Arrhythmias

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An arrhythmia is a disturbance in ..
A. rate
B. rhythm
C. site of origin of electical impulse
D. A and B
E. A, B, and C

E

Which of the below is not true of Pacemaker Cells?
A. can spontaneously depolarize
B. Ca++ dependent upstroke
C. K+ dependent repolarization
D. Ca++ dependent plateau
E. no resting potential

D

Which of the below is not true of Contractile Myocytes?
A. Na+ dependent upstroke
B. Ca++ dependent plateau
C. resting potential -80 to -90
D. K+ dependent repolarization
E. Ca++ dependent upstroke

E

Which of the below arrhythmia orginination sites has a very wide and bizarre QRS complex?
A. supraventricular
B. ventricular
C. A and B
D. none of the above

B

There is concern about which patients need treatment for their arrhythmia. What are some indications to NOT treat your patient?

-no hemodynamic abnormalities
-no clinical signs
-extracardiac disease
-GDV, splenic disease, trauma, hyperthyroidism

What is the most common arrhythmia found in normal resting dogs, but not in cats?

Sinus arrhythmia

A dog is excited in the examining room and has a heart rate of 170 bpm. When hooked up to ECG, there is a regular sequence of P, QRS, and T waves. The patient has consistent P-P and P-R intervals. Which of the below is most likely true in your patient?
A. sinus bradycardia
B. sinus tachycardia
C. sinus arrest
D. supraventricular tachycardia

B

What is the difference in the site of origin for a junctional escape beat versus a ventricular escape beat? Which tends to have a higher heart rate? which tends to have a wide and bizarre QRS complex?

junctional- AV node- higher heart rate (40-60bpm)
ventricular- bundle branches or purkinje fibers (20-40 bpm)- tend to have wide and bizarre QRS complex.

When there are escape beats, is it indicated to medically suppress the escape beats in your patient?

No- results in long periods of asystole

Which breeds of dogs are most likely to develop a supraventricular tachycardia?

lab, boxer, bulldog, golden retriever

What can be done to acutely terminate a sustained supraventricular tachycardia?

vagal maneuver- carotid sinus massage, eyeball pressure, or sharp blow to the chest wall
IV vasopressors
IV bolus Diltiazem, Esmolol, Procainamid
Electrical Cardioversion

which breed of dog has an increased risk of hepatotoxicity associated with administration of amiodarone?

Dobermans

On ECG, if there is an irregular rhythm and "saw tooth waves", what does this indicate?

Atrial flutter

What are 3 ECG hallmarks of Atrial Fibrillation?

-absence of identifiable P waves in all leads
-QRS-T complexes occur in an irregularly irregular patten
-the baseline frequently displays oscillations or undulations, but their organization is chaotic and ill-defined

What treatments would be recommended for atrial fibrillation?

quinidine +/- digoxin
procainamide
amiodarone
DC cardioversion

Which of the below is an emergency?
A. sinus tachycardia
B. sinus bradycardia
C. ventricular tachycardia
D. ventricular premature beats

C

What is the first choice of treatment for a dog with ventricular tachycardia?

lidocaine IV bolus or CRI

Which arrhythmia is associated with heart rates more similar to a normal dog or slightly elevated: ventricular tachycardia or accelerated idioventricular rhythm?

accelerated idioventricular rhythm

What is the primary method of treatment for ventricular fibrillation?

electrial defibrillation

If there is no response to electrical defibrillation, what chemical defibrillation techniques can be used?

lidocaine
epinephrine
and/or bretylium

Which form of ventricular fibrillation is easier to convert: fine or coarse?

coarse

Which AV block tends to be least severe and have less clinical signs in your patient?
A. first degree AV block
B. second degree AV block
C. third degree AV block

A

Second degree AV block has 2 types: Mobitz type 1 and mobitz type 2. Which one is associated with a block in the His bundle?

Mobitz type 2

Which of the below is not associated with a third degree AV block?
A. P waves and QRS complexes are not associated with each other
B. complete AV dissociation is present
C. the ventricular rate is much faster than the atrial rate
D. ventricular escape beats should not be suppressed in these patients

C

In patients with sick sinus syndrome, what typically causes the clinical signs in the patient?

periods of bradycardia

Which breeds of dog most often are associated with SSS?

middle aged to older minature schnauzers
cocker spaniels
westies

What is the hallmark feature of atrial standstill on ECG?

absence of P waves in any lead and a slow, regular junctional/ventricular rhythm

What testing should be done in all dogs presenting with atrial standstill?

serum electrolyte levels

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