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