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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
What causes mobitz type I heart block
Suppression of AV conduction
26
What causes mobitz type II heart block
Failure of conduction system in bundle of His or Purkenje system
27
How will Mobitz type I appear on ECG
Increasing length of the PR interval until a QRS complex is dropped
28
How long is a normal PR Interval
0.12-0.2s
29
How many small squares is the PR interval
3-5
30
How will mobitz type II present on ECG
Regular PR Interval. The conduction of atrial impulses to ventricles follows regular patterns. For example, P (P-1)
31
Explain 2:1 AB block
The AV block, inhibits conduction of every other wave to ventricles
32
How is mobitz type I managed
no treatment, regular follow up
33
How is mobitz type II managed if harm-dynamically stable
- transcutaneous pacing pads | - permanent pace maker
34
How is mobitz type II managed if haemodynamically unstable
atropine
35
What is third degree heart block
No impulses are conducted from atria to ventricles causing complete dissascociation
36
What can cause 3rd degree HB
- Inferior MI - Worsening of first and second degree HB - AV blocking medication - Lev lenegre's disease
37
Name 3 AV blocking drugs
B blocker Calcium channel blockers Digoxin
38
How will 3rd degree heart block present clinically
Bradycardia Severe chest pain Sx of hypoperfusion (dizziness, syncope) Heart failure
39
What rate will the HR be in 3rd degree heart block and why
40bpm. As there is no conduction of impulses from atria to ventricles it causes a ventricular escape rhythm
40
What are signs of hypoperfusion
``` Dizziness Apathy + Irritability Fatigue Breathlessness Syncope ```
41
Explain the pathophysiology of 3rd degree heart block
There is complete obstruction of impulses between atria and ventricles meaning the two rates are independent. Atria contract at 100bpm and ventricles 40bpm.
42
How will 3rd degree heart block present on ECG
P waves and QRS complexes have no association
43
How is 3rd degree heart block managed if haemodynamically stable
Transcutaneous pacing | Permanent pacemaker
44
How is third degree heart block managed if haemodynamically unstable
Transcuatenous pacing dopamine if hypotensive OR, dobutamine if HF
45
What is a complication of 3rd degree HB
Sudden cardiac death

Cardiology (13 decks)

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