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61 Cards in this Set
- Front
- Back
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Ventricular arrhythmias |
arrthymias originating below the branching portion of the HIS bundle in the ventricles |
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When do they most commonly occur |
- Significant cardiac disease (CAD, MI, acute MI) - Increased sympathetic tone - Valvular heart disease - Left ventricular aneurysms - Cardiomyopathies - Congestive heart failure |
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Ventricles arrhythmias can occur with ... 1. __________________ 2. __________________ 3. __________________ 4. __________________ |
1. Hypoxia 2. Electrolyte/acid base imbalances 3. Digoxin toxicity 4. "Pro-arrhythmic" effects of certain drugs |
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Electrophysiologic mechanisms responsible for ventricular arrhythmias 1. __________________ 2. __________________ 3. __________________ |
1. increased automaticity 2. re-entry 3. triggered activity |
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Arrhythmias originating in the ventricles have a ___________ QRS |
Wide QRS (>0.10 seconds to >0.14 seconds) |
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What is a premature ventricular contraction |
Extra ventricular contractions originating from an ectopic focus in the ventricles |
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Unipolar/unifocal/monomorphic PVCs |
PVCs originating from a single focus and the same shape for each early beat |
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Multifocal/polymorphic PVCs |
PVCs originating from multiple sites in the ventricles and the shape of each early beat will vary |
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What is the #1 hallmark sign of PVCs |
The underlying rhythm is not disturbed or interrupted |
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Bigeminal |
Every other beat is a PVC |
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Ventricular tachcardia |
3 or more consecutive PVCs are present at a rate >100/min-250 min (usually 150-180) |
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Non-sustained/paroxysmal rhythm |
V.tach rhythm that may start and stop |
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Sustained V.tach rhythm |
May persist for a long period of time |
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What should always be considered V.tach until proven otherwise? |
Wide QRS tachycardias |
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What drug do you not use with V.tach |
Calcium channel blockers (Verapamil) --> can exacerbate V.tach |
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What drugs should be given in V.tach |
Amiodarone, Procainamide, Lidocaine |
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Torsade de Pointes |
- Twisting around the baseline - Form of V.tach that occurs when the Q-T interval is prolonged |
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What drugs induce Torsade de pointes? |
Quinidine, Procainamide, disopyramide, pehnothiazines, tricyclic anti-depressants |
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What congenital condition produces torsade de pointes? |
Prolonged QT syndrome or electrolyte imbalances |
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Characteristics of Torsade de pointes |
QRS complexes that vary in shape and change above and then below the isoelectric baseline |
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Drug of choice for torsade de pointes |
Magnesium sulphate |
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Normal male QT interval |
440 ms |
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Normal female QT interval |
460 ms |
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V.tach clues 1. __________________ 2. __________________ 3. __________________ 4. __________________ 5. __________________ |
1. Rate 150-180 2. P waves may be present or retrograde or absent but have no relationship to QRS 3. Rhythm is regular but may vary slightly 4. QRS width is usually 0.14 or greater 5. Morphologic clues of QRS in V1 or V6 |
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V.tach possible cause 1. __________________ 2. __________________ 3. __________________ 4. __________________ 5. __________________ 6. __________________ 7. __________________ 8. __________________ |
1. Coronary artery disease 2. Cardiomyopathy 3. Valvular heart disease 4. Increased sympathetic tone 5. Stimulants 6. Electrolyte imbalance 7. Dig toxicity 8. Acid/base imbalances |
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V.tach hemodynamic effects 1. __________________ 2. __________________ 3. __________________ 4. __________________ 5. __________________ |
1. May be symptomatic if the rate is slower (110) or if runs are short (start and stop) 2. Usually symptomatic because of increased rate (150 or >) and sustained 3. Loss of atrial kick 4. No time for heart to fill 5. Can be life threatening and deteriorate to pulseless |
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V.tach Treatments 1. __________________ 2. __________________ 3. __________________ 4. __________________ |
1. Depends on hemodynamic stability or instability 2. With pulse and systolic BP aprox 90: amiodarone, lidocaine, procainamide, magnesium, electrolyte replacement, possible cardioversion 3. With pulse but systolic BP <90: sedate and convert 4. No pulse: CPR, Defibrillate |
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Advanced cardiac life support rules 1. __________________ 2. __________________ |
1. Wide QRS tachycardia is V tach until proven otherwise 2. Always remember rule #1 |
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Hallmarks of V.tach 1. __________________ 2. __________________ 3. __________________ |
1. QRS 0.14-0.16 or greater 2. Regular rhythm 3. P waves are lurking |
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Cardioversion 1. __________________ 2. __________________ 3. __________________ |
1. Timed delivery of electrical impulse to reset 2. Must have a pulse 3. Must have conscious sedation |
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Ventricular fibrillation |
Lethal arrhythmia that occurs when there are multiple areas in the ventricles depolarizing and repolarizing with no "organised" ventricular depolarization |
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Ventricular rate in v. fib |
300-500 bpm resulting in no pulse |
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V. fib clues 1. __________________ 2. __________________ 3. __________________ |
1. Grossly irregular baseline with no normal looking QRS's or P waves 2. May be fine <3mm 3. May be course >3mm |
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V.fib possible cause 1. __________________ 2. __________________ 3. __________________ 4. __________________ 5. __________________ 6. __________________ 7. __________________ 8. __________________ |
1. Coronary artery disease 2. Cardiomyopathy 3. Valvular heart disease 4. Increased sympathetic tone 5. Stimulants 6. Electrolyte imbalances 7. Dig toxicity 8. Acid/base imbalance |
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V.fib hemodynamic effects 1. __________________ 2. __________________ 3. __________________ |
1. Lethal 2. No pulse 3. No BP |
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V.fib treatments 1. __________________ 2. __________________ |
1. Rapid defibrillation 2. CPR |
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Idioventricular rhythm (Ventricular escape) |
Occurs when a focus in the bundle branches, purkinge network or ventricular myocardium is forced to "kick in" and pace the ventricles at a rate of 20-40 because the sinus node and/or AV node have failed |
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Ventricular escape clues 1. __________________ 2. __________________ 3. __________________ 4. __________________ 5. __________________ |
1. Wide QRS 2. Rate 20-40/min 3. Regular 4. Usually no P waves 5. If P waves are present, there is no relationship to the QRS (AV dissociation) |
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Ventricular escape causes 1. __________________ 2. __________________ 3. __________________ 4. __________________ |
1. Coronary artery disease 2. Myocardial ischemia/infarct 3. Degeneration of SA/AV node "Sinus arrest" 4. Dig toxicity |
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Ventricular escape hemodynamic effects 1. __________________ 2. __________________ |
1. Patient will be symptomatic with marked hypotension decreased SV/CO 2. Can be lethal |
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Ventricular escape treatments 1. __________________ 2. __________________ 3. __________________ 4.__________________ |
1. Must be treated immediately with pacemaker 2. Atropine and/or Isuprel 3. Dopamine and/or Epinephrine may be tried if delay in pacing 4. Correct underlying cause |
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Accelerated Idioventricular Rhythm |
Occurs most commonly in a patient experiencing an acute MI where an ectopic focus (from altered automaticity) in the ventricle, exceeds the rate of the sinus node and paces the ventricles at a rate >100 but more than the inherent rate of the ventricles (40) |
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What must happen for accelerated ventricular rhythm to occur 1. __________________ 2. __________________ |
1. The sinus rate must slow 2. The ventricular ectopic's rate exceeds the sinus rate |
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Accelerated idioventricular rhythm 1. __________________ 2. __________________ 3. __________________ 4. __________________ 5. __________________ |
1. Rate >40 and <100 2. Wide QRS 3. Onset and termination gradual with fusion beats 4. Usually regular 5. P waves may be present or absent but no association to QRS |
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Accelerated idioventricular rhythm causes 1. __________________ 2. __________________ 3. __________________ 4. __________________ |
1. Coronary artery disease 2. Ischemia 3. Acute MI 4. Dig toxicity |
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Accelerated idioventricular rhythm hemodynamic effect |
Usually asymptomatic but may deteriorate if associated with digoxin toxicity |
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Accelerated idioventricular rhythm treatments 1. __________________ 2. __________________ |
1. Usually none 2. Treat underlying cause |
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Ventricular asystole |
Electrical impulses fail to enter the ventricles No escape pacemaker takes over Total absence of ventricular electrical and mechanical activity |
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When can ventricular asystole occur 1. __________________ 2. __________________ 3. __________________ |
1. Primary event in cardiac arrest 2. Following V. fib 3. Pulseless electrical activity |
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What does asystole masquerade as |
V. fib - 3 leads are checked to "hunt for v.fib" |
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Ventricular Asystole clues 1. __________________ 2. __________________ |
1. No P waves 2. No QRS complexes |
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Ventricular asystole causes 1. __________________ 2. __________________ 3. __________________ 4. __________________ 5. __________________ 6. __________________ 7. __________________ 8. __________________ 9. __________________ 10. __________________ 11. __________________ 12. __________________ |
1. Coronary artery disease 2. MI 3. Hypoxia 4. Hypovolemia 5. Hypothermia 6. Increased K+ 7. Decreased K+ 8. Acidosis 9. Drug overdose 10. Tension pneumothorax 11. Cardiac tamponade 12. Pulmonary or coronary thrombus |
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Ventricular asystole hemodynamic effects 1. __________________ 2. __________________ 3. __________________ |
1. Lethal 2. No pulse 3. Death |
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Ventricular asystole treatments 1. __________________ 2. __________________ 3. __________________ 4. __________________ 5. __________________ |
1. CPR 2. Consider reversible causes 3. Consider pacing 4. Epinephrine 5. Atropine |
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Trigeminal |
There is one PVC for every two normal beats |
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Paired PVCs |
2 PVCs back to back. Where there are 3 or more in a row, it is termed ventricular tachycardia (or a run) |
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PVC clues 1. __________________ 2. __________________ 3. __________________ 4. __________________ 5. __________________ 6. __________________ |
1. Early wide QRS complex's (0.12/.14 or greater) 2. T-wave opposite to underlying position 3. May have sinus or retrograde P waves "lurking" around but they are not related to the QRS 4. Complete compensatory pause 5. May be incomplete pause if retrograde atrial depolarization fusion 6. Morphologic clues of QRS in V1 and V6 |
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PVC possible cause 1. __________________ 2. __________________ 3. __________________ 4. __________________ 5. __________________ 6. __________________ 7. __________________ 8. __________________ |
1. CAD: ischemia, acute MI, CHF 2. Cardiomyopathy 3. Valvular heart disease 4. Increased sympathetic tone 5. Stimulants 6. Electrolyte imbalance 7. Dig toxicity 8. Acid/Base imbalance |
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PVC hemodynamic effects 1. __________________ 2. __________________ 3. __________________ |
1. Asymptomatic but may be a warning sign of more serious arrhythmias (V. tach/Vfib) 2. Are especially dangerous if they fall on T-waves, are multifocal and occur in runs 3. Symptomatic usually with frequency: Decreased SV, CO, BP; lightheadedness |
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PVC treatments 1. __________________ 2. __________________ 3. __________________ |
1. Correct underlying cause 2. If PVCs occur with bradycardia, correct bradycardia first 3. If symptomatic, antiarrhythmia drugs will be considered |
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Antiarrhythmia drugs 1. __________________ 2. __________________ 3. __________________ 4. __________________ 5. __________________ 6. __________________ |
1. Amiodarone 2. Lidocaine 3. Procainamide 4. Magnesium 5. Quinidine 6. Beta blockers |
