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48 Cards in this Set
- Front
- Back
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Loss of circulation to the brain for how long results in syncope?
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6 seconds
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Cardiac syncope is typically caused by what? What is the onset and offset like? Compare to neurogenic syncope
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Malignant causes with a sudden onset and offset--Neurogenic syncope has a sudden onset and slow offset
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True/False: vasovagal syncope can be life threatening.
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FALSE--benign condition associated with nausea that requires no treatment
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Carotid sinus hypersensitivity is found most in what group? What should be done?
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Old men--avoid precipitating conditions or use pacemaker if persists
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How is cardiac syncope identified and what should be done?
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Typically there is a history of cardiac disease--a lethal syncope can be preceded by a non-lethal syncope so it is a good idea to treat
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What causes cardiac syncope?
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BP is too low, bradycardia OR tachycardia, obstruction to blood flow from aortic stenosis, hypertrophic obstructive cardiomyopathy, pulmonary hypertension, and pulmonary embolism
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What are the main causes of bradycardia?
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sinus node disorders(sinus bradycardia or sinus pauses) and AV node conduction disorders(conduction delay or block in the AV node or his purkinje system)
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Where is the SA node located?
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In the high lateral RA inside of the Crista Terminalis
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What happens to the SA node with age?
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The intrinsic HR of the node declines due to the conduction interval between the SA nodal pacemaker cells and the atrial myocardium increasing
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A disorder can begin to occur in the atria that causes physicians to withdraw all current medications being taken..what is it? What other treatments are used?
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Sinus arrest often caused by beta blockers, digoxin, or Ca++ blockers--implant permanent pacemakers to replace the SA node
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What is tachycardia bradycardia syndrome? How is it treated?
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Atrial flutter happens, then stops--bradycardia occurs after the termination of tachycardia--treat with a permanent pacemaker
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What is idiopathic fibrosis and what can cause it?
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The gradual replacement of the atrial tissue with fibrosis that happens with age and is increased by Beta blockers, digoxin, and Ca++ channel blockers
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What causes the various AV blocks that we learned about? (1st, 2nd, 3rd degree)
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Fibrosis in the AV node(1st/2nd Mobitz I) and fibrosis in the bundle branches(2nd Mobitz II) or both(3rd degree)
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In what type of AV block will you see all of the P waves? What must be done?
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1st degree(has all P waves but there is a long PR interval and a normal QRS)--nothing since this is benign
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What is indicative of a 2nd degree block and how do you tell if it is Mobitz 1 or 2?
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Dropped QRS's--Mobitz 1 = gradually lengthening PR interval until a QRS is dropped(QRS's are varrow); Mobtiz 2 = periodically dropped QRS's(QRS's are WIDE)
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What causes a Mobitz 1? What causes a Mobitz 2?
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Mobitz 1 = AV node block(fibrosis) Mobitz 2 = bundle branch block
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You look at an ECG and the P waves do not correspond to QRS's with any regularity so what kind of block is this?
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3rd Degree AV block
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What pattern is seen in RBBB's?
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RABBIT EARS r-S-R' pattern in V1 with an elongated QRS(>100)
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What pattern is seen in LBBB's?
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r-S pattern in V1 with an elongated QRS(>100) in leads II, III, and aVF or q-R pattern in leads
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What should be done for an individual with a Mobitz alternating LBBB and RBBB?
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Immediate pacemaker!
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What has happened in a 3rd degree AV block?
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This is a complete AV block with no correlation between the P wave and the QRS(which is narrow)--the patient only requires a pacemaker if symptomatic
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What has happened in a 3rd degree bundle branch block?
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Patient has a wide, slow QRS escape that requires an immediate pacemaker
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What commonly causes macroreentry?
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Inexcitable scar tissue--reentrant circuit establishes where current on one side travels slower than the other side and so when it has passed its slow side then it cycles to the fast side, which can now depolarize again
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What is a good example of macroreentry? What is being cycled around?
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Atrial flutter--atrial cavity itself is the inexcitable center and the region near the coronary sinus forms the slow conducting area
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What are the two theories of microreentry?
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leading circle theory and spiral wave theory
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Abnormal automaticity can cause what and looks like what on an ECG?
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Tachycardia and it has a steep phase 4 slope during rest
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What are DAD's?
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delayed afterpotentials--small increase in the AP that occurs after repolarization is over but before another AP can fire--it may result in a new AP
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How do DAD's occur?
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Calcium overload--if there is enough Calcium then it results in depol of the membrane
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P waves are missing from the EKG--what is most likely the problem?
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AVNRT!!! AV nodal reentrance tachycardia
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What causes AVNRT? What drug treats?
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a macroreentrant circuit around the triangle of Koch--treat with adenosine or something that blocks the AV node
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What causes automatic atrial tachycardia?
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Right atrium cells that fire abnormally--can be treated with catheter ablation
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What condition appears with a 2 P waves for every QRS?
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Automatic atrial tachycardia
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You see an abnormally short PR interval..what is the problem? What else will be seen on the EKG?
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WPW syndrome--delta wave slurs the beginning of the QRS
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What can accompany WPW syndrome?
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You can have a reentry tachycardia caused by anterograde conduction over the AV node
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What is a dangerous situation for a person with WPW?
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Atrial fibrillation because the atrial flutter is conducted across the accessory pathwy and causes VFIB
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Atrial flutter appears as what on an EKG?
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SAWTOOTH
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An irregularly irregular QRS complex with no clear P waves is indicative of what?
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Atrial fibrillation
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What causes atrial fibrillation? What is an inherent risk in this situation?
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Rapid firing in the pulmonary viens that causes microreentry and atrial quiver--inherent risk is stroke because clots can develop in the atrial appendage
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People with atrial fibrillation must be given what?
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Anticoagulation treatment because of the risk for clotting
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What treatments and drugs are given to atrial fibrillation patients?
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Warfarin, Dabigatran, Rivaroxaban, and Apixiban--also cauterization of the pulmonary arteries or ligation of the right atrial appendage
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What is the classic anticoagulant? What are two Factor 10a inhibitors? What is a direct thrombin inhibitor?
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Warafarin--Rivaroxaban and Apixiban--Dabigatran
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A patient with a wide and regular QRS has what condition?
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ventricular tachycardia
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How is Ventricular tachycardia treated? What causes it?
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with an implantable defibrillator or with antiarrhythmics or with catheter ablation--caused by any type of heart disease that results in scar tissue
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What is indicative of torsades?
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twisting pattern in EKG with EAD's and a long QT interval
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What are EAD's and what causes them?
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Early afterdepolarizations--caused by drugs or K+ channel abnormalities and a slow HR
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Can torsades be treated with drugs? What must be done?
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Nope--stop drug regimens
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What causes long QT syndrome? What does this lead to?
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Abnormal K+ channels that can easily lead to Torsades
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What causes Brugada? What is the characteristic pattern?
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Congenital Na+ channel defect causes Reflection with an AP in cell 2(long AP) causing cell 1 to fire(short AP)--coved type has characteristic ST elevation in leads V1 and V2
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