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Cardiovascular System > Arrhythmia - Pathophysiology, Presentation & Investigation > Flashcards

Arrhythmia - Pathophysiology, Presentation & Investigation Flashcards

1
Q

What are some different kinds of arrhythmias?

A

Supraventricular ectopics

Supraventricular tachycardia

Ventricular tachycardia

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2
Q

What is an ectopic heart beat?

A

When the heart either skips a beat or adds an extra one

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3
Q

What is it called when the heart either skips a beat or adds an extra one?

A

Ectopic heart beat

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4
Q

What is the presentation of supraventricular ectopics?

A

Asymptomatic

Palpitations

Dyspnoea

Chest pain

Fatigue

Embolism

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5
Q

What investigations are done for supraventricular ectopics?

A

Document arrhythmia on 12 lead ECG (24 hour recording)

Blood tests (especially thyroid function)

Echocardiogram

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6
Q

What are some therapeutic approaches for supraventricular ectopics?

A

Rate control versus rhythm control

Electrical approaches

Consider anticoagulation

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7
Q

What is used for rate control versus rhythm control for supraventricular ectopics?

A

Digoxin/beta blocker/calcium antagonist plus warfarin versus class Ic/III drug with or without DC cardioversion

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8
Q

What are electrical approaches to treat supraventricular ectopics?

A

Pace and ablation of AV node

Substrate modification such as pulmonary vein ostial ablation

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9
Q

What are examples of supraventricular tachycardia?

A

AV-nodal-re-entrant tachycardia

Atrial flutter

Atrial fibrillation

Ventricular fibrillation

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10
Q

What is the most common kind of supraventricular tachycardia?

A

AV-nodal re-entrant tachycardia

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11
Q

What is AV-nodal re-entrant tachycardia often due to?

A

Accessory pathway such as Wolff-Parkinson-White (WPW) syndrome

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12
Q

What does WPW syndrome stand for?

A

Wolff-Parkinson-White syndrome

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13
Q

What does supraventricular tachycardia manifest as?

A

Palpitations

Dyspnoea

Dizziness

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14
Q

What is Wolff-Parkinsons-White (WPW) syndrome?

A

Where in addition to the AV node there is an additional conducting pathway between the atria and ventricles, which conducts action potentials faster than the AV node and therefore results in a short PR interval and a different shaped QRS wave

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15
Q

How does WPW syndrome change the ECG?

A

Shorter PR interval

Different shaped QRS wave

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16
Q

What is atrial flutter?

A

Tachycardia of the atria but the beat is regular

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17
Q

What is tachycardia of the atria with a regular beat called?

A

Atrial flutter

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18
Q

What is atrial fibrillation?

A

Tachycardia of the atria with an irregular beat

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19
Q

What is tachycardia of the atria with an irregular beat called?

A

Atrial fibrillation

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20
Q

What is this?

A

Atrial flutter

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21
Q

What is the treatment of atrial flutter?

A

Control ventricular rate and thomboembolic risk

Prevent with AA or radiofrequency (RF) ablation of cavotricuspid isthmus

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22
Q

What does RFA stand for?

A

Radiofrequency ablation

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23
Q

What is radiofrequency ablation (RFA)?

A

Medical procedure in which part of the electrical conduction system of the heart is ablated (removed) using the heat generated from medium frequency alternating current

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24
Q

What is a medical procedure in which part of the electrical conduction system of the heart is ablated (removed) using the heat generated from medium frequency alternating current?

A

Radiofrequency ablation (RFA)

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25
Q

What does ablated mean?

A

Removed

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26
Q

What is ventricular fibrillation?

A

Heart rhythm problem that occurs when the heart beats with rapid electrical impulse, causing the chambers to quiver uselessly instead of pump blood

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27
Q

What is a heart rhythm problem that occurs when the heart beats with rapid electrical impulse, causing the chambers to quiver uselessly instead of pump blood?

A

Ventricular fibrillation

28
Q

What is this?

A

Ventricular fibrillation

29
Q

What do you respond to ventricular fibrillation with?

A

Cardiac arrest protocol

30
Q

What is the difference between ventricular fibrillation and tachycardia?

A

They are both faster than normal, however fibrillation is irregular and tachycardia is regular

31
Q

What are presentations of ventricular tachycardia?

A

Palpitations

Constructive pericarditis

Dyspnoea

Dizziness

Syncope

32
Q

What investigations are done for ventricular tachycardia?

A

Usually structural heart disease so:

Bloods
ECHO
Angiogram

33
Q

What is the treatment for ventricular tachycardia?

A

Cardiac arrest protocol

DC cardioversion or drugs

34
Q

What is DC cardioversion?

A

Procedure used to convert an abnormal heart rhythm to a normal one

35
Q

What is a procedure used to convert an abnormal heart rhythm to a normal one?

A

DC cardioversion

36
Q

What is Torsades de Pointes?

A

Specific form of ventricular tachycardia in patients with a long QT interval

37
Q

What does ICD stand for?

A

Implantable cardioverter defibrillator

38
Q

What is an implantable cardioverter defibrillator (ICD)?

A

Device implantable inside the body that is able to perform cardioversion defibrillation and pacing of the heart, so can correct arrhythmias

39
Q

What is a device implantable inside the body that is able to perform cardioversion defibrillation and pacing of the heart, so can correct arrhythmias?

A

Implantable cardioverter defibrillator (ICD)

40
Q

What are indications for ICD therapy?

A

Secondary prevention:

Cardiac arrest due to ventricular fibrillation (VF) or ventricular tachycardia (VT) due to transient or reversible cause such as early phase of acute myocardial infarction

Sustained VT causing syncope or significant compromise

Sustained VT with poor left ventricular function

41
Q

What does VF stand for?

A

Ventricular fibrillation

42
Q

What does VT stand for?

A

Ventricular tachycardia

43
Q

What does heart block refer to?

A

Impairment of transmission of excitation from the atria through to the ventricles

44
Q

What is impairment of transmission of excitation from the atria through to the ventricles called?

A

Heart block

45
Q

What are the 3 kinds of heart block?

A

1st degree heart block

2nd degree heart block (Mobitz I and Mobitz II)

3rd degree heart block

46
Q

What is 1st degree heart block?

A

Abnormally long PR interval

47
Q

What is 2nd degree heart block?

A

Some atrial depolarisation fail to be transmitted at all

48
Q

What are the different kinds of 2nd degree heart block?

A

Mobitz I

Mobitz II

49
Q

What is Mobitz I 2nd degree heart block?

A

PR interval progressively lenghtens until there is a failure of transmission, then the whole cycle starts again

50
Q

What is Mobitz II 2nd degree heart block?

A

No progressive lengthening of the PR interval but only some of the atrial depolarisation are transmitted through to the ventricles

51
Q

What is 3rd degree heart block?

A

None of transmission gets through

52
Q

What is Mobitz I thought to arise due to?

A

Defect in the AV node

53
Q

What is Mobitz II thought to arise due to?

A

Defect in the fast conducting system

54
Q

What are some indications for temorary pacing?

A

Intermittent or sustained symptomatic bradycardia, particulary syncope

Prophylactic when patient at high risk for development of severe bradycardia (such as 2nd or 3rd degree AV block, post anterior MI)

55
Q

What are some indications for permanent pacing?

A

Symptomatic or profound 2nd or 3rd degree AV block

Probably Mobitz type II 2nd/3rd degree AV block even when asymptomatic

AV block associated with neuromuscular disease

After (or in preparation for) AV node ablation

Syncope when bifascicular/trifacicular block and no other explanation

Sinus node disease associated with symptoms

Carotid sinus hypersensitivity

56
Q

What is sinus arrest?

A

A condition where the SA node fails to initiate the heartbeat for a period of time

57
Q

What are conditions where the SA node fails to initiate the heartbeat for a period of time called?

A

Sinus arrest

58
Q

What happens during sinus arrest?

A

Rhythm taken over by a slower pacemaker elsewhere which is referred to as an escape rhythm

59
Q

What is sick sinus syndrome?

A

Any problem originating from the SA node

60
Q

What is any problem originating from the SA node called?

A

Sick sinus syndrome

61
Q

Where could ectopic beats arise from?

A

Myocardial cells in the atria or in the ventricles

62
Q

How would atrial ectopic affect the ECG?

A

Produce distorted P wave followed by a normal QRS and T wave

63
Q

How would ventricular ectopic affect the ECG?

A

Would not be preceded by a P wave, and would probably produce an abnormal QRS and T wave

64
Q

What is the most common cardiac arrhythmia?

A

Atrial fibrillation

65
Q

What is the prevalence of atrial fibrillation?

66
Q

Is atrial fibrillation more common in men or woman?

Cardiovascular System (41 decks)

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