CARD 4201 module 2

What disorders and conditions can cause arrhythmias?

What disorders and conditions can cause arrhythmias?

• valvular disease

• cardiomyopathy

• Afib/flutter

• genetic disorders like Long QT syndrome

• accessory pathway conditions like

  • WPW

  • lown-ganong-low syndrome

  • AVRD

  • AVNRT

BCMA standards

• symptoms of arrhythmia occurring 2 or more times in 7 daya

• syncope

BCMA protocol includes patients whose cardiologist/specialist is evaluating:

• pacemaker function

• brady

• afib

• frequent arrhythmias in patients using anti arrhythmic drugs and who need to get monitoring to assess response or adverse reactions

most commonly seen arrhythmmias

SVE(SV ectopic)

• isolated premature ectopic atrial beats

• atrial runs

PVCs

• multifocal or unifocal

• frequent or rare in occurence

some physiologic conditions that may exacerbate SVE

• pregnancy

• fever

• dehydration

Causes of ischemia

• brady

• hypotension

• low CO

• sustained tachycardia

• sinus pause or sinus arrest

rhythm disturbances associated with dizziness and lightheadedness

• AV blocks

• V tachyarrhythmias

• rapid/slow afib/flutter

• ectopic or competing rhythms

Causes of paroxysmal tachycardia

• autonomic imbalance

• MV disease

• postoperative valvular disease

• pre-excitation

• AVNRT

• ectopic atrial rhythms

• Lown-ganong-levine syndrome

• CAD

when can AECG monitoring be an alternate means of documenting ischema?

• symptoms of chest pain transient or infrequent

• ischemia not triggered by exercise

• nocturnal symptoms occur

conditions where AECG monitoring may be useful

• prinzmetal’s angina

• nocturnal dyspnea

• unpredictable chest pain

• chest pain induced by stress/emotions

more common role of holter monitoring in ischemia

eval of post MI arrhythmias

Likely sites to develop foci of spontaneous impulse generation

border areas between damaged cells(ischemia) and normal cells

When is ventricular tissue highly irritable and excitable?

when its in close proximity to an area of ischemia

the use of holter monitoring in evaluation of antiarrhythmic therapy

to monitor the effectiveness of the treatment

Patients commonly treat with antiarrhythmics have:

• complex PVCs

• history of high grade V arrhythmia and ischemia

• PVCs causing syncope, presyncope,angina

• VFib or tachy

• long QT and history of SCD

• MVP w symptomatic Vtach

• SSS and bradyarrhythmias

• WPW w PVCs

use of holter for cardiac rehab

• when med dosage is being titrated over a period of time

• supervised exercise

3 common pre-excitation conditions

• WPW

• Lown-Ganon-Levine syndrome

• Mahaim syndrome

ECG changes in pre-excitation

• delta wave

  • slurred PQ segment

  • short PQ /PR

  • interval

• Wide QRS

Why is prolong QT important to note in a holter report?

• The risk of Vfib is increased

• medication could be prolonging it

• a patient may have family history of long QT that must be noted

symptoms with MVP

• palpitations

• chest pain

• dyspnea

• fatigue or presyncope

arrhythmias that may occur due to MVP

• PVCs

• SVEs

• atrial runs

• brady

• tachy

what must you be aware of when reading a holter scan with cardiomyopathy?

Heart rate variability

• may be blunted showing a restricted range of HR

Standard treatment for cardiomyopathy

beta blockers

• alleviates symptoms and arrhythmia

• encourages remodelling of V tissue

common arrhythmias seen in COPD

• atrial ectopics

• multifocal atrial tachys

• ventricular ectopics - p-pulmonale and low voltage

information to be on the diary

• list of medication

• presenting symptoms

• age

• physicians to be copied

• significant family history

the purpose of the diary in holter monitoring

to be able to correlate symptoms with rhythm changes

examples of activities to include in a diary

• meals

• taking stimulants like coffee, smoking

• taking meds

• exercising

• change in body position

• stress situations

• fatigue

• sexual activity

• symptoms like palpitations, pounding heart, dizziness, shortness of breath