Arrhythmia's

Question 1

How does electrical impulse spread?

Answer 1

From SA node, through AV node, down bundle of His then purkinje fibres

Question 2

P wave is what?

Answer 2

Atreial depolarisation

Question 3

PR inteval is what?

Answer 3

The time from atrial depolarisation until the ventricular depolarisation.

Question 4

WHat is QRS nad T wavses?

Answer 4

QRS is ventricular depolarisation and T is ventricular repolarisation

Question 5

What is sweep speed (paper speed)

Answer 5

25mm/sec

Question 6

4 large squares means what heart rate?

Answer 6

75bpm, and 5 large squares means 60bpm, because 2.5cm/second, 1 beat/2.5cm (5 large squares) = 60pbm

Question 7

What are ectopic beats?

Answer 7

They are premature depolarisations, can be of the atrium of the ventricles, cause an irregular heart beat.

Question 8

What is AF?

Answer 8

When the atria are chaotically depolarising like jelly, and only some signals get through to the ventricles (thank fully), but varies, can be v fast.

Question 9

What do you see on ecg AF?

Answer 9

Irregular narrow QRS complex, no p wave.

Question 10

AF clues and confirmation

Answer 10

Irregularly irregular, confirmed with ECG.

Question 11

AF symptoms

Answer 11

palpatations, dysponea, chest pain, fatigue

Hoever, can be asymptomatic or present with embolus.

Question 12

DO you trust ECG machine diagnoses?

Answer 12

No, always double check the reading yourself

Question 13

WHat investigations ?

Answer 13

12 lead ECG (documented)
Blood tests (eg thyroid - missed unless looked for)
Echocardiogram (to see movements, help determine risk and if there are any underlying causes)

Question 14

Primary care do what? What drugs?

Answer 14

Start them on Rate control:
eg beta blocker/calcium channel blocker eg veraprimil, digoxin

Or Rhythm control in more spontaneous in and out of af - eg class Ic or class III drugs. If unable to control then will be cardioverted (with electricity/drugs eg flecainide)

Question 15

WHat is cardioverson and when use?

Answer 15

It is reset of the heart to normal rhythm, cna be using electricity of drugs. Used mainly when the heart is unable to be controlled by other drugs.

Question 16

When Pacemaker and ablation?

Answer 16

When (esp in older patients), they get a peranent pace maker added and the SA node burnt out so wholly reliant on the pacemaker.

Question 17

What is AF a risk factor for? How do we measure the amount of risk?

Answer 17

Stroke! Measure risk using CHADS2 score (Congestive heart failure, Hypertension, Age ( > 65 = 1 point, > 75 = 2 points), Diabetes, previous Stroke/transient ischemic attack (2 points), so consider anticoagulation eg warfrin or ….aban eg apixaban

Question 18

What is Supraventricular Tachycardia?

Answer 18

A VV fast heart rate, coming from an issue in ecectrical short circuiting between the Atria and the Ventricles, meaning the atria and ventricles will effectivly depolarise at the same time, v narrow QRS complex.

Question 19

What is given if patient presents to A and E with SVT?

Answer 19

Well firstly, most patients don’e end up in A and E with SVT as it can be benign and be managed by patients without medications with Vagal manoeuvres.

If in A and E usually getting palp, and feeling dizzy and dyspnoea, adenosine is usually v good drug.

Question 20

What treatment svt?

Answer 20

Adenosine (short term), then catheter ablation

Question 21

What is an accessory pathway causing Supraventrcualr tachycardia? WHAT LOOK LIKE IN ECG?

Answer 21

Basically an additional strip of muscle connecting the atria and ventricle, meaning that depolarisation can travel through it. Causes AV re-entrant tachycardia. Slurring between P and QRS complex, ind of merge together into one spike, so no individual P wave, and broader QRS complex.

Question 21

What is atrial flutter?

Answer 21

Continual atrial depolarisation v fast.

Question 22

Atrial fluuter ecg?

Answer 22

Shark tooth appearance,

Question 23

How Atrial flutter treated? risk of what out?

Answer 23

Cathater ablation, can try and control with ventricular rate (betablockers, verapamil, digoxin, but a lot harder. If anticoagulated patient then will do a cardioversion.

Question 24

When Ventricular tachycardia?

Answer 24

Fast rhythm distubances not requiring the ventricles in any way.

Question 25

Vent. tachycardia risks and symptoms

Answer 25

Palpatations, Chest pain, dysnponoea, dizziness, syncope. Usually structural disease.

Question 26

ecg looks like vent tachycardia?

Answer 26

Broad QRS coplexes

Question 27

What is long QT syndrome? Genetic? Causes what?

Answer 27

Yes cna be congenital, autosomal dominant, problem involving K+ or Na+ channels. Prolonged depolarisation of the ventricle.

Question 28

What is an ICD? When used?

Answer 28

Implantable cardioverter defibrilator therapy. Pacemakers, but also can shock if VF/VT.

Question 29

What is sick sinus syndrome?

Answer 29

Sinus node fails to create impulse.

Question 30

2nd degree av block?

Answer 30

Impulse struggles to get through the AV node

Question 31

What is comlete heart block?

Answer 31

P wave not followed by QRS complex at all.

Question 32

Who is given a pacemaker?

Answer 32

eg Symptomatic/prfound 2/3rd degree blocks

symptomatic sinus node disease

Question 33

What is wolf parkinson

Answer 33

An example of a recuircuit of depolarisatio back from the ventricles to the atrium to the ventricles to the atrium etc.

Question 34

AF vs atrial flutter

Answer 34

AF is irregular and atrial flutter is regular, but often faster than the ventricles.