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Cardio Pathology > Arrhthymias > Flashcards

Arrhthymias Flashcards

1
Q

What are ectopic beats?

A

Beats or rhythms that originate in places other than the SA node

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2
Q

Are ectopic beats always dangerous?

A

No, depends on how they affect cardiac output

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3
Q

Can myocarditis cause an arrhythmia?

A

Yes

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4
Q

What is the congenital long QT syndrome a mutation of?

A

mutation of cardiac ion channels (can cause arrhythmias)

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5
Q

What causes WFW syndrome?

A

presence of an abnormal accessory electrical conduction pathway between the atria and the ventricles

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6
Q

What do local areas of ischemia or necrosis do to automaticity of neighboring cells?

A

increase

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7
Q

What is triggered activity thought to be the underlying mechanism for?

A

digoxin toxicity, Torsades de Pointes in the long QT syndrome and hypokalaemia

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8
Q

What does a stress ECG look for?

A

Looks for myocardial ischaemia, exercise related arrhythmias

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9
Q

What are q waves a sign of?

A

previous MI

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10
Q

What is pre-excitation a sign of?

A

WPW syndrome

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11
Q

What does an echo help find?

A

structural heart disease (e.g enlarged atria in AF, LV dilatation, previous MI scar, aneurysm)

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12
Q

There is generally no treatment for Atrial Ectopic Beats, but what may help?

A

avoiding stimulants, B-blockers

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13
Q

What type of MI is ischaemia commoner in?

A

STEMI

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14
Q

What is the treatment for sinus bradycardia?

A

Atropine (acute cases)

Pacing if haemodynamic compromise: hypotension, CHF, angina, collapse

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15
Q

What is the treatment for sinus tachycardia?

A

Treat underlying cause

B-blockers

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16
Q

What may SVTs be due to?

A

AV nodal re-entrant tachycardia
Accessory pathway tachycardia i.e., Wolff Parkinson White syndrome
Ectopic atrial tachycardia

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17
Q

What is the acute management for an SVT?

A

Vagal manoeuvres, carotid massage
IV Adenosine
IV Verapamil

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18
Q

What is the chronic management for an SVT?

A 
Avoid stimulants
Radiofrequency ablation 
Antiarrhythmic  drugs (Class II or IV)
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19
Q

What does this describe: Selective cautery of cardiac tissue to prevent tachycardia, targeting either an automatic focus or part of a re-entry circuit?

A

Ablation

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20
Q

In ablation, catheters are placed in the heart via what vein?

A

femoral

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21
Q

What does ablation involve?

A

Intracardiac ECG recorded during sinus rhythm, tachycardia and during pacing manoeuvres
Catheter placed over focus / pathway and tip heated to 55-65C

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22
Q

What does an intracardiac ECG show?

A

shows the activation sequence of the heart

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23
Q

Which is more detailed, an intracardiac ECG or an ECG?

A

intracardiac ECG

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24
Q

What drugs can cause AVN conduction disease?

A

B-blockers

Calcium channel blockers

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25
Q

What disease may these genetic conditions cause: Lenegre’s disease, myotonic dystrophy?

A

AVN conduction disease

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26
Q

What happens to the PR interval in first degree heart block?

A

P-R interval longer than normal (> 0.2 sec)

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27
Q

What is the treatment for 1st degree heart block?

A

None (but follow up recommended)

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28
Q

What is 2nd degree heart block?

A

Intermittent block at the AVN (dropped beats)

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29
Q

What happens in Mobitz 1?

A

progressive lengthening of the PR interval, eventually resulting in a dropped beat

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30
Q

What happens in Mobitz 2?

A

Intermittent non-conducted P waves without progressive prolongation of the PR interval

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31
Q

Where is Mobitz type 2 almost always located?

A

bundle branches

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32
Q

Why would a transcutaneous pacer be used?

A

emergency temporary use till venous access achieved

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33
Q

Is transcutaneous pacing painful?

A

Yes

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34
Q

What vein should be used if patient had received streptokinase and is at risk of major bleed if the artery is punctured accidentally?

A

femoral

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35
Q

What does a single chamber pacemaker pace?

A

the right atria or right ventricle only

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36
Q

What does a dual chamber pacemaker pace?

A

the RA and RV

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37
Q

What is a dual chamber pacemaker used for?

A

AVN disease

38
Q

What are atrial pacemakers used in?

A

isolated Sino-atral node disease but normal AV node

39
Q

What type of pacemaker would be used in AF with a slow ventricular rate?

A

ventricular single pacemaker

40
Q

Are Premature Ventricular Ectopics common?

A

yes

41
Q

What may premature ventricular ectopics be a marker for?

A

inherited arrhythmia syndromes e.g. cardiomyopathy

42
Q

When would you need to investigate a Premature Ventricular Ectopic beat further?

A

if it worsens on exercise

43
Q

What is used to treat Premature Ventricular Ectopics?

A

beta blockers

44
Q

Who are VTs common in?

A

patients with significant heart disease e.g.
Coronary artery disease
A previous myocardial infarction

45
Q

What is a familial arrhythmial syndrom which can cause VT?

A

Long QT, Brugada syndrome

46
Q

Can cardiomyopathy cause VT?

A

yes (a rare cause)

47
Q

What does this describe: Chaotic ventricular electrical activity which causes the heart to lose the ability to function as a pump?

A

ventricular fibrillation

48
Q

What is the treatment for VF?

A

Defibrillation, Cardiopulmonary resuscitation

49
Q

What is the acute treatment for VT?

A

DC cardioversion if unstable
If stable: consider pharmacologic cardioversion with AAD
If unsure if VT or something else - adenosine

50
Q

What changes in electrolyte balance could cause VT?

A

Hypokalaemia, hypomagnesaemia

51
Q

What medications could cause VT?

A

that prolong the QT interval i.e. sotalol, quinidine, terfenadine, erythromycin

52
Q

How could you correct ischaemia in VT?

A

revascularisation

53
Q

Should anti-arrhythmic drugs be used for long term VT?

A

No

54
Q

What should be used for life threatening long term VT?

A

Implantable cardiovertor defbrillators (ICD)

55
Q

What types of AF are there?

A

paroxysmal, persistent or permanent

56
Q

What is the common sustained arrhythmia?

A

AF

57
Q

How long does paroxysymal AF last?

A

less than 48 hours

58
Q

What is permanent AF?

A

cannot restore NSR by any method

59
Q

Can persistent AF be carioverted to NSR?

A

Yes

60
Q

Is Sick sinus syndrome ‘tachy brady syndrome’ related to AF?

A

Yes

61
Q

Can idiopathic AF be genetic?

A

Yes

62
Q

What are the symptoms of AF?

A 
Chest pain
Dyspnea
Sweatiness
Fatigue
Palpitations
Pre-syncope (dizziness)
Syncope
63
Q

In AF what is there an ectopic focus around?

A

pulmonary veins

64
Q

What is the atrial rate in AF?

A

> 300bpm

65
Q

What can be seen on an ECG in AF?

A

Irregularly irregular pulse
Absence of P waves
Presence of ‘f’ waves

66
Q

Can AF exist with a slow ventricular rate?

A

Yes

67
Q

What happens to cardiac output in AF?

A

decreased

68
Q

Which rate control drugs should be used in AF?

A

Betablockers
Verapamil, diltiazem
Digoxin (not first line)

69
Q

How can rhythm be controlled in AF (to restore NSR)?

A
  • Pharmacologic cardioversion (anti-arrhythmic drugs e.g. amiodarone)
  • Direct Current Cardioversion (DCCV)
70
Q

How can NSR be maintained in AF?

A

Anti-arrhythmic drugs
Catheter ablation of atrial focus/ pulmonary veins
Surgery (Maze procedure)

71
Q

What class of anti-arrhythmic drugs are sodium channel blockers?

A

1

72
Q

What class of anti-arrhythmic drugs are beta-blockers?

A

2

73
Q

What class of anti-arrhythmic drugs are potassium channel blockers?

A

3

74
Q

What class of anti-arrhythmic drugs are calcium channel blockers?

A

4

75
Q

What action potential phase is blocked in each of the anti-arrhythmic drug classes?

A

Class 1 - 0
Class 2 - 4
Class 3- 3
Class 4 - 2

76
Q

Which anti-arrhythmic drug classes are rate control and which are rhythm control?

A

Rate - 2,4

Rhythm - 1,3

77
Q

Which anti-arrhythmic drug class prolongs action potentials?

A

3

78
Q

What are examples of class 3 anti-arrhythmic drugs?

A

Amiodarone, sotalol, dronedarone

79
Q

What do Torsades de Pointes have a rate of?

A

200 - 250 bpm

80
Q

How do Torsades de Pointes appear on an ECG?

A

Long QT interval
Wide QRS
Continuously changing QRS morphology
Irregular rhythm

81
Q

What events can cause TdP?

A 
Hypokalemia
Prolongation of the action potential duration (drug induced)
Renal impairment (increased drug levels)
82
Q

Does Thyrotoxicosis put you at risk of thromboembolism?

A

Yes

83
Q

Which valve diseases are an indication for thromboembolism?

A

MS and MR

84
Q

Why would radiofrequency ablation be used in AF?

A

To maintain SR
by ablating AF focus (usually in the pulmonary veins)
For rate control
Ablation of the AVN to stop fast conduction to the ventricles

85
Q

Is atrial flutter usually paroxysmal?

A

Yes

86
Q

What circuit is Atrial Flutter sustained by?

A

macro-reentrant

87
Q

In atrial flutter, where is the circuit confined to?

A

Circuit is confined to the right atrium

88
Q

What does atrial flutter usually progress to?

A

AF

89
Q

Is radiofrequency ablation successful in Atrial flutter?

A

Yes

90
Q

What should drug treatment for Atrial flutter aim to do?

A

Slow the ventricular rate
Restore sinus rhythm
Maintain sinus rhythm once converted

Cardio Pathology (6 decks)

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