39. Arrhythmias Flashcards
What are the signs and symptoms of arrthymias/ presentation? (9)
- can be asymptomatic
- palpitations
- dyspnoea
- chest pain
- fatigue
- embolism
- syncope/pre-syncope
- pulmonary oedema
- hypotension
What investigations should be done for arrhythmias? (3)
- ECG; 12 lead, 24 hour recording, event recorder
- blood tests (esp. thyroid function, U+Es, FBC, glucose, Ca, Mg)
- Echo
What should be looked for an an ECG?
- long QT interval (metabolic imbalance, drugs, congenital)
- short PR interval (WPW syndrome)
- atrial fibrillation
- ischaemic heart disease signs
What should be looked for in an echo?
-any structural heart disease e.g. mitral stenosis
What 2 things are targeted in treatment of arrhythmias?
- rate control
2. rhythm control
What drugs are used to treat arrhythmias? (3)
- digoxin
- beta blockers
- ca antagonist plus Warfarin (or aspirin if low risk)
What electrical approaches are used to treat arrhythmias? (2)
- pace and ablation of AV node
2 substrate modification e.g. pulmonary vein ablation maze procedures
What is supraventricular tachycardia?
- abnormally fast heart rate from upper part of the heart
- they start from either atria or AV node
- regular
What are symptoms of supraventricular tachycardia? (4)
- palpitations
- dyspnoea
3 dizziness/syncope - chest pain
What can be used as treatment for supraventricular tachycardia? (4)
- for acute cases; valsalva manoeuvre (vagotonic manoeuvres)
- IV adenosine, Verapail or beta blockers
Does supraventricular tachycardia have good prognosis?
Yes; low recurrence rate (5%), 1 in 1500 mortality
What is atrial flutter?
- regular
- starts in atrial chamber
- type of supraventricular tachycardia
- re-entrant rhythm in either right or left atrium
- premature impulses arising in the atria
What is atrial flutter treated with?
- beta blockers or verapamil (for control of heart rate)
- digoxin is alternative
(control ventricular rate and thromboembolic risk)
What is ventricular fibrillation?
- irregular
- heart quivers due to disorganised electrical activity
What is ventricular tachycardia?
- regular
- very fast heart rate that arises from electrical activity in the ventricles of the heart
What are symptoms of ventricular tachycardia? (3)
- palpitations
- dyspnoea
- dizziness and syncope
What investigations should be done for ventricular tachycardia? (3)
- bloods
- echo
- angiography
How to treat ventricular tachycardia?
- cardiac arrest protocol
- amiodarone or lidocaine
What can Long QT syndrome also cause?
Torsades de Pointes (abnormal heart rhythm leading to sudden death)
What can cause Torsades do Pointes?
- complete heart block
- atrial fibrillation
What can cause long QT syndrome? (2)
- congenital (due to a gene)
- acquired from drugs (antibiotics, antihistamines, antidepressants, heart medication, diuretics etc)
What is ICD therapy used as? (implantable cardioverter defibrillator)
secondary form of therapy
What patients are recommended ICD (implantable cardioverter defibrillator)? (3)
Patients with…
- cardiac arrest due to VF/ VT not due to transient or reversible causes e.g. early phase of acute MI
- systained VT causing syncope or significant compromise
- sustained VT with poor l. ventricular function
Can indications for pacing be temporary and permanent?
Yes
When are temporary pacing measures taken? (2)
- intermittent or systained symptomatic bradycardia, particularly syncope
- prophylactic when patient at risk of bradycardia e.g. 2nd/3rd degree AV block, post anterior MI, even when asymptomatic
When are permanent pacing measures taken? (4)
- symptomatic or profound 2nd/3rd degree AV block
- probably Mobitz type 2 2nd/3rd degree AV block even if asymptomatic
- AV block associated with neuromuscular disease
- after in preparation for AV node ablation
- alternating right bundle bunch block (RBBB) and left bundle bunch block (LBBB)
- syncope when bifascicular/ trifascicular block and no other explanation
- sinus node disease associated with symptoms
- carotid sinus hypersensitivity/ malignant vasovagal syncope
What 2 types of heart block exist in 2nd degree heart block?
- Mobitz
2. Wenckebach
