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1 CV, Arrhythmias

Step Up to Medicine, Chap 1: Arrhythmias

QuestionAnswer
Tx for PACs? Asymptomatic (most): no tx. Symptomatic: beta blockers
What kind of EKG abnormalities would you see with a PVC? Slower rate of conduction, wide QRS w/hidden P wave (buried in QRS)
Tx for PVCs? Asymptomatic: none. Symptomatic: beta blockers. May need ICD if also have underlying heart disease due to increased risk of sudden cardiac death
What is bigeminy? Sinus beat followed by a PVC.
What is trigeminy? Sinus beat followed by 2 PVCs.
Name that arrhythmia!: multiple atrial foci firing continuously in a chaotic pattern causing irregularly, rapid ventricular rate Afib (rate=75-175)
Why is cardioversion specifically timed NOT to hit the T wave? Hitting the T wave can cause VFib (wan't to aim for QRS instead). Yikes!
Which type of shock is delivered out of synchrony with QRS? Indication? Defibrillation. Indicate: Vfib, Vtach w/out pulse
EKG findings with Afib? Rapid series of tiny, erratic spikes with no P waves
Agents of choice for rate control in hemodynamically stable Afib pt? Beta blockers and CCBs. Target rate 60-100bpm. If LV dysfunction, consider digoxin
In which case must a pt be anticoagulated b/f undergoing cardioversion for Afib? For how long must they be anticoag'd? Goal INR? If Afib present >48h. Anti-coag 3 weeks prior to cardioversion and 4 weeks s/p cardioversion. Goal INR 2-3. Can also do TEE first (still anticoag after).
Which pts with chronic Afib do NOT need to be anticoag'd? Lone Afibbers (no underlying heart disease or cardiac risk factors) or pts <60yo. EVERYONE else should be anticoag'd with warfarin.
Name that arrhythmia!: one irritable automaticity focus in atria with sawtooth baseline on EKG with a QRS every 2nd/3rd tooth (P wave) Atrial flutter
Name that arrhythmia!: seen in pts with severe COPD; at least 3 different P wave morphologies on EKG Multifocal atrial tachycardia
Is electrical cardioversion useful in multifocal atrial tachycardia? Nope. Manage medically (CCBs, beta blockers, dig)
Name that arrhythmia!: Narrow QRS complexes with no discernible P waves most often due to re-entry Paroxysmal Supraventricular Tachycardia (PSVT)
MC arrhythmia assoc'd with dig toxicity? Paroxysmal atrial tachycardia with 2:1 block
Drug of choice to treat acute Paroxysmal Supraventricular Tachycardia (PSVT)? IV adenosine (short duration of action; works by decreasing sinoatrial and AV nodal activity)
Drug of choice for prevention of PSVT? Dig (verapamil and beta blockers are alternatives). Can also ablate AV node or accessory path if pt has recurrent, symptomatic episodes.
Name that arrhythmia!: accessory conduction pathway from atria to ventricles causes premature ventricular excitation b/c it lacks delay normally seen in AV node Wolf Parkinson White Syndrome
EKG findings for WPW? Narrow complex tachycardia, short P-R interval, and delta wave (upward deflection seen before QRS complex). Note: delta wave isn't seen with anterograde.
Which drug should be avoided in WPW? Why? Dig. Acts on AV node and may accelerate conduction thru accessory path. Use IAor IC antiarrhythmics or ablate accessory path.
Name that arrhythmia!: rapid and repetitive firing of 3+ PVCs in a row at a rate of 100-250bpm. V tach
Where does V tach originate? Below bundle of His
MCC V tach? CAD with prior MI
Name 5 factors that prolong the QT interval. What is this a risk factor for? 1. Congenital QT syndromes, 2. TCAs, 3. Anticholinergics, 4. Electrolyte abnormalities, 5. Ischemia. Risk factor for torsades de pointes.
Which physical finding on the neck might you see in V tach? Cannon a waves (atria contract at same time as ventricles). Also get S1 that varies in intensity.
EKG findings for V tach? Wide, bizarre QRS complexes.
Does V tach respond to vagal maneuvers or adenosine like PSVT? Nope.
Tx for sustained V tach? Hemodynamically stable: IV amiodarone, IV procainamide, or IV sotalol. Unstable: immediate synchronous DC cardioversion; follow with IV amiodarone for rate control. ICD placement if EF abnormal.
Tx for unsustained V tach? If no underlying heart disease, NO increased risk of sudden cardiac death. If underlying heart disease, ICD placement. Amiodarone for pharm (2nd line tx).
Name that arrhythmia!: multiple foci in ventricles fire rapidly leading to chaotic quivering of ventricles w/no cardiac output VFib
MCC VFib? Ischemic heart disease
EKG findings with VFib? No identifiable P waves, no identifiable QRS. Basically no identifiable anything. Total chaos.
Tx for VFib? Immediate defibrillation and CPR. Medical emergency!
Is defibrillation useful in asystole? No. Try transcutaneous pacing instead.
At what rate does sinus bradycardia become clinically significant? <45bpm
Name 3 indications for cardiac pacemakers. 1. Symptomatic heart block (Mobitz II or complete), 2. Symptomatic bradyarrhythmias, 3. Tachyarrhythmias
Name that arrhythmia!: prolonged PR interval, QRS after every P wave, benign First degree AV block (delay usually in AV node)
Name that arrhythmia!:progressive prolongation of PR interval until QRS is dropped; benign Mobitz type II (Wenkebach); (block usually in AV node)
Name that arrhythmia!: P wave drops without warning PR interval prolongation; sudden dropping of QRS Mobitz type II
Where is block in Mobitz type II? His-Purkinje system
Tx for Mobitz type II? Pacemaker
Name that arrhythmia!: absence of conduction of atrial impulses to ventricles; QRS and P waves have no relation to each other Third degree (complete) block; characterized by AV dissociation
Tx for complete 3rd degree block? Pacemaker
Created by: sarah3148