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Pre-reg Exam 2021 > Arrhythmias > Flashcards

Arrhythmias Flashcards

1
Q

What are the Class I anti arrhythmias?

A

Na+ blockers

Disopyramide
Lidocaine
Flecainide/propafenone

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2
Q

When is flecainide contraindicated?

A

Asthma

Severe COPD

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3
Q

When should you avoid propafenone?

A

In structural/ischaemic heart disease

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4
Q

What are class II anti arrhythmics?

A

Beta blockers

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5
Q

What are Class III antiarrhythmics?

A

K+ channel blockers

Amiodarone
Sotalol
Dronedarone

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6
Q

When should amiodarone be used in order to increase the chances of success?

A

4 weeks before and 12 weeks after electrical cardioversion

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7
Q

What are the main side effects of dronedarone?

A

Hepatotoxicity

Heart failure

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8
Q

What are the class IV antiarrhythmics?

A

Rate limiting CCBs

Verapamil
Diltiazem

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9
Q

When is digoxin used in arrhythmias?

A

For sedentary patients with non-paroxysmal atrial fibrillation

Associative congestive heart failure

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10
Q

What is atrial fibrillation?

A

Rapid and irregular heartbeat

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11
Q

What are the symptoms of atrial fibrillation?

A

Heart palpitations
Dizziness
SOB
Tiredness

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12
Q

What are the complications of atrial fibrillation?

A

Stroke

Heart failure

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13
Q

What is paroxysmal atrial fibrillation?

A

Episodes stop within 48 hours without treatment

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14
Q

What is persistent atrial fibrillation?

A

Episodes last > 7 days

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15
Q

What is permanent AF?

A

Episodes present all the time

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16
Q

What is rate control?

A

Controls ventricular rate

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17
Q

What is rhythm control?

A

Restores and maintains sinus rhythm

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18
Q

What is cardioversion?

A

Type of rhythm control

  1. Electrical
  2. Pharmacological
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19
Q

Which of the following is most appropriate when there is acute new-onset presentation of atrial fibrillation and life threatening haemodynamic instability?

A) electrical cardioversion 
B) flecainide
C) verapamil
D) digoxin
E) sotalol
A

A) electrical cardioversion

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20
Q

Which of the following is most appropriate when there is acute new-onset presentation of atrial fibrillation without life threatening haemodynamic instability and it is less than 48 hours since onset of presentation

A) electrical cardioversion 
B) bisoprolol 
C) verapamil
D) digoxin
E) sotalol
A

A) electrical cardioversion

Or amiodarone/flecainide

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21
Q

Which of the following is most appropriate when there is acute new-onset presentation of atrial fibrillation without life threatening haemodynamic instability and it is more than 48 hours since onset of presentation

A) electrical cardioversion 
B) Amiodarone
C) verapamil
D) digoxin
E) Flecainide
A

C) Verapamil

Or beta blocker

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22
Q

What is the first line treatment for atrial fibrillation?

A
  1. Rate control - B-blockers (not sotalol), rate limiting CCB, digoxin. Monotherapy - dual therapy - rhythm control
  2. Rhythm control - beta blockers/amiodarone/flecainide/propafenone/dronedarone
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23
Q

What are the treatments for paroxysmal and symptomatic atrial fibrillation?

A

Ventricular or rhythm control - beta blocker or oral antiarrhythmic

Pill in pocket - flecainide or propafenone

24
Q

What tool is used to calculate bleeding risk in atrial fibrillation?

A

ORBIT

Older (75+)
Reduced Hb or history of anaemia
Bleeding history
Insufficient kidney function
Treatment with antiplatelet
25
Q

What is the tool used to determine risk of stroke in atrial fibrillation?

A

CHA2-DS2-VASc

Chronic heart failure
Hypertension 
Age 75+
Diabetes
Stroke
Vascular disease
Age 65-74
Sex female

Anticoagulant if 2 or more

26
Q

For new onset atrial fibrillation what anticoagulant would you give for stroke prevention?

A

Parenteral anticoagulant

27
Q

For diagnosed atrial fibrillation what anticoagulant would you give?

A

Warfarin or DOAC

DOAC in non valvular + 1 or more risk factors

28
Q

How would you treat pulseless v.tach (ventricular tachycardia)?

A

Immediate defibrillation + CPR

Amiodarone refractory to defibrillation

29
Q

How would you treat unstable sustained v.tach?

A

Direct current cardioversion

Failure then IV amiodarone and repeat

30
Q

How would you treat stable sustained v. Tach?

A

IV anti arrhythmic (amiodarone preferred)

31
Q

How would you treat non-sustained v. Tach?

A

Beta blocker

32
Q

What is the first line treatment for maintenance after v.tach?

A

Cardioverter defibrillator implant

Some require drug too - sotalol, beta blocker, beta blocker + amiodarone

33
Q

What is the treatment for prolonged QT interval?

A

Magnesium sulphate

34
Q

What causes prolonged QT interval (torsades de pointes)?

A

Sotalol
Other drugs
Hypokalaemia
Bradycardia

35
Q

What is the treatment pathway for paroxysmal supraventricular tachycardia?

A
  1. Spontaneously terminates or reflex vagal nerve stimulation
  2. IV adenosine
  3. IV verapamil
36
Q

What is amiodarone?

A

Class III anti arrhythmic

Used for supraventricular arrhythmias and ventricular arrhythmias

37
Q

What is the dosing schedule for amiodarone?

A

200mg TDS for 7/7
200mg BD for 7/7
200mg OD maintenance

38
Q

What are the side effects of amiodarone?

A 
Corneal microdeposits 
Optic neuropathy 
Phototoxicity
Slate grey skin
Peripheral neuropathy
Pneumonitis
Pulmonary fibrosis
Hepatotoxicity 
Hyperthyroidism
Hypothyroidism
39
Q

What are the counselling points for amiodarone?

A

Night time glares when driving
Stop if impaired
Shield skin from light during and after stopping
Numbness, tingling hands and feet, tremors
Shortness of breath, dry cough
Jaundice, nausea, vomiting, malaise

40
Q

What would be the action plan for amiodarone induced hyperthyroidism?

A

Give carbimazole if necessary

Withdraw amiodarone

41
Q

What would be the action plan for hypothyroidism cause by amiodarone?

A

Start levothyroxine without withdrawing amiodarone if essential

42
Q

What are the monitoring requirements for amiodarone?

A 
Annual eye test
Chest X-ray before treat,met
LFTs every 6 months
Thyroid function 
BP and ECG
Serum potassium - causes hypokalaemia
43
Q

What are the interactions for amiodarone?

A

Long T1/2
Grapefruit juice - increases amiodarone concentration
Warfarin, phenytoin, digoxin - increases plasma concentration of these drugs
Statins - myopathy
Beta blockers, rate limiting CCBs - bradycardia
Quinolones, macrolides, TCAs, SSRIs, lithium, quinine, hydroxychloroquine, antimalarials, antipsychotics - QT prolongation

44
Q

What is the ideal serum concentration of digoxin?

A

1-2 mcg/L (Cp 6 hours after dose)

Regular monitoring not required unless toxicity suspected or renal impairment

45
Q

What is digoxin?

A

Cardiac glycosides

46
Q

What is the mechanism of action of digoxin?

A

Increases force of myocardial contraction

Reduces conductivity in the AV node

47
Q

Is a loading dose required for digoxin?

A

Yes as long half life

48
Q

What is the maintenance dose of digoxin?

A

Atrial flutter and non paroxysmal AF in sedentary patients - 125-250mcg

Worsening or severe heart failure - 62.5-125 mcg

49
Q

What are the signs of digoxin toxicity?

A

Slow and sick

Bradycardia
Nausea and vomiting
Blurred or yellow vision
Confusion
Delirium

Risk of toxicity in: Hypo K+, Hypo Mg2+, Hyper Ca2+, hypoxia, renal impairment

50
Q

What is the treatment for digoxin toxicity?

A

Withdraw and correct electrolytes

Digoxin specific antibody

51
Q

What are the interactions of digoxin?

A

CRASED

CCB (verapamil)
Rifampicin
Amiodarone
St Johns Wort
Erythromycin 
Diuretics
52
Q

Which drugs cause hypokalaemia when given with digoxin?

A

Diuretics
B2 agonists
Steroids
Theophylline

53
Q

What drugs increase plasma digoxin concentration?

A

Amiodarone
Rate limiting CCB
Macrolides
Ciclosporin

54
Q

What drugs decrease the plasma digoxin concentrations?

A

St Johns Wort

Rifampicin

55
Q

What drugs cause reduced renal excretion and lead to digoxin toxicity?

A

NSAIDS

ACEi

Pre-reg Exam 2021 (79 decks)

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