Cv-Arrhythmias

Front 1

T or F: most arrhythmias are the result of reentry.

Back 1

true

Front 2

What are the 3 arrhythmia mechanisms?

Back 2

1. reentry
2. automaticity
3. parasystole

Front 3

What are the 3 classes of common arrhythmias?

Back 3

1. supraventricular
2. A/V
3. ventricular

Front 4

T or F: heart disease is a primary cause of arrhythmia.

Back 4

true

Front 5

If patient awakens with confusion following syncopal episode, is this likely cardiac or non-cardiac in origin?

Back 5

non-cardiac (syncopal episodes following arrhythmias wake up with clarity)

Front 6

If syncope occurs w/o prodrome, is this likely to be cardiac or non-cardiac?

Back 6

cardiac

Front 7

If a patient has dizziness at various points throughout the day, what may cause this?

Back 7

medication troughing

Front 8

What are 2 very important questions regarding hx w/syncope?

Back 8

1. Have you ever been shocked, had CPR, or had a heart attack in the past?
2. Has anyone in your family died suddenly or had similar symptoms?

Front 9

T or F: goiters can cause arrhythmias.

Back 9

true

Front 10

Is JVD symptomatic of right or left-sided HF?

Back 10

right-sided HF

Front 11

Why would you obtain a CBC when evaluating for arrhythmias?

Back 11

anemia->poor perfusion->ischemia->arrythmias

Front 12

What cardiac test will record 1-2 weeks of event recordings? (patient presses button, saves data from previous 90 minutes)

Back 12

king of hearts

Front 13

What specific test will often induce a v-tach?

Back 13

TEE

Front 14

What are 3 rules to remember when considering tx of arrhythmias?

Back 14

1. Do I need to eliminate symptoms?
2. Is there an immediate risk of death or hemodynamic collapse?
3. What can I do to offset the long term risk?

Front 15

T or F: all antiarrhythmics have the potential to be pro-arrhythmic.

Back 15

true

Front 16

What are the 7 most common supraventricular arrhythmias?

Back 16

1. sick sinus syndrome
2. carotid sinus syndrome
3. a-flutter
4. a-fib
5. multi-focal atrial tachycardia (MAT)
6. PAT=SVT=PSVT=reentrant tachycardia
7. WPW

Front 17

What disease will cause acute weakness, dizziness or “greying out” when turning there head or applying pressure to the neck?

Back 17

carotid sinus syndrome

Front 18

How do you diagnose carotid sinus syndrome? What should you do before you do this?

Back 18

1. rub carotid sinus->patient will have lowered HR or BP
2. auscultate for carotid bruits

Front 19

What drug will not work for a-fib, a-flutter, or v-tach?

Back 19

adenosine

Front 20

How can you tell the difference between aortic stenosis and a carotid bruit?

Back 20

1. auscultate base of neck and top of neck
2. sound louder at base of neck=aortic stenosis
3. sound louder at top of neck=carotid bruit

Front 21

Adenosine should not be given in what patients?

Back 21

1. transplant patients
2. severe COPD
3. wide QRS tachycardia if you aren't sure of SVT

Front 22

What might cause 2:1 atrial flutter? 3:1?

Back 22

1. underlying heart problems
2. AV node disease or drug abuse

Front 23

Is atrial flutter a stable or unstable rhythm?

Back 23

unstable (usually deteriorates to a-fib or NSR)

Front 24

If an arrhythmia becomes hemodynamically unstable, what should you do?

Back 24

electrical cardioversion

Front 25

What are two drugs that can cardiovert a-flutter?

Back 25

ibutilide or amiodarone

Front 26

What is the difference between cardioversion and defibrillation?

Back 26

cardioversion is waiting until just the right time and delivering timed shock; defib is just blind shocking

Front 27

Irregularly irregular describes which rhythm?

Back 27

a-fib

Front 28

What % of blood delivered from the atria to the ventricle is affected from high atrial contraction in a-fib?

Back 28

only about 20% (80% fills ventricle passively)

Front 29

What is a common cause of a-fib?

Back 29

recreational drugs

Front 30

What arrhythmia is associated with "holiday heart" from drinking alcohol?

Back 30

a-fib

Front 31

T or F: a-fib is an unstable rhythm.

Back 31

false-can last for decades

Front 32

T or F: a-fib has a high risk of clots.

Back 32

true

Front 33

What does the CHADS score represent?

Back 33

risk of thrombosis in a-fib

Front 34

What does CHADS stand for?

Back 34

C-CHF
H-HTN
A-Age>75
D-DM
S-Secondary prevention in patients with prior stroke

Front 35

What are the scores that indicate low, intermediate, and high risk of thrombosis in CHADS?

Back 35

1. 0
2. 1-2
3. >/=3

Front 36

In addition to irregularly irregular pattern, what else does a-fib show?

Back 36

absent p waves

Front 37

What is the best choice of drug to control rate in a-fib if patient has a low EF? Why?

Back 37

amiodarone-doesn't depress CO

Front 38

What are 2 drugs used to cardiovert a-fib?

Back 38

amiodarone or ibutilide

Front 39

When do you anticoagulate patient prior to cardioverting or decreasing rate in a-fib?

Back 39

if arrhythmia has been there at least 48 hours

Front 40

Which is better: rhythm control or rate control+anticoagulants?

Back 40

equal

Front 41

How long would you keep patient on anticoagulant in a-fib>48 hours before cardioverting? How long would you keep the patient on anticoagulants after cardioverting?

Back 41

4-6 weeks before and after

Front 42

What are some causes of multifocal atrial tachycardia?

Back 42

1. pulmonary disease ("bad lunger")
2. low K+ or Mg++
3. heart disease

Front 43

How many types of p-waves must be present to diagnose MAT on the ECG?

Back 43

3

Front 44

What is the treatment of choice in MAT?

Back 44

slow rate with non-DHP CCB's

Front 45

Do antiarrhythmics work well in MAT?

Back 45

no

Front 46

What will make MAT better? Worse?

Back 46

1. oxygen
2. digoxin

Front 47

SVT has what other names?

Back 47

1. PSVT
2. reentrant tachycardia
3. PAT

Front 48

What is characteristic of SVT?

Back 48

abrupt onset and stop of tachycardia

Front 49

What drug will work well on SVT?

Back 49

adenosine-restores NSR

Front 50

What is characteristic of WPW?

Back 50

short PR <.12 with widened QRS > .12 with delta wave

Front 51

What is special about p waves in WPW?

Back 51

inversion due to retrograde conduction

Front 52

What is the treatment in WPW?

Back 52

procainamide

Front 53

What is absolutely contraindicated in WPW if QRS is wide or if seen with a-fib? What can you use?

Back 53

1. verapamil, BB's, and digoxin
2. procainamide

Front 54

What is the golden rule of treating PVC's?

Back 54

if not symptomatic, do not treat

Front 55

When are PVC's significant?

Back 55

when due to MI with EF<40%: risk of sudden death

Front 56

What is first line therapy for PVC's? What should you avoid?

Back 56

1. oxygen
2. Class IC and III (increase mortality)

Front 57

What usually causes v-tach? How does it present?

Back 57

1. ischemia
2. PVC's and HR>120

Front 58

How do rabbit ears look in RBBB? SVC? V-tach?

Back 58

1. normal complex w/rabbit ears
2. little ear->big ear
3. big ear->little ear

Front 59

What is the DDX for tall R's in V1?

Back 59

1. posterior wall MI
2. RVH
3. RBBB
4. WPW
5. dextrocardia
6. improper lead placement
7. muscular dystrophy

Front 60

In addition to prolonged QT and quinidine, what else can cause torsades?

Back 60

hypomagnesemia

Front 61

What is the treatment of choice in torsades?

Back 61

Mg++

Front 62

What antiarrhythmic will worsen torsades?

Back 62

any Class IA