Arrhythmia

Question 1

Treat bradycardia

Answer 1

1. Treat cause (drugs, MI, infiltration)
2. Medical (atropine, isoprenaline)
3. External pacing

Question 2

Permanent pacing indication

Answer 2

Mobitz II, 3rd degree heart block

AF, sick sinus

Question 3

Manage SVT

Answer 3

1. Vagal manoeuvres
2. Carotid sinus massage
3. IV adenosine 6mg
4. Digoxin, atenolol, verapamil, amiodarone

Question 4

Differential of broad complex QRS

Answer 4

VT, torsades de points, SVT + BBB

Question 5

VT causes

Answer 5

Infarction, myocarditis
Prolonged QT, low K
Valve abnromality

Question 6

VT pulse and unstable management

Answer 6

Synchronised DC cardioversion

Question 7

VT manage

Answer 7

1. Treat cause
2. Amiodarone
3. Lidnocaine

Question 8

Torsades de point cause:

Answer 8

Hypocalcaemia, amiodarone

Question 9

Torsades de point treat

Answer 9

Magnesium sulphate

Question 10

Causes of AF

Answer 10

MITRAL P

Mitral valve disease, IHD, thyrotoxicosis, rheumatic heart disease, alcohol/low K, LVH, PE

Question 11

Symptoms of AF

Answer 11

Asymptomatic, chest pain, palpitations, dyspnoea, faintness

Question 12

Signs of AF

Answer 12

Irregularly irregular pulse
Single waveform JVP
1st HS of variable intensity

Question 13

Management of acute AF

Answer 13

Emergency cardioversion, medical cadioversion:
1st line - flecainide/sotalol
2nd line if structural heart disease - Amiodarone
Start LMWH

Question 14

Failure of acute AF cardioversion option

Answer 14

Rate control - diltiazem, verapamil, metoprolol

Question 15

Manage paroxysmal AF medication

Answer 15

Sotalol or flecainide

Question 16

Persistent AF rhythm control

Answer 16

1. Warfarin for 3 weeks/TOE to rule out intracardiac thrombus
   Electrical/medical cardiovert (flecainide, amiodarone, sotalol)
   Further anticoagulation

Question 17

Rate control AF medical options

Rate control AF if in acute heart failure

Answer 17

1. B blocker/Ca blocker
2. Add digoxin
   If in heart failure:
3. Digoxoin
4. Amiodarone

Question 18

CHA2DS2-VASc of 1 or more give

Answer 18

Oral anticoagulant - warfarin

Or dabigitran, rivoroxiban, apixaban

Question 19

Sorry another question from me 
An 84 year old lady presents with a fall and is found to be in persistent atrial fibrillation. Regarding her management of AF, which of the following is recommended?
A) Warfarin
B) Digoxin 250mcg
C) Aspirin
D) Amiodarone
E) Amlodipine

Answer 19

Warfarin