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45 Cards in this Set
- Front
- Back
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what are the six types of atrial arrhythmias?
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premature atrial contractions
paroxysmal atrial tachycardia atrial flutter atrial fibrillation multifocal atrial rhythm junctional reentrant tachycardia |
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describe premature atrial contractions on an EKG?
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early occuring QRS identical to sinus beats preceded by a P wave.
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what are the four etiologies for premature atrial contractions?
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normal variant, stimulants, atrial enlargment, HTN, valvular dz, ischemia, irritants
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when is therapy for atrial premature contractions warrented?
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if pt is extremely symptomatic
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describe Paroxysmal atrial Tachycardia on an EKG?
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rate 150-250
P waves are evident before EACH QRS narrow QRS complex. abnormal axis sudden onset and cessation summary: 150-250 bpm + abnormal axis + bursts |
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what is the etiology for PAT?
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Hyperthroidism, toxins, HTN, digoxin toxicity, holiday heart syndrome
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why would you get an echocardiogram in a pt experiencing PAT?
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looking for the atrium and dilation because pulmonary HTN, tricuspid atresia, mitral regurg and stenosis would make it dilate.
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how do you tx PAT?
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DC cardioversion if hypotensive or in CHF
adenosine diltiazem metoprolol or atenolol digoxin |
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what is the fxn of adenosine in txing PAT? how is it administered?
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functions to slow the AV node condution and is an excellent coronary dilator. Administered IV in a large bolus in a proximal vein.
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what is long term therapy for PAT?
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metoprolol, verapamil or diltiazem... consider antiarrhythmic if above is unsuccessful.
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describe A flutter on an EKG?
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regular atrial waves at 250-350/ min. QRS rate generally reg, but may be irregular and atrial waves often have biphasic configuration.
summary: Reg rhythm, P waves present, 300 rate |
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what are the 5 etiologies for A flutter?
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irritants, toxins, stimulants, atrial enlargement, valvular dz.
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how do you evaluate for atrial flutter?
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drug screen, echocardiogram and consider stress testing
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what is the therapy for A flutter in a acute intervention for tachycardic response?
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B-blocker, calcium blocker, digoxin, vagal maneuver, adenosine, DC cardioversion in extreme cases
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what is the fxn of the vagal maneuver? give some examples of vagal maneuver.
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fxn: shuts down the AV node pretty quickly.
ex: valsalva, carotid massage, ice cold water shock, gag reflex |
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why can't you use to vagal maneuver to tx PAT?
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in PAT there is an irritated foci not a circuit to break and so you have to hit a certain spot. So, you focus with a depressing agent hard to stop it.
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what is the long term management for Atrial flutter?
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b-blocker, digoxin, calcium blocker, antiarrhythmic, anticoagulation, and ablation/pacemaker.
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describe Atrial fibrillation on ECG?
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irregular rhythm w/ no reproducable P waves.
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in pts >75 yoa, what is the Risk factor for developing/ having atrial fibrillation?
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7-10%
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what is the etiology of atrial fibrillation?
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HTN, valvular dysfunction, LV hypertrophy/ diastolic noncompliance, toxins, ischemia, thyroid dysfunction, irritants/ post operative
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what surgery has a 33% change of its pts developing atrial fibrillation in post op? what percentage of pts will have this rhythm after valvular replacement surgery?
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any cardiac surgery; 50%
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how do you evaluate for atrial fibrillation?
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echocardiogram, labs for TSH, toxins and stress testing
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what is the therapy for A fib?
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control ventricular response, prevent thrombosis/embolism (on anticoagulants for the rest of their lives)
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what are the two decisions that must be made once a pt is diagnosed with A fib?
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control v conversion. Control- make the rhythm livable, conversion make the rhythm sinus.
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how do you control ventricular response in A fib? which drug is NOT indicated?
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digoxin, verapamil/ diltiazem, b-blocker.
CI: adenosine |
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how do you convert A fib to sinus?
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DC cardioversion if in extremes, elective cardioversion, medical cardioversion w/ type 1c Ibutilide.
often occurs spontaneously in acute setting when ventricular rate is controlled w/ meds. |
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Control or convert. tell why
1) large atria 2) severe LV dysfunction 3) unrepaired valvular dz 4) replaced valve |
1) control--> associated w 75% reversion rate
2) control --> associated w/ 50% reversion rate 3) control--> increases failure rate 4) control--> if you can't fix 5) convert --> since it is fixed |
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what is the most commonly used drug in A. fib? what is its fxn?
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Digoxin: allows for rapid return to sinus rhythm
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which drug should you use to maintain sinus rhythm in a pt w/ A. fib and HTN?
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verapamil/ diltiazem --> excellent indication w/ HTN
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which drug is used to maintain sinus rhythm in A. fib pts has an increased risk of sudden cardiac death?
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quinidine
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which drug used to maintain sinus rhythm is pts w/ A fib has a 50-55% efficacy in direct arrhythmia, but a moderate risk of proarrhythmia?
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flecainide/ propaphenone
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which drug used to maintain sinus rhythm is pts w/ A fib has a 70% efficacy in direct arrhythmia prevention and has rare, but morbid SEs?
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amiodarone
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which drug used to maintain sinus rhythm is pts w/ A fib has a 65% efficacy in direct arrhythmia prevention, but high risk of proarrhythmia?
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sotolol
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which drug used to maintain sinus rhythm is pts w/ A fib is similar to amiodarone, but w/o the toxicities?
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dronedarone
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what is the percentage of embolic incidence in older pts on warfarin?
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14%
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when are invasive therapies indicated in A fib pts? what are they?
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for refractory arrhythmia and high risk pts unable to tolerate medical therapy.
1) Maze procedure--> creates electrical channel from sinus to AV node. 2) Catheter AV node ablation w/ pacemaker insertion--> blocks AV node |
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describe Multifocal atrial rhythm on EKG?
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irregular rhythm w/ P waves before each QRS, but at least three different morphologies.
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how does Multifocal atrial rhythm differ from A fib on EKG?
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Multifocal atrial rhythm has very discrete visible P waves.
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what disease is most commonly associated with Multifocal atrial rhythm? what are the old etiologies?
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-decompensated pulmonary dz
other: valvular dz |
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what therapy is used for Multifocal Atrial rhythm?
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anticoag, and maybe antiarrhythmics
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describe SVT on EKG. what does it look IDENTICAL to?
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rate 200-250
reg rhythm w/ no P wave or retrograde P wave looks identical to PAT if the P waves are retrograde. |
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how do you tx SVT?
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AV node blockade:
- adenosine - beta blocker - verapamil/ diltizem - digoxin - vagal maneuvers - antiarrhythmics |
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describe Pre-excitation on EKG.
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PR interval less than 120 msec
w/ or w/o delta wave narrow or wide QRS |
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what age group are pre-excitations most commonly expressed in?
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younger pts from teenage years to mid-40s
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how to manage narrow QRS pre- excitation? wide QRS pre-excitation?
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narrow: same as SVT
wide: NO AV BLOCKERS (CI) antiarrhythmics |
