e.g. edoxaban, apixaban, rivaroxaban and dabigatran - 1st line - less bleed risk than warfarin

Arrhythmias Flashcards by India Dodd

define atrial fibrillation (AF)

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

it is the most common sustained cardiac arrhythmia

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triggers of AF

PIRATES get AF:

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

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types of AF

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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clinical features of AF

chest pain
palpitations
dyspnoea
dizziness

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signs of AF

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

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describe fast AF

a ventricular rate of >100bpm

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management of fast AF

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

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rate control management in AF

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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rhythm control management in AF

achieved either via electrical cardioversion or pharmacological cardioversion

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requirements for anticoagulation in AF

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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use of DOACs in AF

e.g. edoxaban, apixaban, rivaroxaban and dabigatran

1st line
less bleed risk than warfarin

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use of Warfarin in AF

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

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common appearance of AF on ECG

absence of P waves

narrow and irregular QRS complexes

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investigations of AF

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

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define atrial flutter

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

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common causes of atrial flutter

COPD
obstructive sleep apnoea 
pulmonary emboli 
pulmonary hypertension 
alcohol 
sepsis

clinical features of atrial flutter

patients are often asymptomatic but may present with:

palpitations
chest pain
dizziness

investigations of atrial flutter

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

ECG

common ECG findings of atrial flutter

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

management of atrial flutter in haemodynamically unstable patients

urgent direct current synchronised cardioversion

management of atrial flutter in haemodynamically stable patients

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

management of atrial flutter if unresponsive to treatment

catheter ablation of aberrant pathway

define ventricular fibrillation (VF)

an irregular broad complex tachycardia with accompanying pulseless rhythm

presentation of VFib

syncope

cardiac arrest

ECG presentation of VFib

irregular, broad and polymorphic QRS complex

management of V-Fib

- 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

define ventricular tachycardia (VT)

a thing

common causes of VT

MI cardiomyopathy metabolic abnormalities long QT syndrome

clinical features of VT

palpitations chest pain syncope

common ECG appearance of VT

tachycardia absent P waves monomorphic regular broad QRS complex

signs of VT

hypotension varying S1 occasional canon A-waves on JVP

management of pulseless VT

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

management of VT in patient with pulse (adverse features)

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

management of VT with pulse and no adverse features

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

define Torsades de Pointes

a polymorphic ventricular tachycardia caused by prolonged QT interval

common causes of TdP

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

management of TdP in haemodynamically unstable patient

urgent synchronised DC shock | 300mg IV amiodarone

management of TdP in haemodynamically stable patients

IV magnesium sulphate (2g over 10 mins) | stop offending drugs and manage electrolyte imbalances