Cardio quiz week 1

• - the most common chronic arrhythmia 
• -incidence and prevalence increase with age
• - it is low amplitude fibrillary waves without discrete p-waves and an irregularly irregular pattern of QRS complexes

- a significant decrease in cardiac output and is the most common cause of embolic cerebrovascular accidents

-a fib, when caused by excessive alcohol use or withdrawal

• asymptomatic, SOB, chest pain, palpitations
• +/- ashmans phenomonon

• in a-fib
• occasional aberrantly conducted beats (wide QRS) after short R-R cycles

• "PIRATES"
• P - pulmonary disease
• I - ischemia
• R - rheumatic heart disease
• A - anemia/atrial myxoma
• T - thyotoxicosis
• E - ethanol
• S - sepsis
• Chronic a fib = HTN, CHF

EKG

• paroxysmal 
• persistant
• permanent
• lone

self-terminating within 7 days (usually <24 hours)

• fails to self terminate, lasts > 7 days
• requires termination; medical or electrical

persistent a fib >1 year

paroxysmal, persistant or permanent WITHOUT evidence of heart disease

• - rate control with beta blockers, CCB, or digoxin
• - anticoagulant with warfarin

regular sawtooth pattern, an atrial rate of 250-300 bpm, and a narrow QRS complex

puts with COPD, HF, atrial septal defect or CAD

usually asymptomatic but can present with palpitations, syncope, and lightheadedness

• -anticoagulation
• - rate control
• - beta blockers or CCB

characterized by refractory conduction of impulses from the atria to the ventricles through the AV node and/or bundle of His and is divided into: 1st degree, 2nd degree (mobitz 1 & 2) and 3rd degree

• - all atrial beats are conducted to the ventricles but the PR interval is >.2 seconds
• (constant prolonged PR interval)

• normal individuals associated with:
• - increased vagal tone and with CCB or beta blocker use

none, observation

not all atrial beats are conducted to the ventricles

• "longer, longer, longer, drop now you've got a wenckebach"
•  - progressive PR interval lengthening, then a dropped QRS

• - stop the offending drug
• - Atropine (most commonly given), or epinephrine 
• - +/- a pacemaker
• - observation
• - cardiac consult

• intermittently non conducted atrial beats
• - " some get dropped, some get through, now you've got a mobitz 2"
• - constant prolonged PR interval then a dropped QRS

a block within the his bundle system

occasionally: syncope, frequent progression to 3rd degree av block

• - atropine or temporary pacing
• - pacemaker

• - also called complete heart block
• - a complete dissociation between atria and ventricles 
• - " P's and Q's don't agree now the block is 3rd degree"

syncope, dizziness, acute heart failure, hypotension, cannon A waves

pacemaker

• - the most common paroxysmal tachycardia and usually occurs in persons without structural problems 
• - a SVT with abrupt onset and offset
• - 2 main types: 
•           - AV nodal reentry tachycardia (AVNRT)
•           - AV reciprocating tachycardia (AVRT)

• - HR > 100 bpm
• - rhythm is usually regular with narrow QRS 
• - p waves are hard to discern due to the rapid heart rate

a racing heart

• - 2 Pathways both within the AV node (slow and fast)
• - the most common type
• - any tachydysrythmia arising from above the level of the bundle of his

• - 1 pathway within the AV node and a second assessor pathway outside the AV node 
• - examples: wolf-parkinson, white  down-ganong-levine syndrome

caused by the presence of abnormal assessor conduction pathway between the atria and the ventricles 

- EKG shows - shortened PR interval, widened QRS, and delta waves

• - orthodromic (95%)
• - antidromic (5%)

narrow complex tachycardia

wide complex tachycardia

• - vagal maneuvers
• - adenosine = first line 
• - beta blockers ot CCB

• - PVC
• - PAC
• - PJC

- ectopic beats arise from ventricular foci

-hypoxia, electrolyte abnormalities, and hyperthyroidism

asymptomatic, may lead to palpitations

• - early, wide QRS not preceded by P wave
• - usually followed by a compensatory pause

• - treat underlying cause 
• - if symptomatic give beta blockers or other antiarythmias

abnormally shaped p wave

• - the QRS complex will be narrow, usually measured at 0.10 seconds or less
• - no p wave or inverted p wave

• - inappropriate bradycardia, sinus pause, sinus arrest, or episodes of alternating sinus tachycardia and bradycardia
• - collective term to describe dysfunction in the sinus node's automaticity and impulse generation

• - the elderly
• - caused by scaring of the hearts conduction system
• - may occur in infants who have had heart surgery

Heterozygous

• - Digitais
• - CCB
• - beta blockers
• - sympatholytic agents
• - antiarrythmic drugs
• - aerosal propellant abuse 
• - underlying collagen vascular or metastatic disease, surgical injury

if caused by: digitalis, quinidine, beta blockers, or aerosol propellants

• - asymptomatic 
• - syncope, dizziness, confusion, HF, palpitations, decreased exersize tolerance

pacemaker

pause < 3 seconds

pause > 3 seconds

• - three or more consecutive ventricular premature beats
• - may be sustained or unsustained (both are associated with electrolyte abnormalities)

acute MI and dialed cardiomyopathy

- 3 or more PVCs, wide QRS in regular rapid rhythm

• - stable -- amioderone, lidocane, procainamide (in that order!!)
• - unstable -- CPR, defibrillation

- no effective pumping action exists, without intevention --> death

• - no discernible heart contractions 
• - wide erratic complex tracing

• - no pulse
• - syncope

CPR, defiibrilation

- a v-tach in which the QRS complex twists around the baseline

- continuously changing axis, polymorphic ventricular contraction

- may occur spontaneously or when the patient has hypokalemia or hypomagnesemia or following administration of drugs that prolong QT interval

- magnesium sulfate