Snapshot A 66-year-old man presents to the emergency deparment with palpitations and lightheadedness. The patient has been experiencing these symptoms for the past few days. He reports mild chest discomfort. Medical history is significant for hypertension, type 2 diabetes mellitus, and rheumatic heart disease. An electrocardiogram is immediately performed, which demonstrates a narrow QRS complex tachyarrhythmia that is irregularly irregular. (Atrial fibrillation) Introduction Aberrant rhythms can occur anywhere along the cardiac conduction system (SA node to a single cardiomyocyte) these aberrant rhythm can originate from the atrium (thus a supraventricular arrhythmia) ventricles Etiology there are a number of causes and they include myocardial infarction cardiac scarring can interrupt the cardiac conduction system atrial stretch alters the cardiac conduction system (e.g., significant mitral stenosis) reentrant circuit accessory pathway (e.g., atrioventricular re-entry tachycardia) normal atrioventricular node (e.g., atrioventricular nodal reentrant tachycardia) Symptoms asymptomatic palpitation light headedness syncope sudden cardiac death Atrial Arrhythmias Type Electrocardiogram Findings Treatment Comments Atrial fibrillation A tachyarrhythmia that is irregularly irregular rhythm and has absent P-waves Stable patients rate control e.g., β-blockers and non-dihydropyridine calcium channel blockers rhythm control e.g., amiodarone Unstable patients synchronized cardioversion Anticoagulation options include aspirin warfarin new oral anticoagulant (NOAC) e.g., dabigatran Most common type of atrial arrhythmia A dilated left atrium can result in atrial fibrillation e.g., mitral stenosis Can result in a thromboembolic event (e.g., stroke) The ventricular rate is determined by the AV node refractory period Often originates in the pulmonary veins Atrial flutter A tachyarrhythmia with a "sawtooth" appearance Stable patients treat similarly as atrial fibrillation Unstable patients synchronized cardioversion Definitive treatment is with catheter ablation Caused by a re-entrant circuit in the right atrium Sick sinus syndrome A bradyarrhythmia with episodes of tachycardia acute patients assess for reversible causes such as medications (calcium channel blockers, digoxin, lithium) chronic patients anticoagulation pacemaker placement
QUESTIONS 1 of 4 1 2 3 4 Previous Next Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (M1.CV.13.41) A 28-year-old woman presents to the urgent care center complaining of weakness, confusion, and that her heart is "racing and flopping" in her chest. She has no significant past medical history. She denies any previous episodes of anxiety attacks or heart issues. She smokes 1/2 of a pack of cigarettes per day and is a social drinker. She denies the use of any illicit drugs. She has no known drug allergies, and she does not take any medications on a daily basis. An EKG is ordered and is shown in Figure A. This patient's ventricular contraction rate is determined by which of the following? QID: 100557 FIGURES: A Type & Select Correct Answer 1 SA node refractory period 3% (3/89) 2 AV node refractory period 61% (54/89) 3 Bundle of His conduction speed 15% (13/89) 4 Purkinje fiber conduction speed 11% (10/89) 5 Purkinje fiber refractory period 10% (9/89) M 1 Question Complexity E Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 2 Review Tested Concept Review Full Topic Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (M1.CV.12.203) A 60-year-old male presents with palpitations. He reports drinking many glasses of wine over several hours at a family wedding the previous evening. An EKG reveals absent P waves and irregularly irregular rhythm. He does not take any medications. Which is most likely responsible for the patient’s symptoms? QID: 100719 Type & Select Correct Answer 1 Atrial fibrillation 95% (102/107) 2 Transmural myocardial infarction 0% (0/107) 3 Untreated hypertension 0% (0/107) 4 Torsades de pointes 2% (2/107) 5 Ventricular hypertrophy 1% (1/107) M 2 Question Complexity E Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 1 Review Tested Concept Review Full Topic
All Videos (2) Login to View Community Videos Login to View Community Videos Atrial Flutter Gio Sabal Cardiovascular - Atrial Arrhythmias E 8/21/2015 65 views 0.0 (0) Login to View Community Videos Login to View Community Videos Atrial Fibrillation Gio Sabal Cardiovascular - Atrial Arrhythmias E 8/20/2015 76 views 5.0 (1)