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 )