Arrythmias
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| Arrhythmia | an abnormality of impulse initiation, impulse conduction or both
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| Normal automaticity | arrhythmias associated with normal automatic pacemakers
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| abnormal automaticity | arrhythmias associated with non pacemaker cells that develop automaticity
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| triggered activity | oscillations in membrane potential that trigger an action potential
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| Normal SAN pacemaker | 60-100 bpm
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| Atrial conduction fibers | 60-80 bpm
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| AV junction | 40-60
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| Ventricular Purkinje | 20-40
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| True normal pacemaker | SA node
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| What makes the latent pacemakers emerge? | High parasympathetic tone
High catecholamine concentration
hypoxemia
ischemia
electrolyte distrbances
drug toxicities
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| Abnormal automaticity | tissue that is not normally automatic becomes automatic; often cannot be overdrive suppressed
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| Triggered activity | early afterdepolarizations
delayed afterdepolarizations
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| EAD | occur before full phase 3 repolarization
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| DAD | occur after phase 3 repolarizations
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| Digoxin | Blocks Na/K pump. Dig toxicity will lead to DADs and has increase in intracellular Na+ which will inhibit Na/Ca pump leading to increased Ca in the SR.
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| 1st degree block | every pulse conducts
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| 2nd degree block | some, not all pulses conduct
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| 3rd degree block | no pulses conduct
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| 2nd degree type I | Wenkebach; progressive prolongation thru the av node with an eventual dropped beat
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| 2nd degree type II | Mobitz II; dropped beats without the prolongation of the PR interval
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| 2:1 Morbitz block | dropping every other beat. Every other P wave has a QRS
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| 3:1 Morbitz | 3 P's for every QRS
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| What are some of the mechanisms that could contribute to block in the AV node? | block Ca+ channel
Increase vagal outflow
Digitalis
Hyperkalemia
Adenosine
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| Re-entry | circus movement; an impulse that does not die out, it instead continues to circulate and re-excite tissue
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| Conditions that are necessary for re-entry to occur. | 1. unidirectional block, or transient block
2. slowed conduction over an alternate pathway
3. Proximal re-excitation
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| Re-entry may be promoted by ______________ | things that slow conduction velocity, shorten the refractory period or a combination of both
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| Examples of random re-entry | Ventricular Fibrillation
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| Is re-entry ordered or random? | both
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| Re-entry may accur around _______ or it may be ______________. | anatomical;functional
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| Classic example of re-entry | wolff-parkinson-white syndrome
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| WPW | pre-excitation; has an accessory pathway; result is supraventricular tachycardia
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| Pre-excitation shows what kind of wave? | Delta wave
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| 3 Examples of re-entry | V-Fib
A-Fib
WPW
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