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Cardiovascular System > Arrhythmias > Flashcards

Arrhythmias Flashcards

1
Q

define atrial fibrillation (AF)

A

a condition of uncoordinated atrial contraction due to delayed AV node impulses

  • it is the most common sustained cardiac arrhythmia
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2
Q

triggers of AF

A

PIRATES get AF:

pulmonary embolism 
ischaemia 
respiratory disease 
atrial enlargement 
thyroid disease 
ethanol 
sepsis/sleep apnoea
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3
Q

types of AF

A

acute - lasts >48hrs
paroxysmal - lasts < 7 days + intermittent
persistent - lasts > 7 days but responds to cardioversion
permanent - lasts > days and is not amenable to cardioversion

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4
Q

clinical features of AF

A

chest pain
palpitations
dyspnoea
dizziness

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5
Q

signs of AF

A

irregularly irregular pulse
single JVP waveform due to a-wave loss
apical - radial pulse deficit
variable intensity S1

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6
Q

describe fast AF

A

a ventricular rate of >100bpm

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7
Q

management of fast AF

A

unstable: immediate DC cardioversion
stable: rate + rhythm control or electric cardioversion

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8
Q

rate control management in AF

A

beta-blocker (e.g. bisoprolol) OR rate-limiting calcium channel blocker (e.g. dilitiazem)

if cardiac failure or hypotensive: digoxin
if young with paroxysmal AF: oral flecainide

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9
Q

rhythm control management in AF

A

achieved either via electrical cardioversion or pharmacological cardioversion

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10
Q

requirements for anticoagulation in AF

A

provided if CHADS2VASc score >1 (in men) or >2 in women

and no major risk of bleeding according to ORBIT score

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11
Q

use of DOACs in AF

A

e.g. edoxaban, apixaban, rivaroxaban and dabigatran

  • 1st line
  • less bleed risk than warfarin
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12
Q

use of Warfarin in AF

A
  • requires LWMH cover for 5 days prior to initiation + regular INR monitoring
  • used in cases of valvular AF
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13
Q

common appearance of AF on ECG

A

absence of P waves

narrow and irregular QRS complexes

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14
Q

investigations of AF

A

bloods (FBC, U+Es, LFTs, TFTs and glucose)
ECG
BP

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15
Q

define atrial flutter

A

a condition arising due to aberrant macro-circuit within the right atrium cycling @ ~300bpm

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16
Q

common causes of atrial flutter

A 
COPD
obstructive sleep apnoea 
pulmonary emboli 
pulmonary hypertension 
alcohol 
sepsis
17
Q

clinical features of atrial flutter

A

patients are often asymptomatic but may present with:

palpitations
chest pain
dizziness

18
Q

investigations of atrial flutter

A

bloods (FBC, U+E, TFTs, glucose)

ECG

19
Q

common ECG findings of atrial flutter

A

regular rhythm tachycardia
saw tooth baseline of 300bpm
narrow QRS complexes

20
Q

management of atrial flutter in haemodynamically unstable patients

A

urgent direct current synchronised cardioversion

21
Q

management of atrial flutter in haemodynamically stable patients

A 
fluid resus 
rate control (e.g. beta-blocker or calcium-channel blocker)
22
Q

management of atrial flutter if unresponsive to treatment

A

catheter ablation of aberrant pathway

23
Q

define ventricular fibrillation (VF)

A

an irregular broad complex tachycardia with accompanying pulseless rhythm

24
Q

presentation of VFib

A

syncope

cardiac arrest

25
Q

ECG presentation of VFib

A

irregular, broad and polymorphic QRS complex

26
Q

management of V-Fib

A
  • ABCDE approach and commence CPR
  • administer unsynchronised cardioversion (200J biphasic)
  • restart CPR
  • after 3rd shock, 1mg adrenaline + 300mg amiodarone
  • adrenaline administered every 3-5 mins following 3rd shock
27
Q

define ventricular tachycardia (VT)

A

a thing

28
Q

common causes of VT

A

MI
cardiomyopathy
metabolic abnormalities
long QT syndrome

29
Q

clinical features of VT

A

palpitations
chest pain
syncope

30
Q

common ECG appearance of VT

A

tachycardia
absent P waves
monomorphic regular broad QRS complex

31
Q

signs of VT

A

hypotension
varying S1
occasional canon A-waves on JVP

32
Q

management of pulseless VT

A

unsynchronised DC shock
CPR for 2 mins
IV adrenaline + 300mg amiodarone after 3rd shock
adrenaline every 3-5mins after 3rd shock

33
Q

management of VT in patient with pulse (adverse features)

A

synchronised DC shock

if > 3 shocks:
- IV 300mg amiodarone (over 10-20mins followed by 900mg over 24hrs)

34
Q

management of VT with pulse and no adverse features

A

300mg amiodarone IV over 20-60 mins, followed by 900mg over 24hrs

35
Q

define Torsades de Pointes

A

a polymorphic ventricular tachycardia caused by prolonged QT interval

36
Q

common causes of TdP

A

congenital long QT syndrome
drugs (e.g. antiarrhythmics)
MI
renal/liver failure

37
Q

management of TdP in haemodynamically unstable patient

A

urgent synchronised DC shock

300mg IV amiodarone

38
Q

management of TdP in haemodynamically stable patients

A

IV magnesium sulphate (2g over 10 mins)

stop offending drugs and manage electrolyte imbalances

Cardiovascular System (6 decks)

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