Sinus Node Subtleties
A healthy patient’s P–P interval changes with respiration, decreases during inspiration, increases during expiration, and becomes regular during breath-holding. Name the intervention required.
What is respiratory sinus arrhythmia? No intervention required
An ECG has a PR interval of 240 milliseconds, but every atrial impulse produces a ventricular complex. The finding represents delayed rather than failed conduction. How would you treat it?
What is first-degree AV block? Don't treat it just observe pt
An ECG shows a series of at least three monomorphic, nonsinus P waves at an atrial rate above 100 beats/minute with normal PR intervals and regular 1:1 AV conduction. IV beta-blockers or calcium channel blockers are more effective than adenosine.
What is atrial tachycardia?
A patient has a QRS duration greater than 0.12 seconds with terminal conduction delay. V1 is predominantly positive, and the patient has no symptoms or underlying disease requiring treatment.
What is an isolated right bundle branch block?
A patient has palpitations every day, but the office ECG is normal. This ambulatory test is most likely to capture the rhythm.
What is a Holter monitor?
An irregular sinus rhythm does not change with respiration. The patient has underlying heart disease and recently began demonstrating signs of digitalis toxicity.
Name the tx
What is nonrespiratory sinus arrhythmia?
Investigate underlying cause and manage appropriately
A patient taking verapamil develops progressively longer PR intervals followed by a nonconducted P wave. The abnormality is most consistent with AV nodal disease. How would you treat it?
What is Mobitz type I AV block? No tx
A rapid atrial rhythm has at least three different P-wave morphologies and no dominant atrial pacemaker. Treating the underlying condition and controlling the rate are appropriate, but electrical cardioversion is ineffective.
What is multifocal atrial tachycardia?
A wide QRS is negative in V1 and positive in V5–V6. Unlike an isolated right-sided abnormality, this finding warrants investigation for CAD, heart failure, hypertension, cardiomyopathy, or aortic stenosis.
What is left bundle branch block?
Episodes are intermittent rather than daily, making this patient-activated or automatically triggered monitor more appropriate than a standard Holter.
What is an event monitor?
An ECG shows P waves with a normal sinus axis but gradually changing morphologies and slightly varying PR intervals. The P–P intervals remain essentially constant.
Name tx for stable AND unstable pt
What is a wandering pacemaker within the SA node?
Stable: Treat underlying causes, Permanent pacemaker
Unstable: Atropine, Dopamine, Epinephrine, Temporary cardiac pacing
A patient with symptomatic heart failure and reduced ejection fraction receives a device with leads in the right ventricle and left ventricle, with the left-sided lead positioned in the coronary sinus. A right atrial lead is also typically present.
What is a CRT-P or biventricular pacemaker?
A patient has recurrent paroxysmal SVT caused by an accessory pathway. During a wide-complex episode, the lecture recommends procainamide or ibutilide rather than relying on an AV-nodal blocker alone.
What is atrioventricular reentrant tachycardia?
A patient with known structural heart disease has sustained ventricular tachycardia but remains hemodynamically stable. The lecture lists three IV antiarrhythmics as treatment options.
What are amiodarone, lidocaine, or procainamide?
A patient has rare, unexplained episodes of syncope that have escaped detection by external monitoring.
What is an implantable loop recorder?
During an otherwise sinus rhythm, both P waves and QRS complexes suddenly disappear. The pause is not an exact multiple of the preceding cycle length.
What is sinus arrest or sinus pause?
The atrial rate exceeds the ventricular rate, the PR interval continuously changes, and no relationship exists between P waves and QRS complexes. How would you treat it?
What is third-degree or complete AV block? Perm. Pacemaker
A patient has a regular atrial reentry rhythm with sawtooth waves. Rate control and anticoagulation are considered, electrical cardioversion is used if unstable, and catheter ablation is preferred for long-term management.
What is atrial flutter?
A medication-induced prolonged QT produces polymorphic ventricular tachycardia. Magnesium is first-line while stable, synchronized cardioversion is required if unstable, and unsynchronized defibrillation is required if pulseless.
What is torsades de pointes from prolonged QT syndrome?
A patient’s narrow-complex SVT persists despite mechanical maneuvers. The selected medication must be given rapidly, has a 10-second half-life, may cause bronchospasm, and can precipitate atrial fibrillation or rarely ventricular fibrillation.
What is IV adenosine?
The absence of identifiable P waves and an irregularly irregular rhythm indicate this diagnosis. Name the diagnosis and treatment for an hemodynamically stable pt (Subsequent management), hemodynamically stable pt (initial tx), what CHADs2 score is needed for anticoagulation, 3 anticoag meds, and 3 rhythm meds
What is atrial fibrillation and see slides 47-48 to verify
A patient with structural heart disease has fixed PR intervals with unpredictable nonconducted P waves. Even without symptoms, permanent pacing is indicated if no reversible cause is found. How would you treat it
What is Mobitz type II AV block? Perm. Pacemaker
A stable patient has an irregularly irregular rhythm of unknown duration. Before cardioversion, one study must exclude left atrial thrombus because the rhythm may have been present for more than 48 hours.
What is atrial fibrillation requiring TEE before cardioversion?
The monitor shows organized electrical complexes without a pulse. A wide-complex form suggests a metabolic problem, and the rhythm must be treated with CPR, epinephrine, and correction of the underlying cause rather than defibrillation.
What is pulseless electrical activity?
A patient’s hypertension reflects sympathetic hyperactivity, abnormal renal or cardiovascular development, RAAS activity, defective natriuresis, altered intracellular sodium and calcium, and environmental exposures—but no single curable disease.
What is primary or essential hypertension?