Cardiology Test 4-Montepara Arrhythmias

____ (ECG): noninvasive test to evaluate the electrical activity of the heart. With each beat, an electrical impulse or "wave" travels through the heart.

electrocardiogram

The P wave occurs when the SA node and atrial walls ___

depolarize

The QRS complex occurs as the atria ____ and the ventricular walls ___

repolarize, depolarize

The T wave occurs as ventricular walls ____

repolarize

overview of cardiac cycle

-heart wall relaxes, ECG constant

-SA node and atrial walls depolarize -___ wave

-atrial walls completely depolarize, ECG constant

-atria repolarize and ventricular walls depolarize-___ wave

-atrial walls completely repolarize, ventricular walls completely depolarize, ECG constant

-Ventricular walls repolarize-___ wave

P, QRS, T

QT interval: measured from ___ of QRS complex to __ of T wave

beginning, end

QT interval: represents the period from onset of ventricular ____ to completion of ventricular ____

depolarization, repolarization

QT interval: dependent on ___ ___

heart rate

QT interval:

faster heart rate= ____ QT interval

slower heart rate= _____ QT interval

shorter, longer

corrected QT (___) interval accounts for changes in heart rate

QTc

a longer QTc increases risk for ___ ___ ___

torsades de pointes

Types of Arrhythmias- Bradycardia (HR<60bpm)

1) ____ bradycardia

2) ___ block

sinus, AV

Types of Arrhythmias- Tachyarrhythmias (HR>100bpm)

1) ___ tachycardia

2) ____ tachycardia

3) ____ tachycardia

4) ___ fibrillation

sinus, supraventricular, ventricular, ventricular

Sinus Bradycardia- Causes

1) drugs (beta blockers, digoxin, non DHP CCB)

2) ___ age

3) ___

4) ___

old, athletes, sleep

Treatment of Sinus Bradycardia (only if symptomatic)

-discontinue ____ meds (beta blockers, digoxin, non DHP CCB)

-acute therapy

-permanent therapy (____)

aggravating, pacemaker

Treatment of Sinus Bradycardia (only if symptomatic)

what are the 4 acute therapy treatments?

atropine, dopamine, epinephrine, temporary pacing

Symptoms of Sinus Bradycardia (that indicate we need to treat)

1) hypotension

2) acutely altered ___ status

3) signs of ___

4) ischemic chest discomfort

5) acute ___ ___

mental, shock, heart failure

What is 1st line treatment for Sinus Bradycardia?

Atropine

Atropine dosing for Sinus Bradycardia

first dose is ___mg, repeated every __-__min

1, 3-5

Atropine dosing for Sinus Bradycardia

-max dose is __mg

3

If atropine is ineffective for Sinus Bradycardia:

1) transcutaneous ____

2) ____ IV infusion

3) ____ IV infusion

pacing, dopamine, epinephrine

There are __ types of AV block

1st degree AV block (least severe)

2nd degree AV block

3rd degree AV block (most severe)

3

1st degree AV block

-has __:__ AV conduction (means every time atrium contracts, ventricles contract)

-however, there is a ___ PR interval>200 msec

1:1, prolonged

2nd degree AV block

-can be either Mobitz type I or Mobitz type II

-both types have a ___ than 1:1 conduction (not every atrial impulse is conducted to the ventricles)

less

Two types of 2nd degree AV block

Mobitz type I:

progressive PR interval ____ until ventricular complex is ___

lengthening, dropped

Two types of 2nd degree AV block

Mobitz type II:

PR interval does ___ lengthen, and ventricular beats drop ____

not, randomly

“Ventricular complex is dropped”=

The atria contract (a P wave is present), but the ventricles do NOT contract, so the ____ complex is missing (“dropped”) from the ECG

QRS

3rd degree AV block

-complete heart block

-____ AV conduction

-these patients must have a pacemaker

no

Causes of AV block

1) _____ heart disease

2) drug therapy

3) myocarditis

4) cardiac ____

5) congenital heart disease

6) aging

7) idiopathic ____ of the conduction system

ischemic, surgery, fibrosis

Treatment of AV block

-observation

-discontinue aggravating meds

-trascutaneous/transvenous pacing/permanent pacemaker

-____, ___, ___ if symptomatic

atropine, epinephrine, dopamine

pacemaker

-can only __ up HR, not slow down

-be very careful with ____

speed, infections

Sinus Tachycardia Causes:

1) ___/anxiety

2) caffeine

3) ____ (like amphetamine and cocaine)

5) exercise

stress, stimulants

CO= ___ x ___

SV, HR

sinus tachycardia is a ____ response

-if you need ↑ CO due to exercise= HR ↑

-↓ SV (from bleeding, diarrhea, low fluid)= HR ↑

compensatory

Treatment of Sinus Tachycardia

Important- We do NOT target HR with rate-control agents. We ___ the underlying cause

remove

if you were to give a pt with sinus tachycardia a rate-control agent (like a beta blocker), their HR↓, so then ↓____ (bc sinus tachycardia is a compensatory response), patient could go into shock

CO

Supraventricular Tachycardia (SVT)

1) atrioventricular nodal reentrant tachycardia (____)

2) atrioventricular reentrant tachycardia (___)

3) atrial ___

4) atrial ___

5) atrial ___

AVNRT, AVRT, tachycardia. fibrillation, flutter

atrioventricular nodal reentrant tachycardia (AVNRT)

-a reentrant tachycardia involving 2 functionally distinct pathways referred to as "___" and "___" pathways

-reentry happens entirely inside the AV node

fast, slow

atrioventricular reentrant tachycardia (AVRT)

-a reentrant tachycardia caused by an ___ pathway

-so not entirely inside the AV node

accessory

atrial tachycardia

-___ focus of atrial activity as a result of either reentry, triggered activity, or increased automaticity

abnormal

regular rhythm Supraventricular Tachycardia (SVT) refers to ___ and ___

AVNRT, AVRT

Initial treatment of regular rhythm SVT

-first nonpharm treatment is ___ maneuver (can include bearing down, blowing in straw with closed end, pushing on carotid arteries)

-also can use IV ___ (circuit cutter, pt dies for a sec)

vagal, adenosine

Adenosine dose for regular rhythm SVT

-first dose is ___mg rapid IV push, followed with NS flush

-second dose (if required), is ___mg

6, 12

Initial treatment of regular rhythm SVT

-if vagal maneuvers/adenosine not working, see if pt is hemodynamically ___ (normal blood pressure, alert, no signs of shock)

stable

If vagal maneuvers/adenosine ineffective/not feasible, and patient is hemodynamically unstable:

-only option is to use syncronized ____ (shock the patient)

cardioversion

If vagal maneuvers/adenosine ineffective/not feasible, and patient is hemodynamically stable:

-can use IV rate control agents (IV ____ blockers, IV ___, IV ___)

beta, diltiazem, verapamil

If vagal maneuvers/adenosine ineffective/not feasible, and patient is hemodynamically stable:

-can use IV rate control agents

-if that is ineffective/not feasible, then use synchronized ____ (shock the patient)

cardioversion

Atrial Fibrillation

-rhythm is "irregularly irregular"

-there is no ____ wave

P

Atrial Flutter

-P waves are in ___ pattern

-can be 1:1, 2:1, or 3:1 ventricular rate

-in Atrial flutter, 1:1 conduction is not good, because both atrium and ventricles contracting very fast

sawtooth

Ventricular Tachycardia (VTach)

-unlike Afib, ventricular fibrillations are deadly

-QRS complex is ____ and _____ (1 pattern)

-ventricular contractions are ____

wide, monomorphic, premature

Torsades de Pointes

-QRS complex is ____ and ____ (varying)

-no P wave, no PR interval, irregular rhythm

variable, polymorphic

QT interval prolongation risk factors

-____ gender

-bradycardia

-HF

-recent ____

-congenital long QT syndrome

-electrolyte abnormalities

-QT prolonging meds

female, cardioversion

Drugs that can cause QT interval prolongation

1) Class ____ antiarrhythmics (quindine, procainamide, disopyramide)

2) Class ____ antiarrhythmics (dofetilide, sotalol, ibutilide)

Ia, III

Drugs that can cause QT interval prolongation

3) _____ (macrolides, fluoroquinolones)

4) ____ (TCAs, SSRIs)

antibiotics, antidepressants

Drugs that can cause QT interval prolongation

5) ____ (haloperidol, droperidol, quetapine, thiordazine, ziprasidone)

6) others (azole antifungals, antiemetics, methadone, triptans)

antipsychotics

Treatment of Torsades de Pointes

-discontinue offending medications and correct exacerbating factors, such as _____ abnormalities

electrolyte

Treatment of Torsades de Pointes

-direct current ____ (DCC) if unstable but have pulse

-_____ if pulseless

cardioversion, defibrillation

What is drug of choice for Torsades de Pointes?

magnesium sulfate

if magnesium sulfate is ineffective for Torsades de Pointes, use either temporary ____ pacing or pharmacological pacing (isoproterenol or epinephrine) can be initiated

transvenous

Ventricular Fibrillation

-____ of all arrhythmias

-no P wave, PR interval, or QRS

deadliest

If patient has acute sustained VTach >30 seconds

-correct underlying ____

-ACLS algorithm (involves shocking patient)

abnormality

if patient has recurrent VTach

-class __ or ___ antiarrhythmics

-automated implantable ___-___

I, III, cardioverter-defibrillator

If patient has Vfib:

-AHA ACLS ___ (involves shocking patient)

algorithm