third degree; pacemaker!
major complication d/t a-fib
thromboembolism --> CVA
SidE Effect of Amiodarone
thyroid dysfunction
this is a distinctive form of polymorphic V tach
torsades de pointes
in this test, the lower risk pathways will "disappear" when HR increases
treadmill stress test
a wide complex rhythm w/ 3+ irregular beats = this condition until proven otherwise
v tach
heart rate is dependent on _________ tone
autonomic (balance b/w sympathetic and parasympathetic)
occurs when the ventricles are NOT pumping together
bundle branch block
bundle associated with Wolff Parkinson White Syndrome (WPW)
bundle of Kent
always r/o this condition with bradycardia
cardiac ischemia
if a pt is unstable and is monomorphic with Vtach, what is the ACUTE TX?
cardioversion
type of rhythm control that is best used in first 7 days , when pt does NOT go into normal rhythm on their own
cardioversion
Definitive tx for atrial flutter
catheter ablation
what may be added to the tx regiment of torsades de pointes?
chronic K+ replacement
In what instances is Sinus Node disease NOT ABNORMAL
conditioned athletes with HR in the 40s
treatment goal of A-fib
control the rhythm, rate, and anticoagulate
complication with Vfib
death ensues if not treated quickly
if a pt is unstable and is polymorphic with Vtach, what is the ACUTE TX?
defibrillator (really only used for Vfib)
how do you decide b/w controlling the rhythm or the rate for tx in A-fib ?
depends on sx
if pt is stable and has vtach, what is the ACUTE TX?
either IV amiodarone or procainamide
types of patients where PVCs occur
elderly and health pts
best tx for asystole
epinephrine or vasopressin
T/F Vtach cannot be idiopathic
false- can be
why does adenosine have good diagnostic effects in PSVT?
good to slow down the heart to see if its a flutter or afib
type of tachycardia where there complexes that are regular, but narrow, and the onset is abrupt , also terminates abruptly
SVT
Which is ablation used for: SVT or Vtach?
SVT * more difficult in vtach
how does a BBB appear on EKG
Two conjoined QRS (bc one ventricle depolarizes slightly later than the other)
leads to look for a RBBB
V1 and V2
what leads is the QRS negative?
V1 and V2
what precordial leads have the QRS positive?
V3-V6
leads to look for a LBBB
V5 and V6
type of cardiac testing that helps you catch abnormal episodes that are NOT occurring in the office
holter and event monitoring
work up for PSVT
holter monitor
phrase that correlates to PSVT!!
"cannot tell if its a T or P, has to be an SVT"
MOA of Defibrillation
- not synchronized - for cardiac arrest - higher energy joules - NO escalating energy shock
other tx for VFIB
- BB, ACE I , CCBs - CABG - Angioplasty - Ventricular Ablation - if not an ICD candidate --> chronic amiodarone
these three HTN meds can be used for Vfib
- CCBs - BB - ACE I
two main tx for Vfib!
- CPR - Defibrillator
three different options for acute tx of Vtach!
- cardioversion - defibrillator - chemical way
at home tx for pts with PSVTS
- carotid sinus massage - cold water in face - #1 = valsalva manuever (bearing down)
other acute tx for bradycardia
- dopamine - epinephrine
potential reversible causes of Vtach
- electrolytes - MI - medications that cause a long QT and VT
PE and symptoms with Vtach
- hypotension - increased JVP - Tachypnea - Palps, anxiety, CP, lightheadedness, and syncope
six things to eval for if suspecting sick sinus syndrome
- meds - caffeine - diet - ETOH - tobacco - illicit drugs
what is the theraputic effect of Adenosine ?
- results in transient complete heart block - chemically shuts off the AV node
five potential causes of PSVT
- stimulants - drugs - ETOH - hyperthyroidism - digoxin toxicity
name other causes of A-fib besides an MI
- structural heart dz (ie. left atrial enlargement) - out of control pneumonia - hyperthyroidism - hyperkalemia - pulm dz - certain illicit drugs
type of BBB that is more common
RBBB
CHAD VASC scoring indicating NO TX
0
CHAD vasc score indicating either ASA or an oral anticoag
1
three meds for RATE CONTROL of a-fib
1. BB and CCBS (also for rhythm) 2. Digoxin 3. Amiodarone (anti-arrhythmic)
PO antiarrhymic meds for long term management of Vtach
1. amiodarone 2. sotalol 3. mexiletine
these are three options for RHYTHM CONTROL in tx of A-fib !
1. cardioversion 2. BB and CCBs 3. ablation
two acquired causes of torsades
1. electrolyte abnormalities 2. medications
only types of bradycardias that need long-term managment with a pacemaker
1. symptomatic sinus node dysfunction 2. SSS 3. symptomatic bradycardia @ any level of block 4. high degree AV block (mobitz II and 3rd degree)
type of AV block w/ a regular rhythm, no bradycardia, and a PR interval > 0.2 seconds
1st degree
CHAD VASC score indicating use of an anticoag
2 or more
PVC is less than ____________ areas of Vtach
3
number of VTs in a row to be considered non sustained and sustained dVT
3+ in a row
Most common sustained arrhythmia
A-fib
gatekeeper to the ventricles
AV node
in order to use this tx for rhythm control of A-fib, an early referral is needed, where it tries ti knock out the abnormal rhythm
Ablation
when there is no electrical or mechanical activity of the heart.; no blood being pumped
Asystole
most common medications leading to reversible bradycardia
BB and CCB ** others= = digoxin, lithium, anti-arrhythmic medications
high does the rate in the bundle of kent compare to the AV node
Bundle of ken has a significantly higher rate than the AV node (NOT slower)
#1 acute tx for bradycardia (CAN NOT BE USED LONG TERM)
IV atropine
which BBB is more ominous
LBBB (but less common!)
patients with Vfib typically just had a __________
MI
#1 cause of a-fib
MI d/t to R coronary artery
treatment for torsades de pointe
Magnesium ** also remove causitive med, and correct electrolyte problem
pts should be on this medication if pt has a valvular issue leading to a-fib to prevent a stroke!
Coumadin + heparin (use until Coumadin works)
this is the best way to eval risk in WPW !!
EP study (electrophysiology)
T/F You do not have to tx asymptomatic WPW
F- ALWAYS TX WPW, EVEN IF ASYMP !
T/F The best tx for asystole is a defibrillator
F- cannot SHOCK in asystole
fast reversal agent for coumadin
FFP
location of block in second degree Mobitz II
HIS and purkinje system (after AV node)
Do those with PSVTs need anticoagulants?
NO!
these two waves are UPRIGHT in limb leads
P wave and QRS
long term management of Vtach
PO anti-arrhythmic medications (amiodarone, sotalol, and mexiletine) + a defibrillator
T/F A defibrillator implant is almost always implanted in a pt w/ VT
T
T/F Atrial flutter and Afib have the same stroke risk
T
T/F First degree AV block has a regular rhythm and NO BRADYCARDIA
T
T/F Symptoms of bradycardia can be similar to tachycardia
T
this is a heart condition that is "irregularly irregular" with an atrial rate up to 500 BpM , where the heart is just quivering and not pumping blood
a-fib
if this node is positive then it is a VT
aVR (right arm)
best tx for SVT that are healthy!
ablation
CURE FOR WPW
ablation (surgery)
#1 pharmacological intervention for a PSVT
adenosine
this drug is safe for acute tx of any regular tachycardia
adenosine
"drug for a dyin heart"
amiodarone
most pts have these signs & symptoms in PSVT
asymp!! *may have palpitations, anxiety, SOB, and dizziness
most pts have these signs and symptoms with a PCV
asymptomatic! * can have palpitations, "skipped beats"
often coexists with a-fib
atrial flutter
COPD is seen with what type of arrhythmia?
atrial flutter ** also in valvular / strutural disease and surgically repaired congenital disease
WHY DOES catheter ablation work better for atrial flutter rather than afib
atrial flutter has one foci - where you just zap it!
most common cause of Vfib
ischemic heart disease d/t CAD
cornerstone of ablation in A-fib
isolation of the pulmonary veins
name the complication with WPW
lead to AFIB --> w/ a risk of sudden cardiac death
MOA of cardioversion
lower energy joules zap heart back into rhythm and synchronizes heart with QRS
this disease is a reversible cause of bradycardia
lyme disease
complication with torsades de pointes
may degenerate into vfib
complication of Vtach
may progress to Vfib
type of AV block where there is progressive prolongation of PR interval before a dropped QRS
mobitz I (weckebach)
why is the heart just quiverin in afib?
multi atrial foci zappin at different times
EKG findings with Vfib
no P or QRS waves
Is a pacemaker used in tx of lyme disease induced brady cardia?
no! only if the pt fails tx w/ abx
treatment for PVCS
none except eliminating caffeine and reducing stress
long - term tx for bradycardia
pacemaker
Long term management of PSVT if needed
possible ablation / pacemaker (probs dont need)
an increase in this electrolyte can lead to A-fib
potassium
another anticoagulant that can be used as stroke prevention from A-Fib
pradaxa (dabigatran)
ekg findings with Torsades de pointes
prolonged QT interval
number one cause of Vtach
pts w/ prior MI and weak hearts
where to PVCs orignate?
purkinje fibers of ventricles (NOT the SA node)
this is a Ventricular Arrhythmia that needs treated ASAP - ventricles are just quivering and cannot pump blood
vfib
slow reversal agent for coumadin
vitamin K
appearance of the DELTA WAVE in WPW
wider than normal QRS with a slurring of the R wave
anticoags for a nonvalular issue leading to afib
xarelto (rivaroxaban) and eliquis (apixaban)
pt population for PVCs are rare!
young pts (< 20 )