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45 Cards in this Set
- Front
- Back
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Manifestations of Cardiac Arrhythmias
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Palpitations
Lightheadedness or Syncope Angina Heart Failure Sudden Cardiac Death (not good) |
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Causes of Arrhythmias
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Hypoxemia
Ischemia Sympathetic Stimulation Drugs Electrolyte Disturbances Bradycardia Stretch |
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5 Basic Types of Arrhythmias?
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1. Normal Pathway, but too fast, slow, or irregular (sinus origin)
2. Originates from focus other than SA node (ectopic) 3. Reentrant Arrhythmias 4. Conduction Blocks 5. Preexcitation Syndromes |
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Easy way to determine HR from an ECG?
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1 box between QRS's = 300bpm
2 boxes = 150bpm 3 = 100 4 = 75 5 = 60 6 = 50 7 = 43 8 = 37 |
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Arrhythmias of Sinus Origin?
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Sinus Bradycardia (<60bpm)
Sinus Tachycardia (>100bpm) Sinus Arrhythmia Sinus Arrest |
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How does breathing affect Sinus Arrhythmia?
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Inhale = Increases Rate
Exhale = Decreases Rate |
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What does it mean when there is no P wave?
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Sinus Arrest
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Non-Sinus Pacemakers and their rate
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A-V Node: 40-60bpm
Atrial Pacemaker: 60-75bpm Ventricular Pacemaker: 30-45bpm |
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In general, what causes ectopic rhythms
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Enhanced Automaticity of Nonsinus node sit
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What is a common drug cause of Ectopic Rhythm?
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Digoxin (digitalis) toxicity
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How do we analyze rhythm?
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Normal P-waves?
Width of QRS complexes? Relationship between P-waves and QRS complexes? Rhythm Regular or Irregular? |
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How do we analyze p-waves for normalcy?
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are they present and upright in leads 1 and 2
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What is a supraventricular arrhythmia?
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its an atrial arrhythmia usually caused by the sinus node
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Types of Sinus Node issues that can cause Supraventricular Arrhythmias?
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Sinus Arrhythmia
Sinus Bradycardia Sinus Tachycardia |
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Rx for Sinus Node Supraventricular Arrhythmias?
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NONE
look for underlying cause |
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Types of Supraventricular Arrhythmia?
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Atrial & Junctional Premature Beats
Paroxysmal Supraventricular Tachycardia (PSVT) Atrial Flutter Atrial Fib Multifocal Atrial Tachycardia Paroxysmal Atrial Tachycardia (ectopic?) |
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site of impulse formation in Atrial Premature Beats?
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not SA Node
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ECG reading for Atrial Premature beats?
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p-wave different from sinus P
QRS can be absent or wide depending on refractory conduction |
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Cause of Atrial Premature Beats?
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Excessive Sympathetic Tone
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Difference between PAC, PJC, and PVC?
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PAC and PJC have a narrow QRS (unless aberrant conduction)
PVC has a widened QRS w/ no preceding P-wave |
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How does a blocked PAC look on an ECG?
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no subsequent QRS
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Typical Course w/ PSVT?
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pts w/o structural heart disease
Begins and ends abruptly |
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HR w/ PSVT?
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possibly 140-240
usually 160-220 |
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Most common etiology of PSVT?
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Reentry involving dual pathways in A-V Node
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Typical outcome of PSVT?
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w/o heart disease, serious effects are rare
Usually terminates spontaneously |
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Rx for PSVT?
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Vagal Maneuvers
Drugs Cardioversion |
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Types of vagal maneuvers?
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Valsalva
Carotid Sinus Massage |
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Drugs used for PSVT?
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Adenosine
Verapamil others (diltiazem, esmolol, digoxin) |
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What is the most common chronic arrhythmia?
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Atrial Fibrillation
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How does atrial fib affect ventricular rhythm?
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it causes it to be rapid and very irregular
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Sx's of A. Fib?
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Sx's are related to underlying heart disease, med conditions, and HR
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How does A.Fib look on an ECG?
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moderately course "fib waves" w/ normal QRS if you get a controlled ventricular response
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How do you manage A.Fib?
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Rate Control
Rhythm Control Anticoagulation |
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How do you treat the Rate?
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Beta Blockers
Ca Channel Blockers |
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how do you Rx the rhythm?
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Electrical or Pharm Cardiovesion
+/- drugs to maintain sinus rhythm |
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Why anticoagulation?
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To prevent Strokes
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Pop Quiz: unstable patient (hypotensive, HF, ischemia) w/ Atrial Fib...WHAT DO YOU DO?
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Urgent Cardioversion
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How many A-Fib pts (initial time) spontaneously convert w/in 48hrs?
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2/3rds
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Causes of Atrial Flutter?
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COPD
Valvular Heart Disease CAD HF Surgically repaired CHD |
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Pathogenesis of Atrial Flutter?
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Ectopic focus in atrium fires at 250-350 times per minute
Every 2nd-4th beat transmits to ventricle |
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ECG of Atrial Flutter?
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just think LOTS of p-waves and small spikes before and after p-waves...
that's not very descriptive...oh well |
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Rx of unstable pt w/ atrial flutter?
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urgent cardioversion
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Rx of stable pt w/ atrial flutter?
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Elective Electrical Cardioversion
Pharmacologic Cardioversion Rate Control |
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How does Rate control Rx differ between atrial flutter and fib?
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Rate control is more difficult w/ a. flutter
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Drugs for Pharm Cardioversion of A-Flutter?
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Class III Antiarrhythmics:
Ibutilide Dofetilide |
