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Cardiology > 1: Bradyarrthymias > Flashcards

1: Bradyarrthymias Flashcards

1
Q

Define an AV block

A

Interrupted conduction between the atria and ventricles

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2
Q

What are the different types of heart block

A

First degree
Second degree
Third degree

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3
Q

Define first-degree heart block

A

a PR interval of >200ms

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4
Q

How many squares is the PR interval

A

3-5

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5
Q

How many ms is the PR interval

A

120-200ms

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6
Q

What are 6 causes of first degree heart block

A 
Increased Vagal Tone 
Inferior MI
Athlete 
Myocarditis
Hyperkalaemia
AV node blocking drugs
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7
Q

What are 4 AV blocking drugs

A

B blockers
Calcium channel blockers
Digoxin
Amiodarone

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8
Q

How does first-degree heart block present

A

Asymptomatic

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9
Q

Explain the pathophysiology of first degree HB

A

Damage or fibrosis to the AV node results in impaired conduction from atria to ventricles

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10
Q

What is first-line investigation for HB

A

ECG

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11
Q

How will first degree HB present on ECG

A

Prolonged PR interval >200ms

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12
Q

What is second investigation for first-degree heart block

A

Medication review

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13
Q

How is first-degree HB managed

A

No management plan

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14
Q

What are the two types of second degree HB

A
  1. Mobitz type I

2. Mobitz type II

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15
Q

What is mobitz type I

A

Progressive prolongation of the PR interval until a QRS complex is dropped

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16
Q

What is mobitz type I also referred to as

A

Wenckebach phenomenon

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17
Q

What is mobitz type II heart block

A

Constant PR interval. Intermittent non conducting p waves without QRS

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18
Q

What causes mobitz type I heart block

A

Increased vagal tone with NO underlying structural HD

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19
Q

What are 4 causes of mobitz type I heart block

A
  1. Medications
  2. Ischaemia
  3. Hyperkalaemia
  4. Myopathy (eg. Lyme disease)
20
Q

What causes mobitz type II heart block

A
  1. Anterior MI
  2. Lev Lenegre’s Disease
  3. Infiltrative (amyloidosis, sarcoidosis, haemochromatosis)
  4. Medication
  5. Autoimmune (SLE, sarcoidosis)
  6. Cardiac surgery involving septal repair
21
Q

What is Lev Lenegre’s Disease

A

Idiopathic fibrosis of the AV node

22
Q

What medications may cause type II HB

A

Amiodarone
Digoxin
Calcium channel blocker
B blocker

23
Q

How may mobitz type I present clinically

A

Asymptomatic. May present with symptoms of dizziness, syncope and bradycardia

24
Q

How will mobitz type II present clinically

A

Symptoms of reduced cardiac output:

  • bradycardia
  • fatigue
  • chest pain
  • dyspneoa
  • dizziness
  • syncope
25
Q

What causes mobitz type I heart block

A

Suppression of AV conduction

26
Q

What causes mobitz type II heart block

A

Failure of conduction system in bundle of His or Purkenje system

27
Q

How will Mobitz type I appear on ECG

A

Increasing length of the PR interval until a QRS complex is dropped

28
Q

How long is a normal PR Interval

A

0.12-0.2s

29
Q

How many small squares is the PR interval

A

3-5

30
Q

How will mobitz type II present on ECG

A

Regular PR Interval. The conduction of atrial impulses to ventricles follows regular patterns. For example, P (P-1)

31
Q

Explain 2:1 AB block

A

The AV block, inhibits conduction of every other wave to ventricles

32
Q

How is mobitz type I managed

A

no treatment, regular follow up

33
Q

How is mobitz type II managed if harm-dynamically stable

A
  • transcutaneous pacing pads

- permanent pace maker

34
Q

How is mobitz type II managed if haemodynamically unstable

A

atropine

35
Q

What is third degree heart block

A

No impulses are conducted from atria to ventricles causing complete dissascociation

36
Q

What can cause 3rd degree HB

A
  • Inferior MI
  • Worsening of first and second degree HB
  • AV blocking medication
  • Lev lenegre’s disease
37
Q

Name 3 AV blocking drugs

A

B blocker
Calcium channel blockers
Digoxin

38
Q

How will 3rd degree heart block present clinically

A

Bradycardia
Severe chest pain
Sx of hypoperfusion (dizziness, syncope)
Heart failure

39
Q

What rate will the HR be in 3rd degree heart block and why

A

40bpm. As there is no conduction of impulses from atria to ventricles it causes a ventricular escape rhythm

40
Q

What are signs of hypoperfusion

A 
Dizziness
Apathy + Irritability
Fatigue 
Breathlessness
Syncope
41
Q

Explain the pathophysiology of 3rd degree heart block

A

There is complete obstruction of impulses between atria and ventricles meaning the two rates are independent. Atria contract at 100bpm and ventricles 40bpm.

42
Q

How will 3rd degree heart block present on ECG

A

P waves and QRS complexes have no association

43
Q

How is 3rd degree heart block managed if haemodynamically stable

A

Transcutaneous pacing

Permanent pacemaker

44
Q

How is third degree heart block managed if haemodynamically unstable

A

Transcuatenous pacing
dopamine if hypotensive
OR, dobutamine if HF

45
Q

What is a complication of 3rd degree HB

A

Sudden cardiac death

Cardiology (13 decks)

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