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UKMLA > Arrhythmia > Flashcards

Arrhythmia Flashcards

1
Q

Narrow QRS complex

A
  • < 0.12
  • indicates supraventricular origin
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2
Q

Wide QRS complex

A
  • > 0.12
  • indicates ventricular origin
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3
Q

Types of bradyarrhythmias

A
  1. AV block (first, second I, second II, third degree)
  2. Sick sinus syndrome
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4
Q

Classifying tachyarrhythmias

A
  • regular vs. irregular
  • narrow vs. wide QRS
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5
Q

Irregular, narrow QRS tachyarrythmias

A
  • atrial fibrillation
  • atrial flutter
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6
Q

Irregular, wide QRS tachycardia

A
  • polymorphic VT
  • Torsades de pointes
  • Wolff-parkinson-white syndrome
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7
Q

Regular, narrow QRS tachyarrhythmias

A
  • sinus tachycardia
  • atrial flutter (with consistent AV conduction)
  • paroxysmal supraventricular tachycardia (AV nodal reentry SVT, SA nodal reentry SVT)
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8
Q

Regular, wide QRS tachyarrhythmias

A
  • monomorphic VTs (ventricular tachy, ventricular fibrillation)
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9
Q

Managing regular, narrow complex tachycardia (haemodynamically stable)

A

Acute:
1. vagal maneouvers (valsalva, carotid sinus massage)
2. IV adenosine (6mg, 12mg, 18mg)
3. Consider trying verapamil
3. electrical cardioversion

Prevention:
- beta-blockers
- radio-frequency ablation

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10
Q

Managing haemodynamically unstable tachycardia

SVT and VT

A
  • synchronised DC cardioversion (up to 3 times)
  • perform under sedation
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11
Q

Managing irregular, narrow-complex tachycardia (haemodynamically stable)

Atrial fibrillation or atrial flutter

A

> 48 hours:
- do not treat with cardiovesion until anti-coagulated for at least 3 weeks (reduce risk dislodging thrombus)
- if haemo unstable- can give LMWH prior to immediate cardioversion

< 48 hours:
- chemical cardioversion using flecainide, propafenone, or amiodarone

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12
Q

Long-term management of arrhythmias

A
  • radio-frequency ablation
  • beta-blockers or calcium channel blockers
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13
Q

Managing broad-complex QRS tachycardia (haemodynamically unstable)

A

immediate electrical cardioversion

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14
Q

Managing broad-complex QRS tachycardia (haemodynamically stable)

A

Chemical cardioversion:
- amiodarone
- lidocaine

Drugs fail?
- electrophysiological study
- implantable cardioverter defibs

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15
Q

Which drug is contraindicated in VTs?

A

VERAPAMIL

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16
Q

Atrial fibrillation

A

Most common, sustained arrhythmia

17
Q

Types of atrial fibrillation

A
  • first presentation
  • paroxysmal (< 7 days, self-terminating )
  • persistent (> 7 days, not self-terminating)
  • permanent (cardioversion failed, rate control)
18
Q

Clinical features of atrial fibrillation

A

Symptoms:
- SOB
- palpitations
- syncope
- chest pain

Signs:
- irregularly irregular pulse

19
Q

ECG findings in atrial fibrillation

A
  • irregularly irregular rhythm
  • narrow QRS complex
  • tachycardia (> 100)
  • absent p-waves
20
Q

General management of atrial fibrillation

A
  1. rate and rhythm control
  2. stroke risk reduction
21
Q

Rhythm control in atrial fibrillation

A

Acute:
- electrical cardioversion
- chemical - flecainide, amiodarone

Long-term:
- beta-blockers
- amiodarone
- domperidone (dopamine antagonist)

22
Q

Rate control in atrial fibrillation

A
  • beta-blocker (atenolol)
  • calcium channel blocker (diltiazem)
  • digoxin
23
Q

Reducing stroke risk in atrial fibrillation

A
  • long-term anticoagulation
  • DOACs most common
  • warfarin
24
Q

Determining stroke risk in atrial fibrillation

A

CHA2DS2VaS

25
Q

CHA2DS2VaS

A

Congestive HF (1)
Hypertension (1)
Age (> 75 (2), 65-75 (1))
Diabetes (1)
Stroke, TIA, thromboembolism (2)
Vascular disease (1)
Sex - female (1)

26
Q

Interpreting CHA2DS2VaS scores for anti-coagulation

A

0 = no anticoagulation needed
1 = men consider, females not needed
2 = offer anticoagulation

27
Q

What to do if CHA2DS2VaS score is 0

A

Echo to rule out valvular cause of AF

28
Q

Determining bleeding risk in patients requiring anti-coagulation for AF

A

ORBIT

haemoglobin low (anaemia) (2)
age > 74 (1)
bleeding hx. (2)
renal impairment (GFR < 60) (1)
on antiplatelets (1)

29
Q

Torsades de pointes

A
  • ‘twisting of the points’
  • polymorphic VT with long QT interval
30
Q

Managing torsades de pointes

A

IV magnesium sulphate

31
Q

Causes of long QT on ECG

A
  • congenital
  • antiarrhythmics
  • tricyclic antidepressants
  • macrolides (e.g. erythromycin)
  • electrolyte disturbance
  • hypothermia
  • subarachnoid haemorrhage
  • myocarditis

UKMLA (36 decks)

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