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arrythmias
arrhythmias
37
Medical
Graduate
05/27/2009

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Term
mechanisms of arrhtymias
Definition
altered impuse formation(sinus node, latent pacemakers,myosite), triggered activity(early afterdepolarisation, late afterdepolarisiations) altered impulse conduction (conduction block, re-entry)
Term
morphology of MI
Definition
Gross - selling and hyperemia, yellowing, progressive pallor and scar formation. Microscopic - loss of nuclei/striations, influx of neutraphils, coagulative necrosis, influx of macrophages and phagocytosis, influx of fibroblasts and collagen synthesis and scar formation
Term
complications of MI
Definition
arrhythmias, sudden death, cadiogenic shock, pericarditis, rupture, mitral insufficiency, aneurysm, mural thrombosis
Term
dilated cardiomyopathy
Definition
four chamber dilation. etiology - idiopathic, toxins (alcohol,iron), genetic, viral infection, autoimmune. Features - biventricular pump failure, sudden death, transplant
Term
Hypertrophic cardiomyopathy
Definition
autosomal dominant genetic disorders of heart muscle. Hypertrophy of all chamber walls esp septum. Micro - disoreintated, tangled, hypertrophied muscle. natural history - suddden death, outflow obstruction, pump failure
Term
restrictive cardiomyopathy
Definition
infiltrative process that results in stiffening fibrosis of the myocardium.
Term
Myocardidits
Definition
hrt failure in young without valve or congenital disease. Morphology - myocardial degen, necrosis, inflammation. aetiology - idiopathic, infective, immune, radiation
Term
sinus bradycardia
Definition
decreased firing of SA node. physiological or pathological. causes - age,disease of atrium, extrinsisic factors (meds, metabolic,exess vagal tone) symptoms-fatigue, light headded, confuse, syncope. tx -atropine, pacemaker
Term
sick sinus syndrome
Definition
dysfunction of the SA node.etiology-disease of atria/fibrosis. symptoms- dizziness, confusion, syncope. brady-tachy syndrome.
Term
escape rhythm
Definition
protective mech of the heart. source - junctional (narrow QRS-rate 40-60) or ventricular (wide qrs 30-40)
Term
first degree AV block
Definition
delay between atrial and ventricular conduction. long pr. etiology structure av defect (MI, age) reverssabe - drugs, ischemia, increase vagal. prognosis - benign
Term
Mobitz I
Definition
gradual lengthening of pr until p not followed by QRS, then returns to normal. cause benign (children, athletes,vagal) MI, ishaemia. usually not treated
Term
mobitz II
Definition
sudden loss of qrs without pr lengthening. causes - MI involving his-purkinje system. treatment - permenant pacing risk of third degree
Term
third degree block
Definition
failure of conduction between atria and ventricles. no relationship between p and qrs. wide (HIS-P) or narrow qrs (AV). symptoms - HR 40-60, syncope, light headed. etiology - MI drug toxicity (dig,B-B,Ca-B). treatment - PPM
Term
sinus tachycardia
Definition
SA node >100bpm. physological or pathological (fever, hypoxia,hyperthyroidism,hypovolaemia,anaemia). Tx - underlying cause or B-B or Ca-B
Term
atrial premature beat
Definition
earlier P wave +/- qrs. caused automaticicty or re-entry. worseded by symphathetic, caffeine, alcohol, stimulant. treatment - B-B or Ca-B
Term
Atrial Flutter
Definition
atrial rate 180-350 with 1:1,2:1,3:1or4:1 block. Cause-large re-entry circuit involving tricuspid valve. Symptoms-palpitations, dyspnea, weakness. Tx - as per AF
Term
Atrial fibrillation
Definition
atrial rate 350-600, irreqularly-irregular qrs 140-160bpm. Causes -re-entry circuits (heart fairlure, HT, CAD, pulonary disease)precip-thyroid,alcohol, infection. outcomes - compromised output, thromboembolism. Treatement - rate V rhythm control, thromboembolism prophylaxis
Term
AVNRT
Definition
sudden onset palpitations/tachy, normal width QRS, p hidden. cused by rentry circuit involving the AV node. Tx - valgal maneouvers, adeonsine/verap. px-B-B, Ca-bl, sotalol, flecainide. Catheter ablation
Term
AVRT (WPW)
Definition
accessory AV pathway. slurred upstroke of ECG. creates re-entry circuit via accessory pathway (narrow qrs) or AV node(reseple VT). combined with AF - VR or 300. tx - vagal, adenosine/verapamil,
Term
ventricular premature beat
Definition
premature wide QRS complex. common healthy or diseased. caused by ectopic focus. tx reduction caffeine,stim. B-B
Term
VT
Definition
three or more VEBs. sustained or nonsustained. wide qrs rate 100-200. Sx symcope, pulm oedema, arrest. Causes- structural heart disease (MI,isc, heart failur,LVH),long QT, valve, congenital. Monomorphic or polyomorphic(longQTsyndrome). Tx non-comp lignocaine/amiodarone. comp - DC cardioversion
Term
VT
Definition
disordered ventricle stimulation no co-ordinated contraction. immediate life threatening. cause preceeded by VT. Tx immediate defibrillation
Term
Class I antiarrhtmics
Definition
Blockage of Na channels a-lenthen AP, B-shorten AP, C-no effect AP. slow AP decrease conduction thru damaged tissue. all pro-arrhytmic
Term
B-blockers
Definition
blockade of B1 receptors - slows conduction thru AV node. used for SVT. contra/prec-asthma,PVD,DM. Adv - bronchospams, nausea, depression/lethargy, heart block, mark hypos
Term
amiodarone
Definition
type III- blocks K also, B, Ca, Na. suppresses ectopic and re-entry. Pk-v.long half life. Adv thyroid dist, visual dist/corneal deposits. neurological, skin pigmentatio, lung fibrosis, liver fibrosis
Term
Sotalol
Definition
potassium blocker with B-blocking activity. pro arrythmic and has B-blocker side effects
Term
Calcium channel blockers
Definition
blocks Ca channels and slows conduction thru the AV node. used in SVT. Adv - negative inotrophic, constipation, peripheral oedema, headache
Term
digoxin
Definition
negative chronotropic (delays SA,AV node), positive inotropic (increase Ca). use Rate control in AF, CHF. Adv nausea, bradycardia, diarrhoea
Term
Adenosine
Definition
Blockage of AT1 receptor and hyperpolarises cell depresses automaticity and slow conduction thru AV node. Use PSVT. Adv - short half life. bronchospasm, chest pain, SOB, flushing, impending doom
Term
Vagal maneuvers
Definition
Increase vagal tone and slow conduction thru AV node for SVT. Carotid sinus massage. Valsalva. Diving reflex
Term
Cardioversion
Definition
used for SVT and Pulse VT. delivers syncronised shock on a QRS to a presedated patient
Term
Defibrillation
Definition
used for VF and pulseless VT. delivers a asynchronous charge. No presedation required
Term
somatisation
Definition
experience physical symptom for which there is insufficient or no organic cause
Term
functional symptoms
Definition
left mammory pain, breathlessness, sighs, palpitations, fatigue, dizziness
Term
clinical relevance of psycosomatic diseae
Definition
many have underlying pathology but may elabolate on disease. serious psychiatric illness may be missed. many with normal coronary arteries have symptoms. many with psychiatric disease have CAD
Term
causes of arrhythmias
Definition
Structural defect (ASD,VSD,valve). Throid. Rheumatic. Ischemia. Druges. Electrolytes
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