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Year 4 Cardiology > 6. Arrhythmias > Flashcards

6. Arrhythmias Flashcards

1
Q

What is the definition of an arrhythmia?

A

A disturbance of cardiac rhythm

They are typically common, benign, intermittent and may be severe

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2
Q

What are the cardiac causes of arrhythmias?

A 
Ischaemic heart disease
Cardiomyopathy
Pericarditis
Myocarditis 
Aberrant conduction pathways
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3
Q

What are some non-cardiac causes of arrhythmias?

A 
Caffeine 
Smoking
Alcohol
Pneumonia 
Drugs (B agonists, digoxin, l-dopaminergic tricyclics, doxorubicin)
Metabolic imbalance
Phaeochromocytoma
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4
Q

How may arrthymias present?

A 
Palpitations
Chest pain 
Presyncope/syncope
Hypotension
Pulmonary oedema 
Incidentally
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5
Q

What are the main tests for arrhythmia’s?

A

FBC, U&E’s, glucose, TSH
ECG
24 hour ECG monitoring
ECHO

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6
Q

What are the general classes of arrhythmia’s?

A

Narrow complex tachycardias
Atrial fibrillation and flutter
Broad complex tachycardia
Bradycardia

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7
Q

How do you manage pacemaker?

A

Remove triggers

Medical mangement- regular tablets or pill in pocket

Interventional management- pacemakers, ablation, implantable defibrillators

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8
Q

What is sick sinus syndrome?

A

Commonly found in elderly, the sinus node fibroses ending to bradycardia, tachyarrhythmias or sinus pauses

Treated with pacemakers and thromboembolism

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9
Q

What is meant by narrow complex tachycardia?

A

HR>100bpm
QRS<120ms (normal <120)

The QRS is normal however something is causing the heart to be tachycardiac

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10
Q

How do you treat narrow complex tachycardias?

A

Identify and treat the underlying rhythm

Transiently blocking the atrioventricular node will help in supra ventricular tachycardias (valsalva manoeuvres, carotid sinus massage, IV adenosine)

May require more serious treatment e.g. ablation

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11
Q

What is meant by broad complex tachycardia?

A

ECG shows a rate of >100 and QRS of greater than 120ms

If there are no clear QRS complexes then it is VF or asystole (or the machine isn’t working)

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12
Q

How do you manage broad complex tachycardia

A

Patient may be periarrest so get help
If in doubt treat as VT
If suspected wolf Parkinson white then avoid drugs that slow AV conduction

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13
Q

How can ectopic beats be classed as broad complex tachycardias?

A

When an ectopic beat happens it will have a broad QRS complex

Bigeminy-ectopic every other beat
Trigeminy - every third beat is an ectopic
Couplet- two ectopic together
Triplet - three ectopic together

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14
Q

Are ectopic concerning or not?

A

Frequent ectopic in otherwise healthy people are common and rarely significant

However if they occur >60 beats per hour then they’re frequent and cardiac disease should be looked for

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15
Q

What is af?

A

A chaotic irregular atrial rhythm at 300-600bpm.

The AV node reposnds intermittently hence an irregular ventricular rhythm

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16
Q

What are the causes of AF?

A 
Heart failure 
Hypertension
Ishchaemic heart disease
Pulmonary embolism
Mitral valve disease
Pneumonia
Hyperthyroidism
Caffeine
Alcohol
17
Q

What are the symptoms of AF?

A

An irregularly irregular pulse. May be asymptomatic

May also cause chest pain, palpitations, breathlessness or faintness

18
Q

What are the tests that should be carried out when someone has AF?

A

ECG
bloods: U&E’s, cardiac enzymes, TFT’s
ECHO

19
Q

How do you manage acute AF?

A

Look for adverse signs, ABCDE and get senior input

Correct electrolyte imbalance

< 48 hours- rate or rhythm control (DC cardioversion) and heparin
>48 hours- rate control (bisoprolol)

20
Q

What is DC cardioversion

A

A procedure used to convert an abnormal heart rhythm into a normal one

21
Q

What are the goals of treat,ent of chronic AF?

A

Rate control and anticoagulation

22
Q

How do you treat chronic AF?

A

Rate control- beta blocker or calcium channel blocker

Rhythm control- elective D.C. cardioversion

Paroxysmal AF- pill in the pocket

23
Q

What are some temporary pacemaker indications

A

Symptomatic bradycardia, unresponsive to atropine
After acute anterior MI
After inferior MI
Suppression of drug resistant tachyarrythmias.

24
Q

What are some permenant pacemaker indications?

A

Complete AV block
Mobitz type II AV block
Symptomatic bradycardia
HF

Year 4 Cardiology (18 decks)

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