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92 Cards in this Set
- Front
- Back
USUAL RHYTHM FOR A PAC
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WILL USUALLY BE REGULAR EXCEPT FOR THE PAC
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RATE OF PAC
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DEPENDS ON THE UNDERLYING RHYTHM
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WHEN DOES THE P WAVE OCCUR WITH PAC
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P WAVE OF ECTOPIC BEAT OCCURS EARLY AND DIFFERS FROM THE SINUS P WAVES; CAN BE FLATTENED, NOTCHED, OR MAY BE LOST IN PRECEDING T WAVES
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WHAT TWO THINGS WILL YOU SEE IN A PAC?
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PREMATURE P WAVE AND A COMPENSATORY PAUSE AFTER THE QRS
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WHAT WILL THE PP INTERVAL BE IN PAC?
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IT WILL BE NORMAL. CHECK IT INSTEAD OF THE RR.
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HOW DO YOU DIFFERENTIATE A PAC FROM A SINUS ARRHYTHMIA?
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THE P WAVE IN A SINUS ARR. WILL BE THE SAME IN EACH, BUT THE PAC WILL HAVE A P WAVE WITH A DIFFERENT MORPHOLOGY ON THE ECTOPIC BEAT
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WHAT ARE THE THREE PRESENTATIONS OF PAC?
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PAC WITH NORMAL IV CONDUCTION; NONCONDUCTED PAC; PAC WITH RBBB ABERRATION
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WHAT ARE FIVE ETIOLOGIES FOR PAC?
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COPD, MI, ENDOGENOUS CATECHOLAMINE RELEASE, DIGITALIS TOXICITY OR ALCOHOL, VALVE DISEASE
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WHAT WILL BE THE CAUSE OF SYMPTOMS IN PAC?
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MOST WILL NOT HAVE SYMPTOMS, BUT IF THE PATIENT DOES NOTICE IT WILL BE BECAUSE OF FREQUENCY AND PALPITATIONS
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WHAT IS THE TREATMENT FOR PAC?
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CORRECT UNDERLYING CAUSE AND CORRECT UNDERLYING RHYTHMS; BETA BLOCKERS IF THERE ARE SYMPTOMATIC PALPITATIONS
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WHAT IS THE NORMAL RHYTHM FOR ATRIAL ESCAPE BEAT?
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DEPENDS IN UNDERLYING RHYTHM; ESCAPE BEAT FOLLOWS A PAUSE IN THE NORMAL RHYTHM
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WHAT DOES THE P WAVE LOOK LIKE IN ATRIAL ESCAPE BEAT?
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P WAVE OF ECTOPIC BEAT OCCURS LATE AND DIFFERS FROM SINUS P WAVES; CAN BE FLATTENED OR NOTCHED
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WHY IS AN ECTOPIC ATRIAL RHYTHM UNLIKELY?
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BECAUSE THE AV JUNCTION WOULD LIKELY TAKE OVER AS DOMINANT PACEMAKER, NOT THE ATRIAL TISSUE
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WHAT WILL P WAVE LOOK LIKE IN ECTOPIC ATRIAL RHYTHM?
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WILL VARY FROM BASELINE P WAVE AND LIKELY NOT BE POSITIVE IN II, III, AND AVF
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THIS OCCURS WHEN MULTIPLE ATRIAL FOCI TAKE OVER WHEN SA NODE IS FAILING; NONE OF THEM SUCCEED TO BECOME DOMINANT
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WANDERING ATRIAL PACEMAKER
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RHYTHM OF WANDERING ATRIAL PACEMAKER
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SLIGHTLY IRREGULAR
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RATE OF WANDERING ATRIAL PACEMAKER
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USUALLY NORMAL 60 TO 100
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P WAVE MORPHOLOGY IN WANDERING ATRIAL PACEMAKER
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MORPHOLOGY CHANGES FROM BEAT TO BEAT- MUST HAVE AT LEAST THREE DIFFERENT P WAVES
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WHAT WILL THE PP INTERVAL BE IN WANDERING ATRIAL PACEMAKER?
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MAY BE SLIGHTLY VARIABLE, AS WILL THE PR INTERVAL
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WHAT ARE THE ETIOLOGIES FOR A WANDERING ATRIAL PACEMAKER?
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IDIOPATHIC ESP. IN YOUNG MALES, CHANGES IN VAGAL TONE, DIGOXIN TOXICITY, INFLAMMATION OF ATRIAL TISSUE, VALVULAR HEART DISEASE
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SYMPTOMS OF WANDERING ATRIAL PACEMAKER
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USUALLY ASSYMPTOMATIC
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TREATMENT FOR WANDERING ATRIAL PACEMAKER
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USUALLY NO TREATMENT IS NECESSARY
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THIS IS THE SAME AS WANDERING ATRIAL PACEMAKER, BUT THE RATE IS GREATER THAN 100
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MULTIFOCAL ATRIAL TACHYCARDIA (MAT)
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CAUSE OF MULTIFOCAL ATRIAL TACHYCARDIA
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COPD
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HOW DO YOU DIFFERENTIATE MULTIFOCAL ATRIAL TACHYCARDIA FROM A FIB?
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P WAVES
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HOW DO YOU TREAT MULTIFOCAL ATRIAL TACHYCARDIA?
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DO NOT STOP TACHYCARDIA; IT IS THE ONLY COMPENSATORY MECHANISM. TREAT COPD AS BEST YOU CAN.
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SIGNS AND SYMPTOMS OF MAT
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PALPITATIONS, SOB, CHEST PAIN, SYNCOPE, LIGHTHEADEDNESS,- PALPAITATIONS ARE FROM TACHYCARDIA, ALL OTHERS ARE FROM COPD OR SEVERE RESP. PROBLEM
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LABS YOU WOULD RUN WITH A MAT PATIENT
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LYTES, TOX SCREEN, CARDIAC PANEL, BNP, ABG
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RATE IN ECTOPIC ATRIAL TACHYCARDIA
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150 TO 250 BEATS PER MINUTE
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P WAVES IN ECTOPIC ATRIAL TACHYCARDIA
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WILL VARY FROM BASELINE P WAVES AND WILL LIKELY NOT BE UPRIGHT IN II, III, AND AVF
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WHAT DOES PAROXYSMAL ECTOPIC ATRIAL TACHYCARDIA MEAN?
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SUDDEN ONSET/ SUDDEN STOP
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WHAT DOES ADENOSINE DO TO HEART?
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BLOCKS ALL CONDUCTION THRU AV NODE; CAUSES SYSTOLE FOR 12 SECONDS
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HOW LONG DO BETA BLOCKERS AND CCB LAST?
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6-12 HOURS
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MOST COMMON TYPE OF SUPRAVENTRICULAR TACHYCARDIA?
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AVNRT
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SECOND MOST COMMON SUPRAVENTRICULAR TACHYCARDIA?
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AVRT
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FOUR TYPES OF SVT
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AVNRT, AVRT, ATRIAL TACHYCARDIA, AND ATRIAL FIB OR FLUTTER
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ETIOLOGY OF SVT
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CONGENITAL ANOMALIES, HYPOXEMIA, MEDS- DIGITALIS TOXICITY, ALBUTEROL, COCAINE, ATRIAL INSULT, INCREASED SYM TONE
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WHAT DOES PAROXYSMAL ECTOPIC ATRIAL TACHYCARDIA MEAN?
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SUDDEN ONSET/ SUDDEN STOP
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SYMPTOMS OF SVT
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SUDDEN ONSET PALPITATIONS, HYPOTENSION, CHEST PAIN, SOB, SYNCOPE, ANXIETY**
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WHAT DOES ADENOSINE DO TO HEART?
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BLOCKS ALL CONDUCTION THRU AV NODE; CAUSES ASYSTOLE FOR 12 SECONDS
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TREATMENT OF SVT
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USUALLY NO TREATMENT NECESSARY
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HOW LONG DO BETA BLOCKERS AND CCB LAST?
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6-12 HOURS
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WHAT IS THE SAFETY NET FOR SVT?
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IV, OXYGEN, EKG MONITOR
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MOST COMMON TYPE OF SUPRAVENTRICULAR TACHYCARDIA?
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AVNRT
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SECOND MOST COMMON SUPRAVENTRICULAR TACHYCARDIA?
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AVRT
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FOUR TYPES OF SVT
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AVNRT, AVRT, ATRIAL TACHYCARDIA, AND ATRIAL FIB OR FLUTTER
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ETIOLOGY OF SVT
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CONGENITAL ANOMALIES, HYPOXEMIA, MEDS- DIGITALIS TOXICITY, ALBUTEROL, COCAINE, ATRIAL INSULT, INCREASED SYM TONE
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SYMPTOMS OF SVT
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SUDDEN ONSET PALPITATIONS, HYPOTENSION, CHEST PAIN, SOB, SYNCOPE, ANXIETY**
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TREATMENT OF SVT
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USUALLY NO TREATMENT NECESSARY
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WHAT IS THE SAFETY NET FOR SVT?
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IV, OXYGEN, EKG MONITOR
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WHAT IS CARDIOVERSION?
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TIMED SHOCK TO THE HEART; TRYING TO DEPOLARIZE EVERYTHING AT ONCE IN AN ATTEMPT TO RESET SA NODE AS PACEMAKER
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IF YOU HAVE UNSTABLE PT WITH SVT, WHAT DO YOU DO?
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CARDIOVERSION
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IF YOU HAVE UNSTABLE PT WITH SVT, WHAT DO YOU DO?
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VAGAL MANEUVERS (INITIATE PARASYMPATHETIC RESPONSE)
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WHAT DOES AVNRT STAND FOR?
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AV NODAL REENTRY TACHYCARDIA
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WHAT IS THE CAUSE OF AVNRT?
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CONGENITAL ANOMALY
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IN WHAT RHYTHM DO WE SEE CIRCUS RHYTHM IN AV NODE DUE TO REENTRY?
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AV NODAL REENTRY TACHYCARDIA
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WHAT IS THE PRECIPITATING FACTOR IN AVNRT?
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PAC
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WHAT IS THE TX FOR AVNRT?
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BURN ATYPICAL CONDUCTION PATHWAY
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WHAT ARE THE CRITERIA FOR AVNRT?
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ABNORMAL CONDUCTION PATH IN THE AV NODE, PAC, SUSTAIN TACHYCARDIA IN AV NODE
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BECAUSE THERE IS NO LONGER NORMAL AV NODE CONDUCTION DELAY IN AVNRT, WHAT IS THE VENTRICULAR RATE WITH THIS RHYTHM?
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180-200 BEATS PER MIN
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20-30% OF SVT ARE THESE?
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AVRT
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WHERE IS THE ACCESSORY PATHWAY IN AVRT?
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OUTSIDE OF THE AV NODE; NORMALLY IN THE FIBROUS SKELETON OF THE LEFT VENTRICLE (BUNDLE OF KENT)
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IS THERE A DELAY IN AVRT?
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NO...BECAUSE THE AV NODE IS NOT INVOLVED IN CONDUCTION
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WHAT TYPE OF CONDUCTION OCCURS AFTER IMPULSES GO THROUGH THE BUNDLE OF KENT IN AVNR?
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CELL TO CELL DEPOLARIZATION
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WHAT DISTINCT FEATURE IS SEEN ON THE EKG IN AVRT?
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PR SEGMENT DISAPPEARS; UPWARD DEFLECTION CAUSES A DELTA WAVE (REPRESENTS DEPOLARIZATION THROUGH VENTRICULAR TISSUE)
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DESCRIBE THE PR INTERVAL AND QRS IN AVRT
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SHORT PR INTERVAL AND PSEUDOWIDE QRS
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TRUE OR FALSE. WOLF-PARKINSON-WHITE IS AN AVRT
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TRUE
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THIS IS THE CLASSIC TYPE OF AVRT
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TYPE A- QRS COMPLEXES UPRIGHT AND USUALLY ASSOCIATED WITH KENT BUNDLE (CLASSIC DELTA WAVE SEEN)
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WHAT SPARKS AN AVRT?
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A PAC
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WHAT IS THE BEST LEAD TO SEE WPW OR AVRT?
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LEAD V4
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WHAT IS ANTODROMIC AVRT?
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IMPULSE TRAVELS DOWN BUNDLE OF KENT AND BACK UP AV NODE; WIDE COMPLEX TACHYCARDIA
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WHAT IS ORTHODROMIC AVRT?
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WHEN IMPULSE TRAVELS DOWN AV NODE AND RETURNS TO ATRIA THROUGH BUNDLE OF KENT' NARROW COMPLEX TACHYCARDIA BECAUSE IT MAINTAINS A DELAY IN THE AV NODE
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IN ANTIDROMIC AVRT, WHAT DOES ADENOSINE DO?
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THE BUNDLE OF KENT WILL BECOME THE NORMAL PACEMAKER
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WHAT DO YOU BASE THE DIAGNOSIS OF ATRIAL FLUTTER ON?
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THE EKG PICTURE
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WHAT IS THE RATE WITH ATRIAL FLUTTER?
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ATRIAL RATE 250-350 BEATS PER MIN; VENTRICULAR RATE VARIES (BEWARE 150)
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WHAT IS THE P WAVE PATTERN WITH ATRIAL FLUTTER?
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CHARACTERISTIC SAWTOOTH PATTERN (F WAVES)
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WHAT DO YOU SUSPECT IN YOUNG PEOPLE WITH ATRIAL FLUTTER?
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SUSPECT HYPER/HYPOTHYROIDISM OR ALCOHOL
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ETIOLOGIES OF ATRIAL FLUTTER
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LEFT OR RIGHT ATRIAL ENLARGMENT, VALVULAR HEART DISEASE
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SIGNS AND SYMPTOMS OF ATRIAL FLUTTER
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ASYMPTOMATIC WITH NORMAL VENTRICULAR RESPONSE; IF THERE IS RAPID VENTRICULAR RESPONSE, THERE WILL BE SIGNS OF POOR CARDIAC OUTPUT
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TREATMENT FOR ATRIAL FLUTTER
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IF UNSTABLE- CARDIOVERT; IF STABLE, CONTROL RATE AND CONSULT
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THIS IS CONTINUOUS RAPID FIRING OF MULTIPLE ATRIAL AUTOMATICITY FOCI; NO SINGLE PULSE DEPOLARIZES THE ATRIA COMPLETELY; AND ONLY AN OCCASIONAL IMPULSE REACHES THE AV NODE
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ATRIAL FIBRILLATION
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RHYTHM In ATRIAL FIBRILLATION
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GROSSLY IRREGULAR- IRREGULARLY IRREGULAR
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P WAVES IN ATRIAL FIBRILLATION
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NO DISCERNABLE P WAVES
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MOST COMMONLY SUSTAINED DYSRHYTHMIA IN THE US
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ATRIAL FIBRILLATION
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CONTINUOUS RAPID FIRING OF MULTIPLE ATRIAL AUTOMATICITY FOCI; NO SINGLE PULSE DEPOLARIZES THE ATRIA COMPLETELY AND ONLY OCCASIONAL IMPULSES REACH THE AV NODE- WHAT RHYTHM?
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ATRIAL FIBRILLATION
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COMMON ETIOLOGIES FOR ATRIAL FIBRILLATION
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ASCVD (ATHEROSCLEROTIC CARDIOVASCULAR DISEASE) AND HYPERTENSION; ALSO HYPO/HYPERTHYROIDISM, ATRIAL SEPTAL DEFECT, MITRAL DISEASE, CARDIOMYOPATHY, LAE, AND ALCOHOL
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WHAT IS ASCVD
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ATHEROSLCEROTIC CARDIOVASCULAR DISEASE
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SIGNS AND SYMPTOMS OF ATRIAL FIBRILLATION
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IRREGULARLY IRREGULAR PULSE; MAY BE ASSYMPTOMATIC IF CHRONIC OR SLOW VENTRICULAR RESPONSE; IF RAPID VENTRICULAR RESPONSE THERE WILL BE SIGNS OF LOW CARDIAC OUTPUT (PALPITATIONS)
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THERE IS NO _________________ IN ATRIAL FIBRILLATION.
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CONTRACTILITY
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IF A PATIENT IS UNSTABLE WITH ATRIAL FIBRILLATION, WHAT IS THE TREATMENT?
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CARDIOVERSION
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IF THE PATIENT IS STABLE WITH ATRIAL FIBRILLATION, WHAT IS THE TREATMENT?
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ANTICOAGULATION, CONTROL RATE, AND REFER
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