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CVS > Arrhythmia - broad complex / Brady / genetic > Flashcards

Arrhythmia - broad complex / Brady / genetic Flashcards

1
Q

What are broad complex tachycardia / ventricular

A

HR >100

QRS >120

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2
Q

If there is no clear QRS what is the Dx

A

VF (chaotic / no pattern)

Unusual to capture on ECG as cardiac arrest rhythm

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3
Q

What is DDX of broad complex tachycardia

A

Ventricular fibrillation
Ventricular tachycardia
SVT with BBB / metabolic disturbance
WPW with anti-dromic tachy

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4
Q

What causes irregular ventricular tachycardia (broaD)

A

Torsades de points

Any cause of SVT + BBB / metabolic usually AF if irregular

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5
Q

What is VF

A

Cardiac arrest
No P wave or QRS
Random signals generated through ventricles

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6
Q

What is VT

A

Signal from AV sets of own impulse instead of going down bundle of His
Very broad QRS

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7
Q

What types of VT can you get

A

Monomorphic - usually MI

Polymorphic - torsade de points

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8
Q

What are symptoms of ventricular tachycardia / broad complex tachy

A 
Palpitations
CHest pain
SOB
Dizzy
Syncope if fast enough 
Low BP
Heart failure
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9
Q

What are adverse signs suggesting immediate cardio version

A 
Decreased consciousness
Syncope
BP <90
Clammy
Oliguria
Angina
Pulmonary oedema
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10
Q

Who is at risk of broad complex tachycardia / ventricular

A 
Post MI
IHD for VT
Long QT syndrome 
Cardiomyoapthy
Hypokalaemia
Hypomagneisum
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11
Q

How do you deal with VT / broad

A 
12 lead ECG
Cardiac monitor 
Have defibrillator close 
O2 sats
Bloods - U+E
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12
Q

How do you differentiate SVT from VT

A

Hx
12 lead ECG showing broad vs narrow
Response to medication

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13
Q

If peri-arrest what do you assume

A

Ventricular and Rx as this

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14
Q

If no pulse

A

Cardiac arrest

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15
Q

If patient is stable what do you do

A 
IV access 
O2 if low sats 
Correct electrolyte 
Identify underlying rhythm
If in doubt treat as VT (most common cause)
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16
Q

What do you do if unstable VT or uncertain

A

HELP FAST
DC Cardioversion if adverse signs
CPR
Correct electorlyte

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17
Q

What do you follow up with

A

IV amiadarone 300mg then 24 hour infusion 900
Lidocaine if fails
ICD / EPS if this fails
Can have maintenance treatment of BB or amiadarone

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18
Q

When do you caution with lidocaine

A

Severe left ventricular impairment

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19
Q

What do you never use in ventricular tachy

A

Verapamil

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20
Q

What do you do after correct

A

Establish cause
Maintenance AA - BB / amiadarone
ICD / surgery may help esp if LV functional impairment

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21
Q

How do you Rx VF

A

Cardiac arrest
DC cardio version
AA
ICD

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22
Q

What is Tornado de point

A

Form of polymorphic VT associated with long QT

Have long QT syndrome then ectopic hits to generate abnormality

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23
Q

What is it associated with / what causes

A 
Long QT syndrome 
Ischaemia - may see STEMI
Drugs  
- Amiadarone 
- Sotolol 
- Anti-psychotics
- TCA 
- Macrolide Ax - mycin
Electrolyte 
- Hypocalcaemia
- Hypomagnesium
- Hypokalaemia
SAH
Hypothermia
Myocarditis
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24
Q

What is seen on ECG

A

VT with polymorphic QRS so height changes

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25
Q

How do you Rx

A

Correct underlying cause
IV Mg sulphate
Stop any drugs that prolong QT

Long term

  • BB (not sotolol)
  • Pacemaker
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26
Q

What can it progress to

A

Usually revert back but can translate to VT and cardiac arrest
Cardiac arrest so have defibrillator ready

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27
Q

What is ventricular ectopic

A

Random beat originating out with atria

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28
Q

When is it common

A

Post MI / IHD / HF

Can occur in healthy

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29
Q

How does it present

A 
Asymptomatic
Palpitation
Thumbing heart
Heart missing a peace
Irregular pulse if frequent
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30
Q

How does it present on ECG

A

Broad QRS with random extra

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31
Q

How do you investigate

A

Blood for anaemia, thyroid, electrolyte

32
Q

How do you Dx

A

Reassure

If post MI can lead to more serious arrhythmia

33
Q

What types of bradycardia

A 
Sinus
Heart block
AF with slow ventricular response
Flutter + high degree block
Junctional
34
Q

When is Brady physiological

A

Athletes

Sleep

35
Q

What are cardiac causes of bradycardia

A 
AV block
Sinus node disease 
Degeneration of conduction if Hx of BBB
Post MI
IHD
Sick sinus
Ablation 
Valvular disease
IE 
Myocarditis
Cardiomyopathy
36
Q

What do you do if IE

37
Q

What drugs cause Brady

A

BB
Rate limiting CCB - Verapamil / dilitiazem
Digoxin
Amiodarone

38
Q

What are non-cardiac causes

A 
Vasovagal = very common
Hypothyroid
Hypoadrenal
Hyperkalemia
Hypoxia
Hypothrmia
Increased ICP / Cushing
39
Q

What are the symptoms of Brady

A 
Asymptomatic
Chest pain
SOB
Fatigue
Nausea
Dizzy
40
Q

What suggests harm-dynamic compromise and the need for Rx as per-arrest with IV atropine

A 
Shock
Hypotension 
Syncope
MI
Ischaemia
HF
41
Q

What causes hypotension

A

Brady NOT hypovolemia so no fluid bolus

42
Q

How do you investigate Brady

A 
ABCDE 
O2 if hypoxic 
BP 
IV access
- Bloods - U+E
- Digoxin level 
Reverse and treat electrolyte abnormality 
12 lead ECG if come in with bradycardia 
Cardiac monitor 
Look at drugs
43
Q

What do you do if think you will need

A

Call anaestheist

44
Q

If adverse signs what do you give

A

IV atropine

500mcg up to 3mg

45
Q

What do you do if not improving

A

Other inotropes
Adrenaline
Transcutaneous pacing

46
Q

What do you do if stable

A

O2
IV access
Treat cause
Observation

47
Q

If Brady improves but still at risk of astyole

A

Long term pacing

48
Q

Who is at risk of astyoel

A

Recent astyole
AV block type II
Complete heart block
Ventricular pause >3s

49
Q

What is important as well as ECG

A

Clinical signs

If look unwell= WORRY

50
Q

What do you do if Cushing’s

A

SENIOR ADVICE

51
Q

What causes AV heart block

A 
AV node issue
IHD - inferior MI RCA 
BB
Amiodarone
Fibrosis
52
Q

What is 1st degree block

A

Electrical impulses slow
All reach ventricle
Long PR >0.2s

53
Q

How does it present and Rx

A

No symptoms

No Rx

54
Q

What is 2nd degree MObitzz type 1

A

PR delayed until beat fails to reach ventricle (no QRS)

May be dizzy

55
Q

Wha is 2nd degree type II

A

PR constant but P wave not always followed by QRS

2:! or 3:!

56
Q

What do you do for type II

A

Pacemaker

Commonly progresses to type 3

57
Q

What is type 3

A

No electrical impulses reach ventricle
Generate own escape beats
Not coordinated with atrial

58
Q

How do you differentiate type 3 from VF

A

Atrial faster than ventricle in AV block

59
Q

What is BBB

A

Impulses slow or blocked as they travel through conducting tissue in one of two ventricles - either R or L

60
Q

How does heart block present

A 
SOB
Syncope
HF
Bradycardia
Wide pulse pressure
JVP shows cannon waves
61
Q

How do you Rx

A

Same as Brady above
Observe if stable
IV atropine
Pacing for type 2 and type 3

62
Q

When is pacing CI

63
Q

What causes sick sinus syndrome

A

Sinus node fibrosis

Common in elderly

64
Q

How does it present

A 
Sinus Brady
AF or atrial tachy
Syncope
Dizzy
Palpitations
SOB
Cardiac arrest
65
Q

How do you Rx

A

PACEMAKER

Anti-coagulant if AF

66
Q

What causes long QT

A 
Congenital / genetic
- Issue with KCN gene 
Drugs
Hypo K, Mg, Ca
MI
Myocarditis
Hypothermia
SAH
67
Q

What drugs

A 
Amiadarone
Sotalol 
TCA
SSRI esp citalopram
Haloperidol
Macrolide - erythromycin 
Methadone
68
Q

What is long QT

A

Delayed depolarisation of ventricle

69
Q

How does long QT present

A 
Ventricular tachy - paroxysmal polymorphic 
Torsade de points
Leads to
- Syncope
- Seizure
- Sudden death
70
Q

What exacerbates

A

Emotion
Exercise
Drugs

71
Q

How do you Rx

A

Avoid drugs which prolonged QT
BB
Nicroandil
ICD if high risk e.g. QT >500 or previous cardiac arrest

72
Q

What BB do you avoid

73
Q

What is Brugada

A

AD SCNA5
Na channelopathy
Causes sudden death

74
Q

What is seen on ECG

A

ST elevation
-ve T wave
V1-V3
Partial RBBB

75
Q

How do you cause more apparent ECG

A

Administer flecainide

76
Q

What do you do if Dx

A

Implantable cardiac device

Screen family

CVS (30 decks)

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