Arrhythmias Flashcards Preview

Internal Medicine > Arrhythmias > Flashcards

Flashcards in Arrhythmias Deck (103)
Loading flashcards...
1

Premature Atrial Complexes, the beat arises from...

within the atria

2

What do premature atrial complexes look like on ECG?

Early P waves with different morphology than the normal sinus P wave; QRS is normal

3

Premature Atrial Complexes are usually asymptomatic but when symptomatic may cause....

palpitations or give rise to PSVTs

4

If premature atrial complexes are symptomatic, how can they be treated?

Beta Blockers

5

Causes of premature atrial complexes:

Adrenergic excess
drugs
alcohol
tobacco
electrolyte imbalance
ischemia
infection

6

Premature Ventricular complexes

Early beat from a focus in the ventricle that then spreads to the other ventricle. PVCs can occur in patients with or without structural heart disease

7

Causes of premature ventricular complexes:

Hypoxia
electrolyte abnormalities
stimulants
caffeine
medications
structural heart disease

8

Premature Ventricular complexes on ECG

Wide, bizarre QRS followed by a compensatory pause

***Wide QRS because conduction is slower because it is not going through the normal conduction pathways, but through ventricular muscle

9

Most patients with premature ventricular complexes are asymptomatic, but if symptomatic experience:

palpitations
dizziness

10

If PVCs are symptomatic, may treat with

Beta Blockers

11

Patients with frequent PVCs and underlying heart disease are at increased risk of

Sudden death due to cardiac arrhythmia, especially VFib and may benefit from an ICD

12

PVC couplet

2 successive PVCs

13

PVC Bigeminy

Sinus beat followed by a PVC

14

PVC Trigeminy

2 sinus eats followed by a PVC

15

Atrial Fibrillation

multiple foci in atria fire continuously in chaotic pattern leading to Irregular, rapid ventricular rate

16

In aFib the atrial rate is

>400 bpm (most beats are inhibited at the AV node so the ventricular rate is about 75-175 bpm)

17

aFib plus underlying heart disease equals marked increased risk of ...

thromboembolism and hemodynamic compromise

18

Signs and Symptoms of aFib

Fatigue and exertional dyspnea
Palpitations, dizziness, angina, syncope
Irregularly irregular pulse
thromboembolism

19

How does aFib contribute to thromboembolic events?

Due to ineffective contraction, blood stasis occurs which leads to formation of intramural thrombi that can then embolize to brain

20

ECG findings in aFib:

Irregular RR intervals with tiny erratic spikes with wavy baseline. No identifiable p waves.
Irregularly irregular rhythm

21

Treatment for aFib in a hemodynamically unstable patient

Immediate electrical cardioversion to sinus rhythm

22

Treatment of aFib in hemodynamically stable patient

Rate control (60-100 bpm) with Beta blocker or calcium channel blocker
Cardioversion (electrical preferred over pharm)
Anticoagulation to prevent embolic cerebrovascular accident

23

What are choice pharmacologic agents for cardioversion?

Ibutilide
Procainamide
flecainide
sotalol
amiodarone

24

why must a patient in aFib receive anticoagulation prior to cardioversion?

risk of embolization during cardioversion is significant, especially if aFib has been present for >48 hours

25

How long should aFib patients be anticoagulated for?

3 weeks before cardioversion and 4 weeks after cardioversion

26

What is the goal INR range for aFib patients?

INR of 2-3 is goal

27

Treatment of chronic aFib includes

Beta Blocker or CCB for rate control
Anticoagulation with warfarin (unless under age 60 with lone-aFib)

28

Cardioversion delivery

delivers shock in synchrony wiht QRS so that it does not hit T wave which could result in VFib

29

Purpose of Cardioversion

terminate certain dysrhytmias like PSVT or VT

30

Indications for cardioversion include:

aFib
Atrial flutter
VT with pulse
SVT