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Cardiovascular System > Arrhythmia and anti-arrhythmics > Flashcards

Arrhythmia and anti-arrhythmics Flashcards

1
Q

How do you tell if an ECG has a sinus rhythm?

A

Regular
Every P is followed by a QRS complex

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2
Q

How do you tell is an ECG shows bradycardia or tachycardia?

A

RR interval
HR= 300/no. big squares in RR interval
>5 big squares → bradycardia
<3 big squares → tachycardia

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3
Q

Bradycardia is <____bpm, Tachycardia is >_______bpm.

A

Bradycardia <60/min
Tachycardia >100/min

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4
Q

What do you do for a px with asystole?

A

CPR or certify death

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5
Q

What are 5 causes of sinus bradycardia?

A

1) High vagal tone (eg. young, athletes)
2) Sick sinus syndrome (elderly)
3) Drugs (eg. ß-blockers, Non-DHP Ca blockers)
4) SA node injury (Ischaemia, Infection eg. myocarditis)
5) Hypothyroidism

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6
Q

How do you tell if an ECG has a sinus arrhythmia?

A

Irregular RR intervals
but every P is followed by a QRS complex

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7
Q

Why does sinus arrhythmia occur?

A

Effect of varying vagal tone on HR due to respiration

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8
Q

How do you tell if an ECG has a 1st degree AV block?

A

Prolonged PR interval
but every P is followed by a QRS complex
(if every P not coupled with QRS → 2nd degree or higher)

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9
Q

What are 3 causes of 1st degree AV block?

A

1) High vagal tone
2) Drugs (eg. ß-blockers, Non-DHP Ca blockers)
3) Aging (fibrosis of AV node)

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10
Q

1st degree AV block are often (symptomatic/asymptomatic)

A

Asymptomatic

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11
Q

How do you tell if an ECG has a 2nd degree AV block?

A

Regularly irregular RR intervals
not every P has QRS but P:QRS ratio is fixed

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12
Q

What are 2 causes for 2nd degree AV block?

A

1) Aging
2) AV node injury (eg. MI for RCA, Myocarditis, Infiltrative disorder)

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13
Q

How do you tell if an ECG has a 3rd degree AV block?

A

No relationship between P and QRS
but regular PP and RR intervals

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14
Q

What are 2 causes for 3rd degree AV block?

A

1) Aging
2) injury to AV node/bundle of his (eg. MI for RCA, Myocarditis, Infiltrative disorder)

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15
Q

What are 4 symptoms of bradycardia?

A

1) Lethargy
2) Giddiness
3) Syncope
4) Exertional dyspnoea (due to chronotropic incompetence)

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16
Q

What are 5 causes of sinus tachycardia?

A

Physiological:
1) Exercise
2) Pain/psychological stress

Pathological:
3) Sepsis/pyrexia
4) Hypovolemia
5) Thyrotoxicosis (excess thyroid hormone)

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17
Q

What are 4 causes of abnormal automaticity (AA) or triggered activity (TA) (eg. EAD, DAD) in tachycardic px?

A

1) Electrolyte abnormalities
2) Channelopathies (eg long QT, brugada)
3) Myocyte injury (eg. ischemia, infection, stretch, infiltration)
4) Anti-arrhythmics

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18
Q

How do you tell if an ECG has an atrial ectopic?

A

Ectopic beat (PQRST complex) disrupting sinus rhythm (occurring earlier than expected)
Differing P wave morphology (inverted P wave on lead II)
narrow QRS

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19
Q

How do you tell if an ECG has an ventricular ectopic?

A

Broad QRS interrupting normal sinus rhythm
- inverted T wave
- R wave&raquo_space;» S wave

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20
Q

How do you tell if an ECG has an ventricular tachycardia?

A

HR>100, sustained ectopics
QRS broad and bizzare

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21
Q

How do you tell if an ECG has an atrial flutter?

A

no p waves
F waves (sawtooth baseline)
regular RR intervals (can be irregular is AV block)

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22
Q

What are some possible causes of atrial flutter?

A

Scarring sets-up closed loop circuits
1) Cardiac failure
2) Atrial surgery
3) Mitral valve disorders

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23
Q

True or false: Ventricular re-entry and ventricular tachycardia have similar ECGs.

A

True
- cannot be differentiated by ECG alone

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24
Q

How does supraventricular tachycardia occur?

A

1) Dual AV node pathways
2) Accessory pathways

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25
Q

How do you tell if an ECG has an atrial fibrillation?

A

Irregularly irregular RR
no p waves
fibrillatory baseline (f waves)

26
Q

What are some possible causes of atrial fibrillation?

A

1) Thyrotoxicosis
2) Mitral valve disease
3) Cardiac failure
4) IHD
5) HTN
6) Chronic lung disease
7) Aging
8) ↑risk of stroke

27
Q

What are some possible causes of ventricular fibrillation?

A

Irregularly irregular RR (no discernable rs btwn P and QRS/QRS all the time)
1) structural aetiologies (eg. AMI, HF, Hypertrophic cardiomyopathy)
2) Inherited channelopathies (long QT, brugada)
3) Hyperkalaemia

28
Q

What are 4 symptoms of tachycardia?

A

1) Cardiac arrest
2) Palpitations
3) Syncope
4) Giddiness

29
Q

How does defibrillation help with ventricular tachycardia?

A

Passes current through thorax to completely depolarise cardiac myocardium

30
Q

Describe the cation flow in excitable cells.

A

K+/Na+ maintains RMP
K+ efflux → polarise
Na+ influx → depolarise
Ca2+ influx → depolarise
CL- influx → polarise

31
Q

Where is the effective refractory period on an ECG?

A

QT interval

32
Q

What is excitability of cells?

A

Cells’ ability to change its internal electrical balance to reach trashold

33
Q

What is automaticity of cells?

A

Cells able to generate an electrical impulse wtihout being stimulated

34
Q

What is conductivity of cells?

A

Cells’ ability to transfer an electrical impulse to the next cell

35
Q

What anti-arrhythmic is used in emergencies?

A

Adenosine

36
Q

What is the T1/2 of adenosine?

A

<10s

37
Q

When is adenosine clinically indicated?

A

Supraventricular tachycardia

38
Q

What is the moa of adenosine?

A

Suppress AV nodal conduction and ↑ AV nodal refractory period
- stimulates K+ channel
- inhibits Ca2+ channel

39
Q

What are 4 AEs of adenosine?

A

1) Flushing
2) SOB, chest burning
3) Induction of AV block or Afib
4) Headache, hypotension

40
Q

What class of anti-arrhythmic is procainamide?

A

Class 1A (Na+ channel blocker)

41
Q

What is the effect of procainamide?

A

1) slows phase 0 depolarisation
2) ↓ conductivity
3) ↓ automaticity
4) ↑ ERP and APD

42
Q

What class of anti-arrhythmic is lidocaine?

A

Class 1B (Na+ channel blocker)

43
Q

What is the effect of lidocaine on the heart?

A

1) slows phase 0 depolarisation
2) shortens phase 3 repolarisation
3) ↓ automaticity
4) ↓ APD

44
Q

What class of anti-arrhythmic is flecainide?

A

Class 1C (Na+ channel blocker)

45
Q

What is the effect of flecainide?

A

1) slows phase 0 depolarisation
2) shortens phase 3 repolarisation
3) ↓ automaticity and conductivity

46
Q

What is the clinical use of flecainide/class 1C Na+ channel blockers?

A

Refractory ventricular tachycardias that send to progress to Vfib

47
Q

What are 2 examples of ß-blockers used as anti-arrhythmics?

A

1) Bisoprolol
2) Metoprolol succinate

48
Q

What is the anti-arrhythmic effect of ß-blockers?

A

1) ↓ HR and contractility
2) reduces phase 4 depolarisation
3) ↓ autopmaticity
4) prolonged AV conduction

49
Q

What are 4 clinical uses for ß-blockers?

A

1) Tachycardia by sympathetic activation
2) Afib
3) AV nodal reentrant tachycardia
4) post MI (reduces sudden arrhythmic death)

50
Q

What class of anti-arrhythmic is amiodarone?

A

Class 3 (K+ channel blockers)

51
Q

What is the anti-arrhythmic effect of amiodarone?

A

1) Prolongs phase 3
2) ↑ ERP and APD

52
Q

A px was prescribed an anti-arrhythmic and has been experiencing bradycardia for the past 2 months after stopping the medication, what medication could it have been?

A

Amiodarone

53
Q

Amiodarone undergoes ______ metabolism to form a (inactive/bioactive) metabolite.

A

Hepatic metabolism to bioactive metabolite
(effected maintained for 1-3months after discontinuation)

54
Q

What are 2 AEs of amiodarone?

A

1) Bradycardia
2) Heart block

55
Q

What are 2 clinical uses for amiodarone?

A

1) Afib to maintain normal sinus rhythm
2) Prevention of reentrant ventricular tachycardia

56
Q

What are Class 4 anti-arrhythmics (give 2 examples)?

A

Non-DHP Ca2+ channel blockers
1) Verapamil
2) Diltiazem

57
Q

What is the anti-arrhythmic effect of non-DHP calcium channel blockers?

A

1) prolongs phase 4 depolarisation
2) ↓ conductivity of AV node
3) ↑ ERP and APD

58
Q

What are 3 clinical uses for verapamil?

A

1) Supraventricular tachycardia
2) HTN
3) Angina

59
Q

What is the main AE for verapamil?

A

Hypotension

60
Q

When is Verapamil contraindicated?

A

In px with pre-existing depressed cardiac function

Cardiovascular System (12 decks)

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