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Cardiovascular system > Arrhythmias > Flashcards

Arrhythmias Flashcards

1
Q

what are ectopic beats

A

electrical hearts beats are spontaneous heart beats that come out outside the normal electrical nodes. This causes an extra heart beat

note patients can still have a normal heart beat and have these occur

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2
Q

what are arrhythmias

A

irregular heart beat

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3
Q

what should you do if a patient has an ectopic beat but still has a normal heart beat

A
  • no treatment needed. just reassure patient
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4
Q

what should you do if a patient has an ectopic beat but the symptoms are troublesome

A

can give the patient a beta blockers

e.g bisoprolol, atenolol, propranolol

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5
Q

what are the 2 aims of treatment for atrial fibrillation (AF)

A
  • reduce symptoms

- prevent complications (most common complication= stroke)

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6
Q

what do you need to assess in all patients with atrial fibrillation (AF)

A

Assess:
- risk of stroke and thromboembolism (balanced with risk of bleeding)

note: when you have AF, the irregular heart beat can leave residual blood in the heart which can form a blood clot, if blood clot moves away into brain (through pumping of blood) this causes a stroke

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7
Q

what are the 2 types of drug treatment to manage atrial fibrillation (AF)

A
  • control ventricular rate (rate control)
  • restore and maintain sinus rhythm (rhythm control) through meds + cardioversion
  • e.g through cardioversion (using electrical pads, to send synchronized electricity to get the heart beat back to normal)*
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8
Q

what is sinus rhythm

A

the normal rhythm of the heart

(normal heart rhythm made up of: a normal heart rate between 60-100 BPM, electrical signal starts from the SAN node, electrical impulse follows normal path of the heart + electrical impulse moves at normal speed)

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9
Q

which drugs are used in RATE control treatment for atrial fibrillation

A
  • beta blockers (not sotalol) most commonly used

- rate-limiting CCB: verapamil (common) + diltiazem (unlicensed)

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10
Q

which beta blocker is NOT used for rate control treatment in atrial fibrillation

A

sotalol

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11
Q

which drugs are used in RHYTHM control after cardioversion in atrial fibrillation

A
  • first line = beta blockers (can use sotalol)

if beta blockers fail, then can use:

  • flecainide
  • amiodarone
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12
Q

which type of atrial fibrillation treatment can we use sotalol

A

sotalol can be used in rhythm control

‘(but NOT IN RATE CONTROL)

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13
Q

how do you assess a patient’s risk of stroke and risk of bleeding

A
  • risk of stroke: use CHAD2DS2-VASC tool (looks at patients risk of cardiovascular disease)
  • risk of bleeding: use HAS-BLED tool
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14
Q

what should you do if a patient has a low risk of stroke after using the CHA2DS2-VASC tool

give the figures which mean low risk

A

low risk CHADS score is: men = 0 and women = 1

if they have this low risk score, the patient doesn’t need any treatment to prevent stroke (no thromboprophylaxis)

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15
Q

which drug is class 2 and class 3 on the vaughan williams classification

A

sotalol

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16
Q

describe the classes for anti-arrhythmic drugs based on the vaughan williams classification

A

Class I: membrane stabilising drugs (e.g. lidocaine, flecainide)

Class II: beta-blockers

Class III: amiodarone; sotalol (also Class II)

Class IV: rate-limiting calcium-channel blockers (includes verapamil but not dihydropyridines)

17
Q

which drugs are used to treat supraventricular arrhythmias

A
  • adenosine (first line choice because it has a short half life of 8-10 secs. so has short-lived side effects + can be used in combination with beta blockers)
  • verapamil
  • cardiac glycosides (e.g digoxin)
18
Q

which drugs are used to treat ventricular arrhythmias

A
  • lidocaine

- sotalol

19
Q

which drugs can be used to treat both supraventricular + ventricular arrhythmias

A
  • amiodarone (first line choice. can be I.V or oral but should be started in hospital/ under specialist supervision)
  • beta blockers
20
Q

which drug class must NOT be combined with verapamil

A 
beta blockers
(because they interact and cause side effects)
21
Q

what is an advantage of using amiodarone to treat supraventricular + ventricular arrhythmias

A

it causes little/ no myocardial depression

22
Q

why might amiodarone still cause interactions with other drugs even if a patient has stopped taking it

A

because amiodarone has a very long half life (weeks/months) so amiodarone can still be present in the body weeks/months after the patient has stopped taking it

23
Q

which cardiac glycoside can be used in a patient who has both atrial fibrillation (AF) and chronic heart failure (CHF)

A

digoxin

24
Q

what is atrial fibrillation

A

a rapid and irregular heart beat

25
Q

which drugs are used for EMERGENCY RATE control in patient with acute presentations of atrial fibrillation

A

use I.V verapamil or I.V beta blocker

26
Q

which drugs are used for EMERGENCY RHYTHM control in patients with acute presentations of atrial fibrillation

A

use I.V amiodarone or I.V flecainide

27
Q

what are the 2 types of cardioversion

A
  • electrical

- pharmacological (with amiodarone or flecainide which can be given I.V or oral)

28
Q

what is cardioversion

A

when an abnormally fast heart rate or cardiac arrhythmia is converted back to sinus rhythm (normal heart rhythm)

29
Q

what should you do for 3 weeks before attempting electrical cardioversion

A

make sure the patient is fully anticoagulated

procedure carries an increased risk of thromboembolism

30
Q

what is paroxysmal atrial fibrillation

what is the treatment

A

atrial fibrillation (rapid + irregular heartbeat) that comes and goes (paroxysmal).

  • it usually stops on its own within 48 hours
  • can use a standard beta blocker to treat symptoms. (if beta-blocker not tolerated, use other anti-arrhythmias e.g amiodarone/flecainide/ sotalol)
31
Q

what is the “pill-in-pocket” approach and when is it used

A

when patients with infrequent (random) episodes of paroxysmal atrial fibrillation are given a supply of oral flecainide or propafenone which they can use to self-treat whenever they get the random episode of atrial fibrillation

32
Q

what is paroxysmal supraventricular tachycardia and what is the treatment for this

A

paroxysmal supraventricular tachycardia = random/ intermittent rapid heart rate that occurs in the atria.

treatment:

  • often stops spontaneously
  • can treat with reflex vagal stimulation such as a Valsalva manoeuvre, immersing the face in ice-cold water, or carotid sinus massage
  • if previous treatments not effective, can give i.v adenosine or i.v verapamil (if adenosine intolerated)
33
Q

what is Torsade de pointes

what is the treatment

A

a type of ventricular tachycardia that has a a prolonged QT interval. it is usually self-limiting but recurrent. if it’s not controlled it can progress to ventricular fibrillation and lead to death

treatment:

  • I.V magnesium sulfate
  • beta blocker (not sotalol)

Cardiovascular system (8 decks)

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