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My Cardiovascular > Arrhythmia > Flashcards

Arrhythmia Flashcards

1
Q

What do supra-ventricular arrhythmias include?

A

arrhythmia that arises above the AV node

  • Afib
  • atrial flutter
  • ectopic atrial tachycardia
  • sinus bradycardia/pauses
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2
Q

Where do ventricular arrhythmias arise from?

A

ventricular muscle or from the fascicles of the conducting system

  • tachycardia
  • fibrillation
  • ventricular ectopics
  • a-systole
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3
Q

What are the types of AV node arrhythmias?

A
  • re-entry tachycardia
  • extra connection to AV reentrant tachycardia
  • AV block (first, second or third degree block).
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4
Q

What are the causes of arrhythmias?

A
  • Abnormal anatomy- LVH, accessory pathways (extra connections between atria and ventricles) and congenital heart disease
  • Autonomic nervous system- sympathetic stimulation (stress, exercise or hyperthyroidism), increased vagal tone (bradycardia)
  • Metabolic- hypoxia (COPD or PE), ischaemic myocardium or electrolyte imbalances
  • Drugs
  • Inflammation
  • Genetics- mutations of genes encoding cardiac ion channels
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5
Q

What are ectopic beats?

A

beats from somewhere other than the SA node, ectopic focus cause single beat or run of beats that are faster than sinus so take over e.g altered automaticity or triggered activity

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6
Q

What is re-entry?

A

additional circuit with more than one pathway with different speeds of conduction and refractory, triggered by ectopic beat

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7
Q

What does the danger of tachycardia depend on?

A

how it affects the cardiac output

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8
Q

What do things that affect the gradient and the threshold of action potentials affect?

A

automaticity

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9
Q

What does increasing phase 4 increase and cause?

A

increases HR and causes ectopics

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10
Q

What factors increase phase 4?

A

hyperthermia, hypoxia, hypercapnia, cardiac dilation and hypokalaemia

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11
Q

What factors decrease phase 4?

A

hypothermia and hyperkalaemia

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12
Q

What does decreasing phase 4 cause?

A

bradycardia

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13
Q

What phase is triggered activity in?

A

phase 3

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14
Q

What is triggered activity?

A

there are retriggers when the cells are usually inexcitable so there are more beats eg Digoxin toxicity

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15
Q

What is reentry due to?

A
  • structural abnormality so scarring from MI, congenital HD, accessory pathways
  • functional abnormality so self-perpetuating circuit due to differences in time for conduction
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16
Q

What are the causes of heart block?

A 
age
acute MI
myocarditis
amyloid
drugs (beta blockers or calcium channel blockers), aortic valve disease
genetic
17
Q

What is 1st degree heart block?

A

P wave is longer than normal so PR interval is longer and there is no treatment

18
Q

What is 2nd degree heart block?

A

intermittent block at the AVN so there are dropped beats

  • Mobitz 1 (lengthening of PR and eventually a dropped beat)
  • Mobitz 2 (pathological and every nth beat so a permanent pacemaker is needed)
19
Q

What is 3rd degree heart block?

A

is normal P wave but ventricles are in asystole or have their own rhythm

20
Q

What are the symptoms of arrhythmia?

A

palpitations, SOB, dizziness, syncope, presyncope, sudden cardiac death and angina

21
Q

What does exercise ECG record?

A

ischaemia or exercise induced arrhythmia

22
Q

What does ECG show in arrhythmia?

A

assess rhythm, signs of previous MI (Q waves) or pre-excitation (extra bridge of tissue), delta wave is where P wave is almost connected to the QRS so there is pre-excitation

23
Q

What is normal sinus arrhythmia?

A

varying due to respiration reducing vagal tone and increasing heart rate

24
Q

What is sinus bradycardia?

A

can be physiological, with drugs like beta-blockers, inferior STEMIs

25
Q

What is the treatment of sinus bradycardia?

A

atropine or pacing if there is a haemodynamic compromise like hypotension

26
Q

What is sinus tachycardia?

A

can be physiological, can be anxiety, fever, hypotension, anaemia or drugs

27
Q

What is the treatment for sinus tachycardia?

A

underlying cause or beta blockers

28
Q

How does an atrial ectopic beat present?

A

asymptomatic or give palpitations

29
Q

What is the treatment for atrial ectopic beat?

A

beta blockers maybe

avoid stimulants

30
Q

What are the types of regular supraventicular tachycardia?

A
  • AVNRT (circuit using AV node with extra bridge of tissue upwards after going down purkinje and goes down AV node or one path is slower)
  • AVRT (reentrant through AV node but goes down normal way so is orthodromic, antidromic goes in the opposite direction so no P wave)
  • EAT
31
Q

What are the types of ventricular arrhythmia?

A
  • ventricular ectopics
  • tachycardia
  • fibrillation
  • asystole
32
Q

What are ventricular ectopics caused by and treated with?

A

caused by LVH, heart failure, myocarditis, ISH or electrolytes
treated with beta-blockers or by ablated

33
Q

What is tachycardia caused by and treated with?

A

due to coronary artery disease or previous MI

long term treatment is ischaemia correction, ICD and VT catheter ablation

34
Q

What is the acute treatment for supraventricular tachycardia?

A

increase vagal tone (valsalva or carotid massage), slow conduction in the AVN with IV adenosine or IV verapamil

35
Q

What is the chronic treatment for supraventricular tachycardia?

A

avoid stimulants, electrophysiologic study and radiofrequency ablation (cautery of cardiac tissue to prevent tachycardia) for young patients, beta blockers and antiarrhythmic drugs

36
Q

What is the difference between single and dual chamber pacemakers?

A

single chamber: which paces the right atria or ventricle only
dual chamber: which paces both the right atria and right ventricle

37
Q

What is radiofrequency catheter ablation?

A

selective cautery of cardiac tissue to prevent tachycardia to target part of reentry circuit

My Cardiovascular (13 decks)

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