WEEK 2 PART 1 - ARRHYTHMIAS STUDYGUIDE QUESTIONS AND CORRECT
ANSWERS
Question:
1. NORMAL SINUS RHYTHM What is normal sinus rhythm? What is a normal HR?
Answer:
•Atrial Rhythm originates from the sinus AV Bundle of Hisv Purkinje Fibers •HR: 60-100bpm
Question:
2. SINUS ARRHYTH- MIA What is sinus arrhythmia? How does it present? How is it diagnosed?
What is the management?
Answer:
Common variation in Normal Sinus Rhythm •Sign of a health heart Presents with an irregular
heart rate (different when you breath in and out) due to intermittent vagus nerve activation
during inspiration •Inspiration inhibits vagal tone’ increase in SA rate •Expiration activates vagus
nerve’ deceleration of SA node •Diagnosis: ECG •Management: Reassurance
Question:
3. What is supraventricular tachyarrhythmia?
Answer:
Tachyarrhythmia: a rapid heart rhythm, regular or irregular, with a rate > 100 beats/min
Question:
4. Sinus Tachycardia What is sinus tachycardia?
Answer:
•Sinus Tachycardia is a common regular cardiac rhythm where the SA node is firing at a rate
>100bpm •Noteable P, QRS, and T for each complex
Question:
5. Sinus Tachycardia: Etiology
Answer:
Physiologic •Exercise, Pain, Anxiety, or Stress (She go away with rest or relaxation) •Fever
•Pulmonary Embolism (Clot in Pulmonary Artery limiting delivering of volume to left side, HR
increases to attempt to maintain CO) •Dehydration (Low volume, increase HR for CO
maintenance) •Anemia •Lung Disease •Shock Medications (ex. Albuterol)/Substances (ex.
Cocaine) •Other: Withdrawal, Hyperthyroidism, etc. there is usually something causing the
tachycardia
Question:
6. Sinus Tachycardia: Clinical Presentation
Answer:
•Asymptomatic •Palpitations •Shortness of breath/Chest Pain •Lightheadedness/Syncope
SYMPTOMS USUALLY CONSISTENT WITH THE UNDERLYING CAUSE •Dehydration (recent
vomiting/diarrhea syndrome, recent excessive exertional activity in heat) •Fever (symptoms of
,infection- Pulmonary, UTI, Wound, Etc.) •Pulmonary Embolism (chest pain, exertional shortness
of breath, potential calf pain) image: HR = 130-140
Question:
7. Sinus Tachycardia: Diagnosis
Answer:
•EKG •Work-Up to Rule In Suspected Underlying Cause
Question:
8. Sinus Tachycardia: Management How is it managed? What should be avoided?
Answer:
TREAT THE UNDERLYING CAUSE!! •Provide Fluids if Dehydrate (Normal Saline) •Diagnose and
intiate anticoagulants for a PE •Figure out cause of anemia and manage it •Blood loss, stop the
bleed and replace! •DO NOT GIVE A RATE CONTROLLER TO TREAT A COMPENSATORY
TACHYCARDIA!!! •These patients are tachycardic for a reason’ They are compensating for an
underlying illness or cause!
Question:
9. Paroxysmal Supraventricular Tachycardia (PSVT) What is PVST? What are they caused by?
Answer:
•Intermittent Episodes of Supraventricular Tachycardia with sudden onset and termination
(starts and stops) 60% of PSVT cases are due to Atrioventricular (AV) Nodal Reentrant
Tachycardia (AVNRT) 30% of PSVT are due to Atrioventricular Reciprocating Tachycardia (AVRT) -
SA node fires, loop circuit goes back into the atria and down the ventricle (recurrent loop)
Question:
10. Paroxysmal Supraventricular Tachycardia (PSVT): Clinical Presentation Supraventricular
Tachycardia (PSVT): Diagnosis
Answer:
•Palpitations •Shortness of breath/Chest pain •Lightheadedness/Syncope •Characterized abrupt
onset and offset •Regular Narrow Tachycardia with a rate between 140bpm-250 bpm EKG -buried
p waves, fast QRS + t-waves
, Question:
11. Paroxysmal Supraventricular Tachycardia (PSVT): Unstable Management
Answer:
UNSTABLE: •Altered mental status, hypotensive, tachycardic, chest pain •Electricity with
Synchronized Cardioversion
Question:
12. Paroxysmal Supraventricular Tachycardia (PSVT): Stable Management
Answer:
The more common presentation for patients 1st Attempt vagal maneuvers •Bear down (blow into
a straw; pretend you are having a bowel movement) •Carotid massage •Dip face in ice water
Medical Therapy: •First line: IV Adenosine’ Terminate rhythm •Make sure to warn them they are
about to feel terrible slows AV node, push med and hold up arm so that it goes it heart •Second
Line: •Non-Dihydropyaidine Calcium or Beta Blocker (rate controllers) -Diltizem -Labetalol
Question:
13. ATRIAL FLUTTER ter?
Answer:
•Atrial Flutter: Regular supraventricular tachycardia characterized by an ATRIAL heart rate
between 240-340/min (typically 300) ventricle cannot fire) For example: If Atrial rate is 300 and it
is 2:1 conduction •Atria is at 300bpm and ventricular rate is 150 regular, all p waves look the
same, seen best in lead II
Question:
14. ATRIAL FLUT- TER: Epidemiology/Etiology What population is it more common in? What
are some causes?
Answer:
Epidemiology: •elderly Etiology: Re-entry over a circuit of tissue along the tricuspid valve annulus
•CAD and MI •Heart Failure •Valve disease •COPD
Question:
15. ATRIAL FLUTTER: Clinical Presentation
Answer:
•Similar to other tachyarrhythmias •Asymptomatic •Palpitations •Lightheaded/Syncope
•Shortness of Breath •Chest pain
Question:
16. ATRIAL FLUTTER: Diagnosis
Answer:
ECG •ECG shows "sawtooth" pattern of atrial activity (rate 300 beats/min) image 3: 1 conduction
-regular, narrow QRS
ANSWERS
Question:
1. NORMAL SINUS RHYTHM What is normal sinus rhythm? What is a normal HR?
Answer:
•Atrial Rhythm originates from the sinus AV Bundle of Hisv Purkinje Fibers •HR: 60-100bpm
Question:
2. SINUS ARRHYTH- MIA What is sinus arrhythmia? How does it present? How is it diagnosed?
What is the management?
Answer:
Common variation in Normal Sinus Rhythm •Sign of a health heart Presents with an irregular
heart rate (different when you breath in and out) due to intermittent vagus nerve activation
during inspiration •Inspiration inhibits vagal tone’ increase in SA rate •Expiration activates vagus
nerve’ deceleration of SA node •Diagnosis: ECG •Management: Reassurance
Question:
3. What is supraventricular tachyarrhythmia?
Answer:
Tachyarrhythmia: a rapid heart rhythm, regular or irregular, with a rate > 100 beats/min
Question:
4. Sinus Tachycardia What is sinus tachycardia?
Answer:
•Sinus Tachycardia is a common regular cardiac rhythm where the SA node is firing at a rate
>100bpm •Noteable P, QRS, and T for each complex
Question:
5. Sinus Tachycardia: Etiology
Answer:
Physiologic •Exercise, Pain, Anxiety, or Stress (She go away with rest or relaxation) •Fever
•Pulmonary Embolism (Clot in Pulmonary Artery limiting delivering of volume to left side, HR
increases to attempt to maintain CO) •Dehydration (Low volume, increase HR for CO
maintenance) •Anemia •Lung Disease •Shock Medications (ex. Albuterol)/Substances (ex.
Cocaine) •Other: Withdrawal, Hyperthyroidism, etc. there is usually something causing the
tachycardia
Question:
6. Sinus Tachycardia: Clinical Presentation
Answer:
•Asymptomatic •Palpitations •Shortness of breath/Chest Pain •Lightheadedness/Syncope
SYMPTOMS USUALLY CONSISTENT WITH THE UNDERLYING CAUSE •Dehydration (recent
vomiting/diarrhea syndrome, recent excessive exertional activity in heat) •Fever (symptoms of
,infection- Pulmonary, UTI, Wound, Etc.) •Pulmonary Embolism (chest pain, exertional shortness
of breath, potential calf pain) image: HR = 130-140
Question:
7. Sinus Tachycardia: Diagnosis
Answer:
•EKG •Work-Up to Rule In Suspected Underlying Cause
Question:
8. Sinus Tachycardia: Management How is it managed? What should be avoided?
Answer:
TREAT THE UNDERLYING CAUSE!! •Provide Fluids if Dehydrate (Normal Saline) •Diagnose and
intiate anticoagulants for a PE •Figure out cause of anemia and manage it •Blood loss, stop the
bleed and replace! •DO NOT GIVE A RATE CONTROLLER TO TREAT A COMPENSATORY
TACHYCARDIA!!! •These patients are tachycardic for a reason’ They are compensating for an
underlying illness or cause!
Question:
9. Paroxysmal Supraventricular Tachycardia (PSVT) What is PVST? What are they caused by?
Answer:
•Intermittent Episodes of Supraventricular Tachycardia with sudden onset and termination
(starts and stops) 60% of PSVT cases are due to Atrioventricular (AV) Nodal Reentrant
Tachycardia (AVNRT) 30% of PSVT are due to Atrioventricular Reciprocating Tachycardia (AVRT) -
SA node fires, loop circuit goes back into the atria and down the ventricle (recurrent loop)
Question:
10. Paroxysmal Supraventricular Tachycardia (PSVT): Clinical Presentation Supraventricular
Tachycardia (PSVT): Diagnosis
Answer:
•Palpitations •Shortness of breath/Chest pain •Lightheadedness/Syncope •Characterized abrupt
onset and offset •Regular Narrow Tachycardia with a rate between 140bpm-250 bpm EKG -buried
p waves, fast QRS + t-waves
, Question:
11. Paroxysmal Supraventricular Tachycardia (PSVT): Unstable Management
Answer:
UNSTABLE: •Altered mental status, hypotensive, tachycardic, chest pain •Electricity with
Synchronized Cardioversion
Question:
12. Paroxysmal Supraventricular Tachycardia (PSVT): Stable Management
Answer:
The more common presentation for patients 1st Attempt vagal maneuvers •Bear down (blow into
a straw; pretend you are having a bowel movement) •Carotid massage •Dip face in ice water
Medical Therapy: •First line: IV Adenosine’ Terminate rhythm •Make sure to warn them they are
about to feel terrible slows AV node, push med and hold up arm so that it goes it heart •Second
Line: •Non-Dihydropyaidine Calcium or Beta Blocker (rate controllers) -Diltizem -Labetalol
Question:
13. ATRIAL FLUTTER ter?
Answer:
•Atrial Flutter: Regular supraventricular tachycardia characterized by an ATRIAL heart rate
between 240-340/min (typically 300) ventricle cannot fire) For example: If Atrial rate is 300 and it
is 2:1 conduction •Atria is at 300bpm and ventricular rate is 150 regular, all p waves look the
same, seen best in lead II
Question:
14. ATRIAL FLUT- TER: Epidemiology/Etiology What population is it more common in? What
are some causes?
Answer:
Epidemiology: •elderly Etiology: Re-entry over a circuit of tissue along the tricuspid valve annulus
•CAD and MI •Heart Failure •Valve disease •COPD
Question:
15. ATRIAL FLUTTER: Clinical Presentation
Answer:
•Similar to other tachyarrhythmias •Asymptomatic •Palpitations •Lightheaded/Syncope
•Shortness of Breath •Chest pain
Question:
16. ATRIAL FLUTTER: Diagnosis
Answer:
ECG •ECG shows "sawtooth" pattern of atrial activity (rate 300 beats/min) image 3: 1 conduction
-regular, narrow QRS
