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42 Cards in this Set

  • Front
  • Back
Which Artery supplies the SA node?
Sinoatrial Br. from RCA (60%)
Through what receptor is vagal tone supplied to heart?
Sympathetic?
Vagal= muscarinic, cholinergic mAchR, (as opposed to nAchR, nicotinic cholinergic)
Symp: adrenergic, B1 receptors
Which 3 factors, released after an MI and retained locally, can cause bradycardia?
Mechanism
glutamic acid,
aspartic acid,
HYPERkalemia
---all have Negative chrontrophic effect
What 3 maneuvers might trigger bradycardia (BC)
Valsalva (shutting mouth/nose and force exhale--sim to lifting heavy objects/straining bowels)
-Carotid Pressure
-Ocular Pres.
With myxedema secondary to it, what is a metabolic cause of BradyCardia
HYPOthyroidism
--hypothermia and Beta adrenergic blockage also causes BC
How does Heart rate change/cause sinus arrhythmias with respiration
HR increases with inspiration
HR degreases with expiration
What is the most common cause of a pause in ECG, thus a BC segment?
a non-conducted PAC.
How does digitalis cause BC
slows SA by increasing parasympathetic tone
--other drugs used for HTN cause BC (clonidine, beta blockers "olols")
-quinidine, hyperkalemia
Which sort of MI often causes BC?
Acute, Inferior MI
--ischemia to this region
inc BP, inc pCO2
dec. pO2, dec. pH
--all cause what arrhythmia?
Bradycardia
What effect do Beta Blockers have on heart rate?
How?
cause BC:
Inhibit SA conduction by suppressing sympathetic tone
What is characteristic of SSS in EKG?
When seen?
tachy and brady and flatline
--seen in ischemic, scleotic or inflammatory changes in SA node
Under what conditions might you treat Sinus BC
if HR < 45-50 with Hemodynamic Compormise or
unstable acute conditions
What is most common Tx of Sinus BC.
Special cautions?

-2nd Line Tx to Atropine?
Atropine: .3-->.5-->1mg or 2mg IV over 10mins
-caution in glaucoma--inc IOP

-Use epinephrine (last is isoproterenol)
--surgical PM implant
List 4 types of Bradycardia
1. Sinus BC
2. Non-conducted Atrial Bigeminy (tri too)
3. SA Block--(look for Atrial/Junctional/Ventricular escape)
4. AV Block--incomplete/complete (complete when ventricular rate is very slow)
Which arrhythmia is associated with lung Dx like COPD, pneumonia etc?
MAT
Multifocal Atrial Tachycardia
Syncope, Lightheadedness, Chest Pain, Palpitation, CHF are Sx/History of what arrhythmia
Both Tachy AND Brady
Which valvular Dx is assc w/ Tachycardia (TC)?
Which Heart Dxs?
Mitral Valve (prolapse)
--stenosis

-Ischemia to/causing CAD, MI
---or inc. BP
Which are aminophylline and thyrotox assc. w/, BC or TC?
Tachy
How are the majority of SVT caused?
Supra Ventricular Tachs are mostly caused by reciprocating reentry tach; due to an ectopic circulating wave
What is a common mechanism for a SVT initiation?
the Conduction of a PAC (or Premature atrial Beat, PAB), P` come early and drop early beat,
as opposed to a blocked PAC (as would cause brady)
List the Six Classifications of SVTs of Atrial Tachycardia
1. Sinus Tach
2. Sinus Node re-entry (rarer)
3. Atrial Fib
4. Atrial Flutter
5. Atrial Tach (1 ectopic automaticity focus)
6. MAT (several foci)
List the 3 Classifications of SVT of Junctional origins causing tachy?
---Sign for on EKG
1. AV nodal reentry
2. AV reentry
3. Paroxysmal Junctional Tach
---look for P wave adjacent, in or after QRS
Name the 2 Pre-excitation syndromes for SVTs & their mechanism
Bypass AV node/insulation straight to ventricle.
-WPW, has Kent down R. side. R. atrium
-LPL-James tract over AV node
----look for blend/curving of P into QRS
What are physiologic causes of Sinus Tach in Thryoid and blood volume?
HYPERthyroid

Hypovolemia
Shortened diastole in SVT causes what EKG feature?
ST-T depression
How might you treat PT with Sinus rhythm into Atrial Tachycardia
Dig
BBlockers
If ekg shows tachycardia w/o identifiable P waves, what is likely classification of SVT?
Junctional (nodal) Tach
How might you treat a SVT due to Junctional/Nodal tach?
ie, how to slow nodal impulses
Adenosine
describe EKG for AVNRT
AV Nodal Reentrant Tach?
P-waves may be obscured in/around QRS, due to retrograde depol starting in node)
describe EKG for AVRT with BT?
Atrioventricular Reentrant Tach with Bypass tract
Short PR intervals
sluring of Pwave into QRS
Delta Wave (in WPW, retrograde depol to above tract)-- U-shaped before T wave
What is main distinguishing EKG feature for determining a Tachycardia is SVT instead of ventricular?
narrow QRS
which SVT is indicated by irregular undulation of baseline assc. w/ irregular ventricular rhythm.
Atrial Fibrilation --- irregularly irregular
--coarse/ medium/ fine
-----few to many impulses get to vents
this arrhythmia has no p-waves, normal QRS complexes that are irregular in time
Atrial Fib
--p waves replaed by 'f' waves (or NO sign at all of atrial activity)
Mitral Stenosis is indicated by what on EKG (until proven otherwise)
Combo of A. Fib and RAD
Term for Atrial Fib with venricular beats (or average of vent beats) of 100 or less
Controlled A-Fib

--Atrial Fib with Rapid Response is vent are tachy
What is difference b/w wandering pacemaker and MAT
Both have changing P` due to multiple atrial foci, but it's MAT ONLY if the atria impulses conduct vents in tachycardia
What are most salient features of Atrial Flutter?
View in V1
Which leads best identify
Sawtooth/Undulating 'f' waves in inferior leads (2,3, AVF)
-Sharp, P-like Wave in V1
-250-350 beats
Inferior LEads best for A.Flutter
What are QRSs like in Atrial Flutter?
Most common ratios
QRS normal (ie, not widened)
2:1 and 4:1 flutters to dropped beat (AV conducted)
range is to 8:1 though, and 3:1 is uncommon
Can an Atrial Flutter be Irregularly Regular
Yes, it can be an irregular heart beat, but have a regular/repeating ration of flutter waves to dropped beats
--ie, will note 2:1 or 4:1 sawtooths to QRS in Inferior Leads (II, III & AVF) and spiked p-like waves in V1
Remember!!!
When counting beats for SVTs, to determine flutter vs fib. your counting the???
The atrial beats, while the vents may or may not be tachycardic (controlled or rapid response) the atrial will be
Which SVT is assc. w/
varying PR-intervals
Irregular Rhythm
freq PACs
---theophylline, catechoalmines
MATs: Lung/Pulmonary Dx
also HYPOKalemia & HypoMg
---treated with MgSulfate