Term
| what is the most common supraventricular arrhythmia |
|
Definition
|
|
Term
| describe EKG in premature atrial contraction, cause |
|
Definition
until early P wave/ORS (hides normal P in it) followed by pick back up of sinus
SA node is resetting |
|
|
Term
|
Definition
asymptomatic- none
BB, type Ic |
|
|
Term
| describe EKG in premature junctional complex, cause |
|
Definition
sinus rhythm followed by premature abnormal P wave (upside down or hidden) and QRS with wide S
complex originates from AV node/His |
|
|
Term
| Tx premature junctional complex 2 |
|
Definition
BB
type IC anti arrhythmics |
|
|
Term
| cause of physiological sinus tachycardia 5 |
|
Definition
| pain, exercise, fever, anxiety, hypotension, anemia |
|
|
Term
| cause of inappropirate sinus tachycardia |
|
Definition
| increase HR with normal activity due to SNS increase, PNS decrease, viral illness causing autonomic dysutonomia |
|
|
Term
| signs of inappropirate sinus tachycardia |
|
Definition
| palpitations, CP, GI upset, syncope |
|
|
Term
| TX inappropirate sinus tachycardia 2 |
|
Definition
|
|
Term
| describe the EKG for AFib |
|
Definition
irregular irregular
rapid ventricles 120-160, atria 500
fine fibrillations of P waves with irregular random QRS |
|
|
Term
| physiology of AFib, complications |
|
Definition
atria automaticity and reentry mostly at atria and pulmonary veins
blood pools and clots in atria apendages and causes thrombus and stroke |
|
|
Term
|
Definition
acute hyperthyroid
acute alcohol/drugs
post-op
coronary disease
SVA - AV reentry
increases with age 5%>75yo |
|
|
Term
|
Definition
asymptomatic
fatigue
SOB
syncope
exercise intolerance
palpitations/angina |
|
|
Term
| risk factors for stroke 8 |
|
Definition
valve disease
mechanical valve
previous thromboembolism
heart failure
systole dysfunction
HTN
DM
age |
|
|
Term
| explain the CHAD2 score scoring and what treatment it correlates with |
|
Definition
CHF, HTN, DM, >75yo = 1
previous stroke/TIA = 2
0= no therapy / aspirin
1= aspirin / warfarin
2 = warfarin / thrombin inhibitor |
|
|
Term
| what drug is a trombin inhibitor |
|
Definition
|
|
Term
| how is asymptomatic AFib treated |
|
Definition
if <100BPM then give anticoag according to CHAD2
if >100bph then try BB, CCB, digoxin. if this dosent work try antiarrhythmic...
A: if has CAD then amioderone, soditol, dofetilide
B: if has LV dysfunction, tachy, cardomyopathy then use limited soditol
C: if has LVH/HTN then use fleconide or class 1C
if this dosent work ablate |
|
|
Term
| how is symptomatic stable AFib treated |
|
Definition
IV heparin +
amiodorine, drocamamide, or dofetilide ibuilid
maintain with direct thrombin inhibitor 1 mo
CCB, BB, or digoxin to control ventricle rate
quinidine or disopyramide
if this dosent work ablate |
|
|
Term
| how is symptomatic unstable AFib treated |
|
Definition
IV heparin
TEE if >24h
synch cardiovert biphasic 200J
maintain with direct thrombin inhibitor 1 mo
CCB, BB, or digoxin to control ventricle rate
quinidine or disopyramide
if dosent work ablate |
|
|
Term
| when do you ablate, 3 types |
|
Definition
when all TX dosent work
when LV problems occur
focus: ablate near pulmonary veins
AV: eliminate and put in pace maker
coxmaze: ablate all reentry spots |
|
|
Term
| describe an EKG in AFlutter / microreentrant atrial tachycardia |
|
Definition
regular irregular
atria 200-300
ventricles 130-150
less tolerated than AFib
spiked P waves with regular ventricle contraction between many |
|
|
Term
| descirbe a multifocal atrial tachycardia EKG |
|
Definition
| P waves with at least 3 different morphlogies |
|
|
Term
| cause of multifocal atrial tachycardia 2 |
|
Definition
| pulmonary or septic infection |
|
|
Term
| TX multifocal atrial tachycardia 2 |
|
Definition
|
|
Term
| what do you never use in multifocal atrial tachycardia 4 |
|
Definition
BB
amioderone
flecinide
propefanone |
|
|
Term
| what does a AV reentry tachycardia / proxysmal supraventricular tachycardia look like, cause |
|
Definition
rate 150-250
atria and vantricles both contract
retrograde P waves
AV node has two pathways: 1 slow, 1 fast. current goes doen slow and up fast |
|
|
Term
|
Definition
teens - 30s
alcohol, drugs, excitement
no underlying heart disease |
|
|
Term
|
Definition
avoid trigger
ablation
B/Ca blocker |
|
|
Term
|
Definition
1. vasovagal
2. IV adensine or IV class IV
3. maintience: CCB, BB, digoxin |
|
|
Term
| what does an accelerated junctional rhythm EKG look like, cause |
|
Definition
50-99
depolarization near the AV node or on it
abnormal P waves or none |
|
|
Term
| cause accelerated junctional rhythm 2 |
|
Definition
digitoxin toxicity
ablation of SA |
|
|
Term
| TX accelerated junctional rhythm 3 |
|
Definition
correct toicity
class 1A or 1C |
|
|
Term
|
Definition
Hypoxia- copd
Ischemia + irritability
Sympathetic
Drugs- BB, digoxin, cocaine
Electrolyte- dec K, inc Ca
Brady/tachy
Stretch- LVH/HTN |
|
|
Term
| explain the ion movements in the 4 phases of cardiac muscle contraction |
|
Definition
4. K leaks out
0: Na rush in
1: Na slows, K rush out
2: K rush out, Ca rush in
3: K rush out
4: K leaks slowly |
|
|
Term
| explain the state of the Na gates in cardiac muscle contraction |
|
Definition
4: resting - resting
0: M gates open - open
1: H gates close - absolute/effective refractory, inactive
2: absolute/effective refractry
3: switches mid phase to relative refractory
4: resting |
|
|
Term
| explain the ion movements in the phases of SA/AV contraction |
|
Definition
4: Na leaks slowly in
0: Ca rushes in
3: K rushes out
4: Na leaks in |
|
|
Term
| explain how to read the boxes on EKG |
|
Definition
1 little = 0.04s
1 big = 0.2 sec, 0.5mV
2 big = 1mV
5 big = 1 sec
30 big = 6 sec
# peaks x 10 = rate |
|
|
Term
|
Definition
| stops for >1 beat (3 sec is ok in athlete) |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| channel blocking dosent work well in resting (4) |
|
|
Term
|
Definition
Ca overload
SNS
digitoxin
MI |
|
|
Term
|
Definition
dec HR
de K
prolonged 3
prolonged QT |
|
|
Term
|
Definition
|
|
Term
| what are the three conditions needed for reentry |
|
Definition
1. obsticle
2. unidirectional block
3. long enough to outlast refractory |
|
|
Term
| why are reentrys scary for pt |
|
Definition
| AFib will be accelerated if it happens and cause m ore deterioration |
|
|
Term
|
Definition
PR>0.12
wide QRS
D waves in some leads
consistantly abnormal P waves |
|
|
Term
| what pathway does WPW take |
|
Definition
|
|
Term
| what pathway does lown ganong levine take |
|
Definition
|
|
Term
| what does lown ganong levine EKG look like |
|
Definition
|
|
Term
| how is a reentry treated 4 |
|
Definition
vasovagal
IV adenosine or diltzem
maintience: BB, CCB, digoxin, fleccanide, procamide |
|
|
Term
| how is a person with reentry in AFib treated |
|
Definition
1. cardiovert
2. procanamide, ibutalide, amioderone |
|
|
Term
| what does a 1st deg AV block look like |
|
Definition
slowed conduction through node and tissue
common, asymptomatic, PR>200ms |
|
|
Term
| what does a mobitz type 1 (wenchebach) look like |
|
Definition
usually benign
block on or by node
progressive lengthening of PR until one is dripped |
|
|
Term
| what does a mobitz type II look like |
|
Definition
block below AV node can progress to 3rd deg
may need pacemaker
consistant PR interval until one is dropped |
|
|
Term
| what does a 3rd deg AV block look like |
|
Definition
AV dissociation, ventricles and atrial are independent
block at AV, upper BB, lower BB
ventricles 30-45
atria 60-100 |
|
|
Term
|
Definition
autnomic- vasovagal
lyme, chagas, sphyilis
metabolic: ince K, dec adrenal
drugs: digoxin, CCB, adenosine |
|
|
Term
|
Definition
type 1: none or atropine/epi/amnioderone
type 2: atropine/eip/amnioderone
type 3: atropine/epi/amnioderone or pacemaker |
|
|
Term
| what does a EKG for premature ventricular complex look like, cause |
|
Definition
normal sinus with an out of place wide QRS, hides P wave
comes from purkinje
compensatory pause |
|
|
Term
|
Definition
bigeminy: sinus/PVC/sinus/PVC/snus
tigeminy: sinus/sinus/PVC/sinus/sinus/PVC
pair/couple: sinus/PVC/PVC/sinus/PVC/PVC/sinus |
|
|
Term
| what increases risk of PVC 3 |
|
Definition
|
|
Term
| what should you NEVER take with a PVC |
|
Definition
| antiarrhythmics = DEATH prolong QT |
|
|
Term
| what is a complication of PVC |
|
Definition
|
|
Term
|
Definition
asymp- nothing
symp- BB, K channel blocker |
|
|
Term
| describe the 2 kinds of VTach EKG |
|
Definition
monomorphic: large repeating, regular QRS
polymorphic: oscilating sizes of QRS |
|
|
Term
|
Definition
| origin below bundle of His sustained |
|
|
Term
|
Definition
sustained: >30sec, >3PVC
nonsustained: <30sec |
|
|
Term
| what drugs should you NEVER use in VTach 2 |
|
Definition
|
|
Term
| how is someone who is stable with VTach tx |
|
Definition
satolol
amoderone
phenytoin
lidocaine - MI
propafenene
cardiovert - synch
maintain: quinidine, phenytoin, mexiletine-MI, dysopramide, sotalol |
|
|
Term
| how is someone who is unstable with VTach tx |
|
Definition
cardiovert
maintain: quinidine, phenytoin, mexiletine-MI, dysopramide, sotalol` |
|
|
Term
| describe the 2 EKG types for VFib |
|
Definition
coarse: spiky fibrillations
fine: small fibrillations |
|
|
Term
| VFib: 2 types, tx, effect in blood |
|
Definition
no CO
primary: no CHF
secondary: with CHF
TX: asnch cardiovert |
|
|
Term
| what is the cause of long QT syndrome |
|
Definition
| defect in cardiac ion channel causing repolarization and prolonged plateau |
|
|
Term
|
Definition
implant defiv ig hx arrahytmic or syncope
avoid long QT drugs |
|
|
Term
|
Definition
erythromycin
clathromycin
procanamide
quinidine
flecanide
sotalol
amioderone |
|
|
Term
|
Definition
|
|
Term
| evaluation of tachycardia |
|
Definition
EKG
24h holder
telemetry
electrophysiolgy
ECHO stress test |
|
|
Term
|
Definition
autonimic dysruption
sick sinus syndrome
hypothyroid
hypotension
hypothremia
physiological - athlete
inflammatory - pericarditis
structural heart disease - CAD
vasovagal
BB
CCB
digoxin
lithium
methadone
K channel blocker |
|
|
Term
|
Definition
block Na channels in abnormal high frequency rhythms
affinity for open/inactive channels |
|
|
Term
| MOA of class 1 A-C, half life |
|
Definition
A: N and K block, 1-10sec. increase ERP, supress 0
B: Na block. decrease ERP, increase ) slope.
C: Na, Ca, K blocker. depress slope 0, decrease max depolarization |
|
|
Term
| explain how the class 1A-C graph looks |
|
Definition
A: lengthens 0 slope, lower plateu height, elongated 3
B: lengthens 0 slope less than A, shortens 3
C: lengthens 0 slope most, shortens plateau height |
|
|
Term
|
Definition
quinidine
procanamde
disopyramide |
|
|
Term
|
Definition
lidocaine
mexiletine
phenytoin |
|
|
Term
|
Definition
|
|
Term
|
Definition
B adrenergic agonist
lengthen (decrease) slope of 0 and 4 (shift right)
decrease automaticity at SA, HR, CO
lengthen PR |
|
|
Term
| what drugs decrease mortality in arrhythmia pt |
|
Definition
|
|
Term
| 4 B blockers used for arrhythmia and when |
|
Definition
propanolol, atenolol, metoprolol: decrease sudden cardiac death after MI arrhythmia
esmolol: shor tacting, IV acute arrhythmia |
|
|
Term
| why is esmolol short acting |
|
Definition
| metabolized by RBC t1/2 9 min |
|
|
Term
|
Definition
K channel blockers
elongaed ERP |
|
|
Term
|
Definition
sotalol
amiodarone
dronedarone
dofetilide
ibutilid |
|
|
Term
|
Definition
Ca channel blockers
increase slow of 0, elongate ERP
increase AV.SA conduction
block inactive and active Ca channels mostly at SA/AV node
increase PR due to AV delay |
|
|
Term
|
Definition
|
|
Term
| dofetilide/ibutilid: administration, use, SE |
|
Definition
IV acute
NOT for long duration AFib/Flutter they dont respond
SE torsades
USE: drug cardiovert in WTD arrhythmia, AFib, AFlut |
|
|
Term
| amiodarone, dronedarone MOA |
|
Definition
blocks Na, Ca, K
increases QRS, PR, QT |
|
|
Term
| SE amniodarone, droendarone |
|
Definition
sinus brady
PULMONARY ACEOLITIS/FIBROSIS
hepatotoxicity
photosensitivity
thyroiditis/blue skin- amioderone |
|
|
Term
| use: amniorarone, droendarone |
|
Definition
| ANY supraventricular tachycardia drug cardiovert: AFib/flut (ok with CAD), VTac, AV Block, WPW tachyarrhythmia |
|
|
Term
|
Definition
prolong QT
ERP prolong
B blocker dec SA automaticity |
|
|
Term
|
Definition
EAD
bradycardia
dyspnea
fatigue
torsades |
|
|
Term
|
Definition
MOST MI
maintance post-VTach
drug cardiovert- VTach, LV dysfunction and CAD asymp AFib/Flut |
|
|
Term
|
Definition
antimalaria
anti-M inc HR
a1 blocker dec HR and cause hypotension and long PR
widen QRS and QT |
|
|
Term
|
Definition
mortality in non life threat arrhythmia
hypertension
vertigo
tinnutis
headache diarrhea
torsades
AFib/flutter (due to dec K)
hypokalemia |
|
|
Term
|
Definition
shorted t1/2
acetylated to NAPA which blocks K |
|
|
Term
|
Definition
mortality in non-life threat arrhythmia
hypotension
lupus like due to NAPA acetylation
torsades (hypokalemia) |
|
|
Term
| disopyramide: administration, MOA |
|
Definition
oral
anti-M dec HR
decrease PR interval |
|
|
Term
|
Definition
mortality in non life threat arrhythmia
hypotension
glaucoma
dry mouth
urinary retention
constipation
torsades |
|
|
Term
|
Definition
| local anastetic decreases automaticity in purkinje blocking NA |
|
|
Term
| lidocaine administration and exretion |
|
Definition
IV high first pass
eliminated in liver |
|
|
Term
|
Definition
drowsiness
slurred speech
confusion
convlusions |
|
|
Term
| administration and MOA mexiletine |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
anticonvulsant
blocks NA and purkinke |
|
|
Term
|
Definition
vertigo confusion, gingival hyperplasia
P450 inducer |
|
|
Term
|
Definition
effects normal heart
prolongs AP in atria and ventricles
inc PR, QRS, QT |
|
|
Term
|
Definition
mortality in ventricle arrhythmia
blurred vision
dizzy
headache |
|
|
Term
|
Definition
| flecanide for life threatning ventricular arrhythmias |
|
|
Term
|
Definition
| increased mortality in non life threating arrhythmia |
|
|
Term
|
Definition
accelerated junctional rhythm
maintience VTach/VFib
maintience AFib/Flut |
|
|
Term
|
Definition
accelerated junctional rhythm
drug cardiovert WPW arrhythmia
maintain WPW |
|
|
Term
|
Definition
accelerated junctional rhythm
maintain AFib/Flut
maintain VFib/Tach
drug cardiovert WPW arrhythmia |
|
|
Term
|
Definition
| chem cardiovert VTach/Fib MI |
|
|
Term
|
Definition
| maintain aftr VTach/Fib MI |
|
|
Term
|
Definition
maintain aftr VTach/Fib MI
chem cardiovert VTach/Fib MI |
|
|
Term
|
Definition
premature atrial contraction
junctional premature complex
not responding asymptomatic AFib/Flutter with HTN/LVH
accelerated junctional rhythm
proprafenone: cardiovert VTach/Fib |
|
|
Term
|
Definition
prematyre atrial contraction
junctional premature complex
inappropirate sinus tachycardia
maintain AFib/Flut
maintain PST/AV reentry
dec symp ot PVC
maintain WOW |
|
|
Term
|
Definition
maintain AFib/Flut
multifocal atrial tachycardia
PST/AV reentry
maintain WPW |
|
|
Term
|
Definition
increase aytomaticity
increase refractory in opurkinjue
decrease refractory in ventricles and atria
parasympathetic via vagus increases PR and and dec conduction |
|
|
Term
|
Definition
increased CA and automaticity causes DAD
extra systole
tachycardia
PVC
fibrillation
visual changes (yellow) |
|
|
Term
|
Definition
maintain AFib/Flut
maintain PST
maintain WPW
VTACH PROPHYLAXIS |
|
|
Term
|
Definition
high dose activates Gi decreasing Ca current decreasing conduction velocity increasing ERP decreasing AV velocity
t1/2 8sec must be IV bolus |
|
|
Term
|
Definition
| flushing, CP, hypotension |
|
|
Term
|
Definition
DOC IV bolus supraventricular tachycardia
PST/AV reentry
WPW |
|
|
Term
|
Definition
decrease ectopic pacemakers
esp from digitalis |
|
|
Term
|
Definition
|
|
Term
|
Definition
| stops digitalis arrhythmia and torsades |
|
|
