Rhythms

Question 1

Atrial fibrillation

Answer 1

1. Atrial tachycardia, irregular rhythm, noisy background with no P waves
2. May be caused by atrial enlargement due to heart failure, CAD, pulmonary disease
3. Anticoagulation (CHAD-vasc score)
4. Address underlying cause
5. Consider rate or rhythm control
6. Catheter ablation if refractory

Question 2

What factors into the CHAD-VASC score?

Answer 2

1. Congestive heart failure
2. Hypertension
3. Age
4. Diabetes
5. Previous stroke, TIA, embolus
6. Vascular disease
7. Female
8. Score of 2 or more means you should anti coagulate someone who has A Fib

Question 3

Ventricular tachycardia

Answer 3

1. Wide complex tachycardia (rate >100)
2. May or may not be perfusing
3. May deteriorate into v.fib and death
4. Caused by abnormal impulse formation (MI, long QT) or conduction (re entry circuit)
5. Past history of MI makes you suspicious
6. ECG may show AV dissociation, capture beats, fusion beats

Question 4

Ventricular fibrillation

Answer 4

1. No rhythm or rate, no QRS: non perfusing rhythm
2. Will lead to syncope and death if prolonged
3. May start as VT/ torsades and degenerate
4. electrical cardioversion ASAP
   5

Question 5

SVT with aberrancy

Answer 5

1. Wide complex tachycardia due to a left or right bundle branch block
2. Look for rabbit ears (RBBB)

Question 6

Who should get an implantable cardioverter defibrillator?

Answer 6

1. Those at high risk for sudden cardiac death
2. Persistent severe left ventricular dysfunction AFTER optimal treatment ( ie pharmacological and revascularization), (most common)
3. Prior cardiac arrest or life threatening irreversible ventricular arrhythmia
4. Other risky conditions: long QT, HCM

Question 7

Right bundle branch block

Answer 7

Rabbit ears in V1

Big S wave in V6

Question 8

Left bundle branch block

Answer 8

Big S in V1
Broad R in V6
Discordant QRS and T waves