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Cardiology > Arrhythmias > Flashcards

Arrhythmias Flashcards

1
Q

What are the ECG changes in first degree heart block?

A

Prolonged PR in isolation

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2
Q

ECG changes in 2nd degree Mobitz type 1?

A

progressively prolonged PR intervals with complete drop of QRS, return to sinus/previous pattern

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3
Q

ECG changes in 2nd degree Mobitz type 2?

A

three consecutive P waves may be followed by a QRS complex, giving the ECG a normal appearance, then the fourth P wave may suddenly not be followed by a QRS complex since it does not conduct through the AV node to the ventricles.The PR interval may be normal or prolonged, however it is constant in length unlike second-degree AV block Mobitz Type I (Wenckebach) in which the PR interval progressively lengthens until a P wave is not conducted.

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4
Q

Are type 1 and type 2 mobitz reversible?

A

type 1 is however type 2 is not, therefore pacemaker required

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5
Q

When can QRS complex be increased and decreased in amplitutde?

A

incr- LVH, can be normal

decr- fluid overload

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6
Q

What are deep Q-waves a sign of?

A

previous MI damage

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7
Q

How should normal R-wave progression appear across ECG leads? What can poor R wave progression be a sign of?

A

it should increase throughout the leads. ? MI

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8
Q

When is ST elevation significant?

A

if >1 in limb leads, >2 in chest leads

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9
Q

What are U-waves pathognomonic of?

A

hypokalaemia

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10
Q

Which drugs increase QT interval?

A

Antipsychotics, TCAs, antiarrhythmic drugs

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11
Q

You see ST depression in anterior leads V1-V3. What are you worried about?

A

posterior STEMI

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12
Q

What is the evidence on ECG of right heart strain?

A

RBBB, r.axis deviation, T-wave inversion

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13
Q

What are findings of PE in ECG?

A

tachycardia and S1Q3T3 (only occus in 10% of people)

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14
Q

Example of supraventricular tachycardia?

A

atrial flutter

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15
Q

What is the AV ratio in atrial flutter and what heart rate does this give rise to?

A

2:1, 150bpm (3:1, 4:1 can happen as well, therefore 300 bpm or 450 bpm!)

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16
Q

Where does the re-entry circuit arise in atrial flutter?

A

right atrium

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17
Q

List three causes of hyperkalaemia

A
  1. Increased intake- potassium supplements, excess in diet
  2. Excessive endogenous- rhabdomyolysis, extensive burns, tumour lysis syndrome, trauma, haemolysis
  3. Redistribution (shift from intra to extracellular) e.g. acidosis, insulin deficiency, drugs
  4. Diminished potassium excretion e.g. AKI, drugs
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18
Q

Which drugs can result in hyperkalaemia?

A

ACEi, NSAIDs, K+ sparring -> reduce potassium excretion

Beta blockers and digoxin -> alter transmembrane potassium movement

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19
Q

A patient has an anterior STEMI. Which coronary artery is affected?

A

LAD

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20
Q

Inferior STEMI, which coronary artery?

A

R coronary A

21
Q

Lateral STEMI. Which coronary artery?

A

L circumflex

22
Q

List three causes of a prolonged QTc?

A 
TIMME
  Toxins/drugs
  Inherited: e.g. Romano-Ward, Jervell (c¯ SNHL) 
  Ischaemia 
  Myocarditis 
  Mitral valve prolapse 
  Electrolytes: ↓Mg, ↓K, ↓Ca, ↓ temp
23
Q

List two drugs that prolong the QTc interval

A
  • Macrolides
    antiarrhythmics: amiodarone
  • TCAs
  • Histamine antagonists
24
Q

List one causes of shortened PR interval?

A

accessory conduction e.g. WPW

25
Q

In which leads are T waves inverted normally? In which leads would T wave inversion be absolutely abnormal

A

aVR and V1

Abnormal in LI LII V4-V6

26
Q

List two causes of abnormal T wave inversion

A 
Strain
ischaemia
ventricular hypertrophy
BBB
digoxin
27
Q

When are U waves observed?

A

Hypokalaemia (following T waves)

28
Q

When are J waves observed?

A

SAH
hypercalcaemia
hypothermia
positive deflections occurring at the junction between the QRS complex and the ST segment

29
Q

What are the features of WPW on EGC?

A

slurred upstroke of QRS= delta wave, usually in V3/V4

Shortened PR intervals

30
Q

What are two features on ECG of brugada syndrome

A

RBBB

ST elevation in V1-V3

31
Q

Name three features on ECG of hyperkalaemia

A

Tall tented T waves
Widened QRS
Absent P waves

32
Q

What are two features of PE on ECG?

A

SI QIII TIII

  • deep S wave in I (RAD)
  • pathological Q in III
  • T inversion in III

Right vent strain
- RAD (S wave in I)
- Dominant R wave and T
wave inversion in V1-V3

33
Q

Two features of hypokalaemia?

A

Small T waves
ST depression
Prolonged QT interval
Prominent U waves

34
Q

List three causes of bradycardia

A 
DIVISIONS
Drugs
Ischaemia
Vagal hypertonia
Infection
Sick sinus syndrome
Infiltration (autoimmune, sarcoid, amyloid)
O- hypOthyroidism, hypOkalaemia
Neuro (Incr ICP)
Septal defect
Surgery or catheterisation
35
Q

State two drugs that can cause bradycardia

A

 Antiarrhythmics (type 1a, amiodarone)
 β-blockers
 Ca 2+ -channel blockers (verapamil)
 Digoxin

36
Q

List two infections that cause bradycardias

A

 Viral myocarditis
 Rheumatic fever
 Infective endocarditis

37
Q

What is the medical treatment for bradycardia?

A

atropine 0.6-1.2 mg IV, isoprenaline IV

38
Q

What is the definitive treatment for bradycardias?

A

pacemaker insertion

39
Q

When do you not need to treat a bradycardia?

A

If asymptomatic and rate <40

40
Q

Differentials for narrow complex tachycardia? (SVT)

A 
Sinus tachy
AF
Atrial flutter
AVNRT
AVRT
41
Q

If tachyarrhythmia is ID as non AF i.e. regular rhythm, how should management proceed of patient?

A

 Continuous ECG trace
 Vagal manoeuvres
 Adenosine 6mg IV bolus
 Then 12mg, then 12mg

42
Q

If tachyarrhythmia is AF what is the treatment?

A

Control rate with beta blocker or digoxin

If onset <48 hr then cardioversion with amiodarone or DC shock

Consider anticoagulation with heparin

43
Q

What is the mechanism of action of adenosine?

A

temporary block of AVN

44
Q

Why do you give adenosine for SVT?

A

unmasks atrial rhythm, cardioverts AVNRT/AVRT to sinus rhythm

45
Q

If adenosine doesn’t work in treating SVT, what other options do you have?

A

Digoxin, atenolol, verapamil, amiodarone

46
Q

What are the contraindications of adenosine?

A

asthma, 2/3rd degree heart block

47
Q

List two differentials for broad complex tachycardias

A

VT
Torsades de pointes
SVT with BBB

48
Q

Three causes of VT?

A 
Infarction
Myocarditis
Valve abnormality
Iatrogenic: digoxin, antiarrhytmic drug
Cardiomyopathy
Electrolyte imbalances: hypokalaemia, low Mg, hypoxia, acidosis

Cardiology (14 decks)

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