Arrhythmias
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| Sinus Arrhythmia will increase or decrease HR with: -Inspiration -Expiration | Inspiration - Increase
Expiration - Decrease
Remember- I and I go together
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| Heart rate less than 60 bpm and increased vagal tone are consider what? | Sinus Bradycardia
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| What are 4 causes of Sinus Tachycardia? | Sinus Tachycardia HR>100 bpm
Causes:
Fever, Exercise, Hyperthyroid, Anemia
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| What is the symptoms and treatment for Atrial Premature beats? | No Sx or Tx, not pathologic, almost everyone has this.
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| What does PSVT stand for? | Paroxysmal (intermittent) Supraventricular Tachycardia (sometimes just referred to as SVT)
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| PSVT will have what findings on EKG? | Lots of spikes
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| What are some mechanical measures you can do to stop or calm PSVT? | 1. Carotid Massage **(Auscultate carotid first to make sure no bruits)
2. Head b/t legs
3. Cold water
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| Adenosine is a treatment for what condition? | PSVT/SVT
1/2 life 12 seconds
MOA- Blocks Atrioventricular Node (AV node) nerve impulse causes flat line on EKG
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| Besides mechanical and drug Txs for PSVT what else can be done? | -Cardioversion - Hook up leads and low voltage shock to over ride circuit and try to reset.
-Ablation - Burn exta nerve pathways once they find it, last resort only use if nothing else works.
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| This is not a common cause of PSVT, but when accessory pathways outside of normal AV node nerve pathways grow called reentry tracks, causing extra N. impulses to AV node is referred to as what? | Wolff-Parkinson-White Syndrome
Remember:
WOLFS will make new ENTRY TRACKS to Allow Very (AV) easy hunting of YOUNG WHITE FEMALES w/ PARKINSONs.
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| A young white female presents with an out of control heart rate b/t 100 -220bpm. EKG show lots of spikes? what does she have and what medication would you use to get HR under control? | PSVT/SVT
Drug- Adenosine
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| What is one of the most common heart conditions that presents in private practice and sounds like "shoes in a dryer" irregular irregular. | Atrial Fibrillation
-Atrium is vibrating not contracting
-Risk of stoke from stasis of blood in atrium
-decreased ejection fraction b/c no atrial loading in ventricle
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| Acute illness, chest trauma, and Holiday alcohol (binge drinking) can all cause what common presenting heart conditions? | Atrial Fibrillation
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| Atrial Fibrillation will have what EKG findings and what finding specifically rules out Atrial Fibrillation? | -EKG - Absence of P-Waves, Irregular rhythm
-R/O - If you see P-Waves Dx can not be Atrial Fibrillation.
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| Atrial Fibrillation is always considered irregular and if patient is hemodynamically unstable what should you do? | Cardiovert them - Stick finger in outlet/SHOCK THEM :)
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| A patients presents to the office and you determine they have A-Fib, what is the window of time that is important in determining Tx? | -W/in 48 hrs can cardio-vert them
-After 48 hrs can not cardio-vert b/c risk of dislodging clot in L.Atrium causing stroke.
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| If A-Fib is Dx after 48hrs you have to have patient on anti-coagulates for how long before you can discuss cardio-verting them? | 4 weeks of anti-coagulates before cardio-vert is an option.
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| If you Dx Atrial fibrillation (A-Fib/AF) before 48hrs or after 4 wks of anti-coagulants (warfarin) and correct arrhythmia the patient does not need to continue use of warfarin. True or False | False: Any patient with paroxysmal, persistent, or permanent AF with no containdications to anti-coag should continue drug with target ratio b/t 2-3.
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| Tx of AF is threefold, what are the 3 things you need to control with therapy? | 1. Prevention of thromboembolic complication (stoke)
2. Rate control ( Beta blockers, CCB, or Digoxin)
3. Restoration and maintenance of sinus rhythm (pharm, catheter ablation, surgical maze procedure)
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| In absence of anti-coagulation drugs in A-fib what is the risk of stroke EACH YEAR? | 5-10%
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| What is defined as a reentrant tachycardia localized to the right atrium with passive activation of the left atrium with a sawtooth pattern on EKG? | Atrial Flutter (AFL)
-Atrial Rate during AFL is 250-350bpm
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| When AFL is associated with hemodynamic compromise or angina what should be done immediately? | Cardioversion (Cardio-vert)
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| When AFL is hemodynamically stable what should the focus of care/Tx? | -Rate control - reduce risk for TACHYCARDIA-induced cardiomyopathy
-Anticoagulation - reduce stroke risk
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| Once class 1A anti-arrhythmic agents are used to convert AFL to sinus rhythm, what is the next focus of Tx to be controlled? | Ventricular Rate - Digoxin, Beta-Blockers, or CCB.
-Class 1A agents may slow flutter rate and augment AV nodal conduction, resulting in 1:1 conduction with rapid Ventricular rates.
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| What % of people have Ventricular Premature beats (PVC)? | -100% of people.
-Benign
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| What clinic finding would make you want to monitor a patient with PVC? and what are to treatment options? | Clinical Finding
-5 PVCs/min
Tx:
-Can go away with exercise
-Chk Magnezium levels.
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| What is defined as 3 or more consecutive Vent depolarizations occurring at a rate greater than 100 beats/min? | Ventricular Tachycardia
-ECG QRS appears wide
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| One of two (or both) factors define VT as sustained, what are they? | 1. last more than 30 seconds
2. Require termination b/c ho hemodynamic instability
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| Acute ischemia, prior infarction with scar formation, congestive cardiomyopathy, right ventricular dysplasia, and hypertrophic heart disease are most frequently underline cause of which rhythm disturbance? | Ventricular Tachycardia
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| What metabolic abnormalities may precipitate VT? | -Hyperkalemia
-Hypoxia
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| What are two causes of idiopathic VT and which one is most common? | Classified by site of origin:
1. Right ventricular outflow tract VT (RVOT-VT). M/C, triggered by activity, sensitive to catecholamines and terminates with adenosine
2. Left VT
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| Nonsustained VT is M/C associated with left ventricular dysfunction. What tx would you provide to non-symptomatic and symptomatic patient? | Non-Sx - Requires no Tx
Sx - Implantable cardioverter-defibrillator (ICD)
**Important Note - Pharmacologic Tx has not been shown to decrease mortality.
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| Which arrhythmia is AKA sudden death? | Ventricular Fibrillation - heart is vibrating no real contractions.
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| What are the ECG finding of VF? | ECG findings:
-no identifiable QRS complexes, ST segments, or T waves
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| What is the Tx for VT? | Nonsynchronized direct current shock at 360 Joules
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| If shocking the heart in VT is successfully terminated what is the very next thing you do? | IV anti-arrhythmic agent (amiodarone or lidocaine) to prevent recurrence.
If acute reversible cause NO chronic Tx. If occurs b/c underlying cardia disease ICD implantation indicated.
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| What is referred to as tachy-brady syndrome? | Sick sinus syndrome
Remember: If sick coughing is normal (sinus rhythm), no coughing (asystole), then couple little coughs (Tachy - sinus rhythm), then quick big breath for big cough (Brady), all cleared out no coughing and repeats.
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| For Sick Sinus Syndrome what is the Tx? | Pacemaker
Drugs do NOT work
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| Of the first, second, and 3rd degree AV blocks, which one has two sub-categories known as Mobitz Type 1 and Type 2? Type 1 or 2 is Wencheback? | Second Degree
-Mobitz Type 1 - Wencheback
-Mobitz Type 2
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| On ECG the PR interval is progressively elongates with each beat until it drops a beat, then starts over, what AV Block is this? | Wenckeback - Mobitz Type 1
Remember: Mobitz are brothers who are baseball pitchers. Type 1 unique Wend up (Wenckeback), Pitcher aRm progressive elongates then throws ball(or drops beat)
Type 2- no Pitcher aRm elong, just throws ball, every 2-3 pitche
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| Which AV block is characterized by prolonged PR interval with no other changes or symptoms? | First Degree
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| What degree AV block is complete and defined by AV dissociation, SA and AV are doing own thing. P-wave is independent of QRS on ECG and Pacemaker is only treatment? | Third degree AV block.
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| What is defined as sudden, transient loss of consciousness? | Syncope
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| What kind of syncope could be dxs due to increased bruises and might help you dx valvular disease? | Cardiogenic Syncope- no symptoms/prodrome so patients pass out with no warning falling and bruising their self due to a bad valvular disease.
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