Arrhythmia Flashcards
Main Arrhythmia Presentations[3 Arrhythmia Types + 1 resulting Presentation/Consequence each]
Tachyarrhythmia - PalpitationsBradyarrhythmia - Pre-/SyncopeCombination - both
History of Palpitations[Cardinal features; 5 Questions to ask; give +2 examples for 4]
Character (forceful/missed beat/how rapid)Tap Out Rhythm (regular/irregular)Onset/OffsetPrecipitant (caffeine, stress, quiet room)Associated Features (chest pain, dyspnea, sync/presyncope)
What could the pt mean with palpitation [ X beat; 4]
Fast Heart BeatMissed BeatIrregular BeatAware of Forceful Beat
Palpitations: What Investigations?[ 3 ]
- ECG (holter monitor)- Echocardiogram (structural heart heart disease)- Special: Electrophysiology study
Holter vs. Event vs. Loop Recorder[ 1 main distinguishing feature]
Holter: 24hrs; records everythingEvent: pt triggered; 20min memoryLoop: 3 yrs; surgery + small scar
Investigation for Cardiac Ischemia [2]
- Stress Test- Coronary Angiography
Premature Ventricular/Atrial Complexes[2: general prognosis; advice ]
- usually benign- cut down on caffeine
Atrial Fibrillation[ important why? Symptoms [3] + when + what causes symptoms?]
- Symptoms due to rapid heart rate- Symptoms: palpitations, SOB, Angina, esp. on exertion- ↑Risk of Stroke / PE
AF Management[ 4 Issues]
- Rule out Precipitant, e.g. hypothyroid, infection2. Cause? e.g. AF common in cardiomyopathy3. Decision: Rate vs. Rhythm4. Evaluate Stroke Risk (vs. Bleed; second Decision)
AF Decision: Rate vs. Rhythm[purpose/idea of each; how to achieve - 3 each; +pro/con]
Rhythm:- Maintain Rhythm- Antiarrhythmic agents:Sotalol, Flecainide, Amiodarone(+/- electrical cardioversion; catheter ablation)- however can cause other arrhythmia - e.g. VTRate Control:- safer- Slow conduction at AV Node- Beta Blockers, Ca Channel Blockers, Digoxin
AF Decision: Stroke Risk vs. Bleeding Risk[2 groups; 5 drugs total]
Anticoagulants - Warfarin- New: Dabigatran, Rivaroxaban, Apixabanvs.Aspirin (note antiplatelet)
AF: Catheter Ablation- When [in what situation]- Aim [+ concept behind]- Target specific
- When: persistent symptoms despite therapy- Aim: maintain sinus rhythm by stopping AF propagating sites- AF sites: around pulmonary veins- 70-80% success
SVT (1)- Describe ECG [3]- Statistics: [%] due to … [pathway/mechanism]; most common [XXX tachycardia]- Also …[a type of SVT]
- ECG: regular, narrow complex tachycardia- 90% due to re-entrant circuits- most common AV Nodal re-entry tachycardia- also Wolff-Parkinson White SyndromeRe-entry Note: when propagating impulse fails to die out after normal activation, and persists to re-excite the heart - can also occur in AF/Flutter, VT after MI, or VF
SVT (2)- [Invasive Treatment] targets [ anatomical location/structure] + why [simple]- [%] success rate
- Catheter Ablation targets: AV node, because it’s normally involved in SVT - 95% success rate
SVT (3) - Acute Treatment- Non-pharmacological [1]- Pharmacological [2]
- Vagal Maneuver- IV Adenosine- IV Verapamil in 1mg increments
SVT Adenosine for Acute Treatment- Before administration [do what?]- How administered?- Effect [why does it work; effective?]
- Before: warn pt of flushing/feeling terrible for a few seconds- 6-12 mg IV stat (followed by saline flush)- transient AV block; very effective
Wolff-Parkinson White Patter- pattern is indicative [what causes this pattern]- Effect of this pathology [as a result; what happens - ECG finding [describe + name]
- indicates large macro re-entrant pathway bypassing AV node- excites the ventricle earlier than normal- ECG: slurred upstroke of QRS ==> Delta Wave
Broad Complex Tachycardia is…
Ventricular Tachycardia until proven otherwise
VTGenerally, requires … [action]A) Sustained VT is a [implication]B) If Hemodynamically Unstable [do what; action]C) If Sustained + Hemodynamically unstable [action; 2 / kind of 3]
Requires continuous Cardiac monitoringA) sustained VT = Cardiac EmergencyB) requires immediate DC ReversionC) Sustained + Hemo-Unstable –> Amiodarone (pharmacological reversion) + DC shock under sedation
VT - Causes [2]For each cause, how would you confirm it? [3 for (a), 1 for (b)]
(a) Cardiac Ischemia- possibly as complication of MI- ECG, Troponin, Angiogram(b) Significant underlying Cardiac Disease- e.g. Cardiomyopathy- Echocardiography
PalpitationsWhen to worry [8 of which 3 are situational]
- PMHx of Cardiac Disease- FmHx of Sudden Cardiac Death- Evidence of Cardiac Disease (on baselines tests; e.g. echocardiography)- Severe Symptoms- Cardiac Arrhythmia documented (at time of symptoms)- High Risk Work environment (e.g. heavy vehicle)- High Level Sporting Activities- Before/During Pregnancy
Syncope ECG Abnormalitites- 2 Types of Disease + signs of ECG- Rarely… [2 diseases/ECG patterns
A) Sinus Node Disease: Sinus Bradycardia, pausesB) AV Conduction Block: 1st/2nd/3rd degree Rare: WPW pattern, Long QT Interval
AV Conduction Block (1)1st Degree[2; 1 abnormal ECG feature]
PR Interval > 0.2 secondsEvery p wave followed by QRS complex
AV Conduction Block (2)2nd Degree: Mobitz Type 1[3; ECG changes]
(Wenckebach Block)1) Progressively ↑PR Interval + ↓RR Interval2) eventually P wave is blocked3) After blocked beat: ↓PR Interval(note: still see P wave, but no QRS/beat pause, because no conduction)
