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Cardiology > 1: Broad Complex Tachyarrythmias > Flashcards

1: Broad Complex Tachyarrythmias Flashcards

1
Q

What does broad complex tachycardia indicate

A

Arrhythmia has arisen from the ventricles

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2
Q

What are the two types of ventricular tachycardia

A

Monomorphic + Polymorphic

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3
Q

What is the most common type of VT

A

Monomorphic

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4
Q

What causes monomorphic VT

A

MI

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5
Q

What is a subtype of polymorphic VT

A

Torsades de pointes

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6
Q

What causes torsades de pointes

A

Prolongation of the QT interval

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7
Q

What is sustained VT

A

VT lasting more than 30s leading to haemodynamic compromise

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8
Q

What is non sustained VT

A

3 or more consecutive ventricular complexes terminating spontaneously in 30s

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9
Q

What causes monomorphic VT

A

MI or previous MI scars

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10
Q

What causes polymorphic VT

A

Torsades de points (gradual prolongation of QT)

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11
Q

What are the congenital causes of prolonged QT interval

A

Jervell-Lange Nielsen

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12
Q

How does Jervell-Lange Nielsen present

A

With deafness

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13
Q

How does Romano Ward present

A

Without deafness

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14
Q

What drugs may prolong the QT interval

A 
Macrolide antibiotics
TCA
Amiodarone
Sotolol 
Class I anti-arrythmics (procainmide) 
Chloroquinine
Terfenadine
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15
Q

What are other causes of prolong QT

A
  1. Hypocalcaemia
  2. Hypokalaemia
  3. Hypomagnesaemia
  4. MI
  5. Myocarditis
  6. Hypothermia
  7. Subarachnoid haemorrhage
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16
Q

How will non-sustained VT present

A

Asymptomatic

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17
Q

How will sustained VT present

A 
Palpitations
Chest Pain
Hypotension
Shock 
Syncope
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18
Q

What may sustained VT progress to

A

VF and death

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19
Q

What are the 3 pathophysiolgocial mechanisms of VT

A
  • Re-entry
  • Triggered activity
  • Automaticity
20
Q

What is the commonest mechanism underlying VT

A

Re-entry

21
Q

What is re-entry

A

Requires two distinct conduction pathways with a block in one and slowing in another

22
Q

What commonly causes re-entry

A

Scar from MI

23
Q

What is triggered activity

A

Where there are either early or late depolarisations

24
Q

What is abnormal automaticity

A

Region of ventricular cells causing abnormal conduction

25
Q

What is first line Ix for VT

A

ECG

26
Q

How will VT present on ECG

A

AV disassociation (no relationship between P wave and QRS)

27
Q

How will monomorphic VT present

A

QRS complexes appear the same

28
Q

How will polymorphic VT present

A

QRS complexes appear different

29
Q

How is haemodynamically unstable VT assessed

A

Whether a pulse is present or not

30
Q

How is haemodynamically unstable VT without pulse managed

A

Defibrillation

31
Q

How is haemodynamically unstable VT with pulse managed

A

DC cardioversion

32
Q

What is first-line for haemodynamically stable VT

A

Amiodarone

33
Q

How should Amiodarone be administered

A

Via a central line

34
Q

What is second line for Stable VT

A

Lidnocaine

35
Q

When should lidnocaine be used with caution

A

Individuals with severe left ventricular impairment

36
Q

What is 3rd line for VT

A

Procainmide

37
Q

What is used for long-term management of VT

A

Implantable cardiac defibrillator (ICD)

38
Q

How is torsades de pointes managed acutely

A

Magnesium sulphate

39
Q

How is torsades de pointes managed in the long-term

A

B blocker

40
Q

What is the main complication of VT

A

Can progress to VF and cause sudden cardiac death

41
Q

What is VF

A

A life-threatening cardiac arrhythmia characterised by high frequency ventricular contractions resulting in diminished cardiac output

42
Q

Explain the pathophysiology of VF

A
  • when the ventricles are damaged there is tissue heterogeneity (cells have different electrical properties)
  • if ventricular pacemaker cells fire at the wrong time but a group of adjacent cells also fire this can cause a premature ventricular contraction
  • > 3 PVC (VT) can lead to VF
  • If adjacent cells have different electrical properties it can lead to re-entry circuits
43
Q

How will ECG present in VF

A

No discernible P waves or QRS

44
Q

How is VF managed

A

Advanced Cardiac Life Support

45
Q

What is the main complication of VF

A

Sudden cardiac death

Cardiology (13 decks)

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