Clinical Treatment of Arrhythmias Flashcards

1
Q
  1. Recognize clinical arrhythmia syndromes in relation to underlying etiologies.
  2. Describe acute treatment of arrhythmias when encountered in clinical practice.
  3. Discuss long-term options for arrhythmia treatment especially as it relates to individualization of patient care.
  4. Discuss the advantages and limitations of different arrhythmia treatment strategies.
A

a

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2
Q

Where in the conduction system do bradyarrhythmias develops?

A
  • SA node
  • AV node
  • Below AV node
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3
Q

Which types of bradyarrhythmias are due to SA node dysfunction?

A

1) Sinus bradycardia
2) Sinus arrest/puase
3) Tachy-brady syndrome
4) Chronotropic incompetence

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4
Q

Describe sinus bradycardia

A
  • Persistent slow rate from SA node
  • HR = 55
  • PR interval = 180ms
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5
Q

Describe sinus arrest

A
  • failure of SA node to discharge => absence of atrial depolarization and periods of ventricular asystole (flat line)
  • HR = 75
  • PR interval = 180ms
  • 2.8 second arrest
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6
Q

Describe brady-tachy syndrome

A
  • Intermittent episodes of slow and fast rates from SA node or atria
  • HR during brady = 43
  • HR during tachy = 130
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7
Q

Describe chronotropic incompetence

A
  • Inability to mount age-appropriate HR w/ exercise

- Remember the graph? Can barely reach and can’t stabilize appropriate HR

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8
Q

Which types of bradyarrhythmias are due to AV node dysfunction?

A

1) First degree AV block

2) Mobitz I 2nd degree AV block (Wenkebach)

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9
Q

Describe first-degree AV block

A
  • AV conduction is delayed
  • PR interval is prolonged (>200ms)
  • HR = 79
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10
Q

Describe Mobitz I 2nd degree AV block (Wenkebach)

A
  • Progressive prolongation of PR interval until ventricular beat is dropped
  • Ventricular rate = irregular
  • Atrial rate = 90
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11
Q

Which types of bradyarrhythmias are due to dysfunction below the AV node (infranodal/His Purkinje system)

A

1) Mobitz II 3rd degree AV block (Wenkebach)

2) Complete heart block

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12
Q

Describe Mobitz II 3rd degree AV block (Wenkebach)

A
  • No impulse conduction from atria to ventricles
  • Atrial rate > Ventricular rate
  • Vent rate = 37
  • Atrial rate = 130
  • PR interval is variable
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13
Q

At what point should you be concerned about bradyarrhythmias?

A

1) When the pt is symptomatic (doesn’t matter which part of conduction system is affected)
2) When rhythm is intranodal

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14
Q

Describe the treatment methods of bradyarrhythmias

A
  • Treat reversible causes (ischemia, hypothyroidism, lyme disease)
  • Stop offending meds if possible
  • Acute tx in unstable pt: beta-agonists, temporary transvenous pacing
  • Long term: pacemaker (only option)
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