Conduction DisturbancesSick Sinus Syndrome | Causes: Digitalis (reversible), CCBs, sympatholytics, antiarrythmic drugs, coronary dz | AV block | Refractory conduction of impulses format he atria to the ventricles through the AV node/bundle of HIS | First degree | PR Interval of 0.4 sec or more | Second degree | Mobitz Type I (Wenckebach) & Mobitz Type II | Third degree | Complete dissociation from atria to ventricles | Treatment | Permanent pacing |
Supraventricular ArrhythmiasSinus bradycardia HR <60 bpm. Sinus node pathology, increased risk of ectopic rhythms. | Sinus tachycardia HR >100 bpm. Occurs with fever, exercise, pain, emotion, shock, thyrotoxicosis, anemia, heart failure, drugs. | Atrial premature beats Usually benign | PSVT Most *common paroxysmal tachycardia. Usually benign. | Atrial fibrillation Most common chronic arrhythmia, "holiday heart" when caused by EtOH or withdrawel | Atrial flutter Usually in pts. with normal hearts, or with myocarditis, CAD, or dig toxicity | Clinical features Palpitations, angina, fatigue | Treatment--PSVT Adenosine, verapamil. Prevent with diltiazem, B-blocker. | Treatment--Acute Afib Electric cardioversion, rate control, prevent thromboembolism | Treatment--Chronic Aflutter Amiodarone |
| | Ventricular ArrhythmiasVentricular premature beats May be benign or lead to sudden death if underlying heart disease | Ventricular tachycardia 3 or more ventricular premature beats in a row. Complication of MI and dilated cardiomyopathy. Sustained or unsustained. | Torsades de Pointe A polymorphic VTach. Happens spontaneously, or from hypokalemia, hypomagnesemia, or QT-prolonging drugs | Long QT Syndrome Congenital or acquired, recurrent syncope. Interval 0.5-0.7 sec. Can get ventricular arrhythmias and sudden death. | Brugada's syndrome Genetic disorder, Asians and men, causes syncope, Vfib, sudden death. | Ventricular fibrillation No cardiac output, associated with sudden death, more in early morning. | Treatment--Vfib B-blockers if symptomatic | Treatment--Vtach Synchronized cardioversion if severe hypotension or LOC. Rx: lidocaine, amiodarone, magnesium. | Treatment--Chronic sustained Vtach, congenital long QT, Brugadas Implantable defibrillator | Treatment--Torsades de Pointe B-blockers, magnesium, temporary pacing | Treatment: if identifiable site of arrhythmic origin Radiofrequency ablation |
| | CardiomyopathiesDILATED Cardiomyopathy Can't squeeze/contract, most common*, reduced strength or ventricular contraction and dilation of left ventricle. | Etiology Genetic (most common), EtOH, chemo, idiopathic | Takotsubo Type of dilated cardiomyopathy, occurs after major catecholamine discharge, sx similar to acute MI, "broken heart syndrome" | Clinical features Sx of CHF, *dyspnea. Possibly S3 gallop, rales, JVP. | Treatment Abstain from ThOH, treat underlying disease, supportive tx for CHF. | HYPERTROPHIC Cardiomyopathy Can't fill/too tight, hypertrophy of septum and left ventricle, diastolic dysfunction | Etiology Almost exclusively *genetic | Treatment B-blockers, CCB or disopyramide (negative inotrope) | Sudden cardiac death from hypertrophic cardiomyopathy occurs in patients <30yo 2-3% yearly | RESTRICTIVE Cardiomyopathy Heart fibers of ventricle all scrambled up, mildly reduced function of L ventricle. Pulmonary HTN. | Etiology From ibrosis or infiltration from diabetes,radiation, amyloidosis | Treatment Diuretics may be helpful. |
Pericardial DisordersPericarditis Inflammation of the pericardium most often from infection, autoimmune, s/p radiation/chemo, drug toxicity. | Clinical Features Pleuritic substernal pain, friction rub, pain relieved by sitting upright and leaning forward, fever if infectious | Pericardial Effusion Secondary to pericarditis/uremia/cardiac trauma. Produces restrictive pressure on the heart | Clinical Features Painless or painful (dyspnea and cough) | Cardiac Tamponade Occurs when fluid compromises cardiac filling and impairs cardiac output | Clinical Features Tachycardia, tachypnea, narrow pulse pressures, pulses paradoxes | EKG Signs Electrical alternans | Treatment If hemodynamic compromise-->pericardiocentesis to relieve fluid accumulation. O/W just NSAIDs if strictly inflammatory or abx if infectious |
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great cheat sheet
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