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cardiovascular > arrhythmia > Flashcards

arrhythmia Flashcards

1
Q

what can arrhythmias cause

A
  • sudden death
  • syncope
  • heart failure
  • chest pain
  • dizziness
  • palpitations
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2
Q

what are 2 main types of arrhythmias

A
  • bradycardia. (<60bpm)

- tachycardia(>100 bpm)

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3
Q

what are tachycardia subdivided into

A
  • SVT

- ventricular

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4
Q

what leads to tachycardia

A
  • reduction of parasympathetic tone

or

  • increase in sympathetic tone
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5
Q

what produces bradycardia

A
  • increased parasympathetic

or

  • decreased sympathetic
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6
Q

who has faster sinus rate men or women

A

women

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7
Q

what is normal sinus rhythm characterised by on ECG

A

p waves upright in leads I and II

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8
Q

why is sinus bradycardia in athletes

A

due to their increased vagal tone

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9
Q

extrinsic causes of bradycardia

A
  • hypothermia
  • drug therapy e.g. beta blocker
  • raised intracranial pressure
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10
Q

intrinsic causes of bradycardia

A
  • infarction of sinus node

- fibrosis

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11
Q

what. does chronic symptomatic sick sinus require

A

permanent pacing

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12
Q

how many forms of atrioventricular block is there

A

3

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13
Q

what is first degree AV block

A

prolongation of PR interval

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14
Q

what are 2 forms of second degree AV block

A

Mobitz I

Mobitz II

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15
Q

what is Mobitz I

A

progressive PR interval prolongation until p wave fails

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16
Q

what is Mobitz II

A

every nth p wave is dropped

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17
Q

when is pacing indicated

A

in Mobitz II

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18
Q

what may an acute MI produce

A

second degree heart block

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19
Q

what is third degree AV block

A

complete heart block

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20
Q

what infection can cause AV block

A
  • endocarditis
  • lyme disease
  • chagas disease
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21
Q

what does narrow complex escape rhythm imply

A

that it originates in the His Bundle

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22
Q

what does the left bundle subdivide into

A

anterior and posterior divisions of left bundle

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23
Q

what is complete bundle branch block do to QRS

A

widen it up to >0.12 secs

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24
Q

right bundle branch block produces

A

late activation of the right ventricle

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25
Q

what is seen in ECG of right bundle branch block

A

deep S wave in leadsI and V6

tall late R wave in V1

looks like an M (MaRRoW)

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26
Q

what does left bundle branch block look like on ECG

A

deep S wave in lead V1

tall R wave in leads I and V6

W shape (MaRRoW)

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27
Q

what is bifsacicular block

A

is a combination of a block of any two of the following:
right bundle branch
left antero-superior division
left posterior-inferior division

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28
Q

symptoms of right bundle branch block

A

splitting of second heart sound

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29
Q

what does right branch block occur

A
  • isolated congenital anomaly
  • atrial or ventricular septal defect
  • pulmonary stenosis
  • Fallots tetraology
  • pulmonary embolism
  • pulmonary hypertension
  • MI
  • fibrosis
30
Q

causes of left bundle branch block

A
  • aortic stenosis
  • hypertension
  • MI
  • coronary disease
31
Q

where do SVT arise from

A

the atrium or atrioventricular junction

32
Q

what is conduction via in SVT

A

His-Purkinje system

33
Q

sinus tachycardia ECG

A

similar to sinus rhythm

34
Q

atrioventricular nodal re-entrant tachycardia ECG

A

no visible p wave

35
Q

atrioventricular re-entrant tachycardia ECG

A

p wave visible between QRS and T

36
Q

atrial fibrillation ECG

A

irregularly irregular RR

37
Q

atrial flutter ECG

A

waves at 300. bpm

sawtooth appearance

2:1 AV conduction

38
Q

multifocal atrial tachycardia ECG.

A

multiple p wave morphologies

irregular RR intervals

39
Q

what is sinus tachycardia a sign of

A

cardiac stress - physiological or pathological

40
Q

acute causes of sinus tachycardia

A
  • exercise
  • emotion
  • pain
  • fever
  • infection
  • acute heart failure
  • acute pulmonary embolism
  • hypokalaemia
41
Q

chronic causes of sinus tachycardia

A
  • pregnancy
  • anaemia
  • hyperthyroidism
  • catecholamine excess
42
Q

what should be used to slow the sinus rate in hyperthyroidism

A

beta blockers

43
Q

who is atrioventricular nodal re-entrant tachycardia more common in n

A

women

44
Q

where are accessory pathways most commonly situated

A

on the left

45
Q

what is most common accessory pathway known as

A

Kent bundles

46
Q

are accessory pathways that conduct form the ventricles to the atria visible on ECG

A

no they are concealed

47
Q

what is a pre excited ECG characterised by

A

short PR interval

wide QRS

48
Q

what have patients with a history of palpitation and pre-excited ECG have

A

Wolff-Parkinson-White syndrome

49
Q

during atrial fibrillation what can the ventricles be depolarised by

A

impulses travelling over both abnormal and normal pathways

50
Q

what drugs can precipitate ventricular fibrillation

A

verapamil

digoxin

51
Q

what drugs should not be used to treat WPW syndrome

A

verapamil

digoxin

52
Q

symptoms of SVT

A
  • palpitations (abrupt onset and sudden termination)
  • anxiety
  • dizziness
  • dyspnoea
  • neck pulsation
  • central chest pain
  • weakness
  • polyuria
53
Q

how can SVT palpitations be terminated

A

valsalva manouevres

54
Q

what can irregular palpitations be due to

A

atrial premature beat
atrial flutter
atrial fibrillation
multi-focal atrial tachycardia

55
Q

what can happen in patients with uncontrolled atrial fibrillation

A

cardiac output can reduce and cause hypotension and congestion heart failure

56
Q

why may polyuria occur in SVT

A

because of release of atrial natriuretic peptide in response to increased atrial pressure

57
Q

why does prominent jugular venous pulsation occur during SVT

A

due to atrial contracts against closed AV valves

58
Q

treatment of SVT in patient who is haemodynamcially unstable

A

emergency cardioversion

59
Q

treatment of SVT in stable patient

A

vagal manoeuvres

e.g. right carotid massage, face in cold water

60
Q

how should valsalva manoeuvre be done

A

patient is resting in supine position

61
Q

what is does next if physical manoeuvres are not successful in SVT

A

intravenous adenosine

62
Q

what is adenosine

A

naturally occurring purine nucleoside

it causes complete heart block for a fraction of a second

63
Q

what is half life like in adenosine

A

very short

64
Q

what are side effects of adenosine

A
  • bronchospasm
  • flushing
  • chest pain
  • heaviness in limb
  • sense of impending doom
65
Q

when is adenosine contraindicated

A

people with asthma

as it can induce atrial fibrillation

66
Q

what is alternative treatment for adenosine

A

verapamil or beta blockers

67
Q

what is long term management of. SVT

A

referred to cardiologist

ablation of an accessory pathway

68
Q

examples of sodium channel blockers

A

flecainide

69
Q

where do atrial tachyarrhythmias arise

A

atrial myocardium

70
Q

what are atrial tachyarrhythmias caused by

A
  • increasing age
  • MI
  • hypertension
  • obesity
  • diabetes mellitus
  • myocarditis
  • pericarditis
  • surgery
  • electrolyte imbalance
  • alcohol
  • chest infection
  • hyperthyroidism

cardiovascular (36 decks)

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