Glossary of IM CV Arrhythmias USMLE 2
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- What does "irregularly irregular" mean on an ECG?
- Irregular RR intervals
- Irregularly irregular rhythm without p-waves prior to each QRS
- Atrial fibrillation
- Etiologies of A-Fib (10)
Pulmonary (COPD, PE), Pheochromocytoma, Pericarditis;
Ischemic heart dz, HTN;
Rheumatic heart dz;
Ethanol (& cocaine), Endocarditis;
- Signs/symptoms of A-Fib (5)
- A FL PT:
Fatigue (most common);
Light headedness, syncope;
Palpitations, skipped beats;
- Complication of A-Fib
- diffuse Embolization (often to brain, leading to TIA or stroke)
- One of two possible Drugs given to A-Fib to control rate in an emergent situation
- IV Calcium channel blocker: Diltiazem
IV Beta-blocker: Metoprolol
- Drugs given to A-Fib to control rate in a non-emergent situation (2)
- oral Beta-blocker:
oral Calcium channel blockers:
Verapamil or Diltiazem
- what are the (2) ways to cardiovert an A-Fib rhythm?
when should you not cardiovert?
what would the Tx be then?
- Medical: Amiodarone
Electrical: start at 100 J Do not cardiovert if patient is in A-Fib > 24 hours.
Tx: Warfarin for 3-4 weeks before cardioversion
- If cardioversion from A-Fib to sinus rhythm does not occur, what should patient be treated with?
- Long-term anticoagulants DOC:
- how many seconds and boxes is a normal PR interval?
- 0.2 ms 5 small boxes
When is it pathologic?
- when initial part of ventricular depolarization is downward
Pathologic: greater then 1 small box
- normal time and boxes for QRS interval?
- < 0.12 ms 3 small boxes
- normal sinus rate
- 60 - 100 bpm
- rhythm originating in the AV node and causing narrow QRS w/o P-waves
no p-waves; all complexes are wide; no changes in height (amplitude) w/ each complex; > 100bpm
- Ventricular tachycardia
wide QRS complexes that vary in amplitude
- Ventricular Fibrillation
Torsades de Pointes
normal sinus rhythm w/ PR interval > 0.2 ms (> 5 small boxes)
- First-degree AV block
PR interval elongates from beat to beat until it becomes so long that a beat drops
- Second-degree AV block, type 1 (Wenckebach)
PR interval is fixed but every so often there is a P-wave w/o a QRS
- Second-degree AV block, type 2 (Mobitz)
no relationship b/t P-waves and QRS complexes
- Third-degree AV block
QRS > 0.12 (> 3 small boxes) RSR' in V1 + V2;
deep S-wave in lateral leads (I, aVL, V5 + V6)
QRS > 0.12 (> 3 small boxes);
RSR' in V5 + V6; diffuse ST elevation
Different shapes to 3 or more P-waves; normal rhythm
(what is it called if it is tachycardic?)
- Wandering pacemaker
MFAT: Multifocal Atrial Tachycardia
short PR interval; slurring delta wave connecting P-wave to QRS complex
- Wolff-Parkinson-White syndrome
diffuse ST elevation that slopes in a concave manner back to baseline + diffuse PR segment depression in all leads except PR elevation in aVR
- drug Tx of wandering pacemaker and MFAT?
- Verapamil (Ca channel block)
- what Tx breaks SVT (superventricular tachy) in > 90%?
- Adenosine (failure to break r/o SVT)
- Tx for V-tach w/ hypotension or no pulse
- Emergency defibrillation @ 200 - 360 J
- Tx of asymptomatic V-tach
- Tx of V-Fib
- Emergent electroshock @ 200 - 360 J
- how do you distinguish Paroxysmal Noctournal Dyspnea from asthma?
- no improvement w/ bronchodilators
SVT w/ AV block + yellow skin
- Digoxin toxicity
- How do you diagnose LVH from a ECG? (2)
- 1. S-wave in V1 + R-wave in V5 or V6 > 7 large boxes (35 small)
2. R-wave in V5 or V6 > 25 small boxes
R-wave in lead aVL > 11 small boxes
- Causes of prolonged QT (8)
- QT WIDTH:
QT: Prolonged QT syndrome
T: Torsades de pointes
H: HypoK, HypoC, Hypomagnesium
- What electrolyte disorder causes short QT segments?
- Causes of Torsades de Pointes (7)*
Other meds (TCAs)
No known cause (idiopathic)
Type 1 Anti-arrhthymics
Syndrome of prolonged QT
- What can be given to a patient to temporarily slow a rapid supraventricular rhythm in order for you to be able to identify it?
- What drugs should not be given to someone w/ Wolff-Parkinson-White syndrome?
What is the DOC?
Calcium channel blockers
- Causes of Mobitz I (3)
Causes of Mobitz II (2)
- Mobitz I:
Inferior wall MI;
Inc Vagal tone
Inferior or septal wall MI;
Conduction system disease
- Tx for Mobitz I & II
Atropine & temporary pacing
(Mobitz II should have pacemaker)
- Causes of third-degree heart block (3)
- Digitalis toxicity;
Inferior wall MI;
Conduction system disease
- Causes of Bradycardia (6)
- if R-R is longer then "One INCH":
Inferior MI / Inc intracranial Pressure;
Normal variant (athletes);
Carotid sinus hypersensitivity;
- Tx for bradycardia (3)
- 1. Atropine
3. pressors for hypotension
- a 24-yo woman w/ preclampsia Tx w/ IV drip of magnesium complains of difficulty breathing and has diminished reflexes.
Next step? (2 together)
- 1. Stop magnesium
2. give IV calcium
- equation for Mean Arterial Pressure
- MAP = (2dBP + sBP)/3
- Dilation of which heart chamber is a major cause of A-fib?
- Left atrium
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