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cardiology > Arrhythmias > Flashcards

Arrhythmias Flashcards

1
Q

What is an arrhythmia?

A

An abnormal heart rhythm (caused by abnormal conduction of electrical activity)

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2
Q

What are the four cardiac arrest rhythms? How can these be categorised?

A

Shockable rhythms:

  • VT
  • VF

Non-shockable rhythms:

  • PEA
  • Asystole
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3
Q

Describe the appearance of atrial flutter on an ECG

A

“Sawtooth” appearance

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4
Q

Describe the acute and long term management of a stable patient with atrial flutter

A

Acute:
- Rate control with a beta blocker

Long term:

  • Radiofrequency ablation of re-entrant loop
  • Anticoagulation
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5
Q

Describe the pathophysiology of supraventricular tachycardia (SVT)

A

Caused by electrical signal re-entering the atria from the ventricles:

  • AV nodal re-entrant tachycardia = signal travels back through the AVN
  • AV re-entrant tachycardia = signal travels back through an accessory pathway (e.g. WPW syndrome)
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6
Q

Describe the acute management of a stable patient with SVT

A
  1. Vagal manoeuvres including Valsalva manoeuvre and carotid sinus massage
  2. Give adenosine (initially 6mg, followed by 12mg, followed by a further 12mg if required)
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7
Q

What is the name of the accessory pathway present in WPW syndrome?

A

Bundle of Kent

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8
Q

What is the definitive management for Wolff-Parkinson-White syndrome?

A

Radiofrequency ablation of the accessory pathway

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9
Q

What are the features of WPW syndrome on an ECG?

A
  • Short PR interval (< 0.12 seconds)
  • Wide QRS complexes (> 0.12 seconds)
  • “Delta wave” (a slurred upstroke on the QRS complex)
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10
Q

How does adenosine work?

A

Slows conduction through the AV node, causing a brief period of bradycardia or asystole in order to “reset” back to normal sinus rhythm

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11
Q

What is Torsades de pointes?

A

Polymorphic VT

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12
Q

Torsades de pointes occurs in patients with…

What are the causes of this?

A

Torsades de pointes occurs in patients with prolonged QT

Causes of prolonged QT:

  • Long QT syndrome (inherited)
  • Meds, e.g. antipsychotics, citalopram
  • Electrolyte disturbances (hypokalaemia, hypomagnesaemia, hypocalcaemia)
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13
Q

Describe the management of Torsades de pointes

A
  • Correct the cause, e.g. meds, electrolyte disturbance
  • Magnesium infusion (even if normal serum magnesium)
  • Defibrillation if VT occurs
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14
Q

What is ventricular bigeminy?

A

Ventricular ectopic occuring after every sinus beat

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15
Q

What is first degree heart block? What ECG change does this cause?

A

Delayed conduction through the AV node, leading to a prolonged PR interval (> 0.2 seconds)

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16
Q

What are the types of second degree heart block?

A
  • Mobitz type I (Wenkeback)

- Mobitz type II

17
Q

Describe the ECG findings in Mobitz type I (Wenkeback) 2nd degree heart block

A

PR interval getting longer and longer until a QRS complex is dropped

18
Q

Describe the ECG findings in Mobitz type II 2nd degree heart block

A

PR interval consistently prolonged, then beat is dropped (usually a set ratio of P waves to QRS complexes, e.g. 3:1)

19
Q

What is third degree heart block? This is also known as…

A

Where there is no association between the P waves (atria) and QRS complexes (ventricles). This is also known as complete heart block.

20
Q

Describe the acute treatment of a stable patient with bradycardia/AV node block

A

Start by observing

21
Q

Describe the acute treatment of unstable patient with bradycardia/AV node block

A
  • Atropine 500mcg IV (this can be repeated up to 6 times, max dose 3mg)
  • Other inotropes e.g. noradrenalin
  • Transcutaneous cardiac pacing (using a defibrillator)
22
Q

What is the definitive long term management of patients with either:

  • Symptomatic bradycardia
  • High risk of asystole, e.g. Mobitz type II AV block, complete heart block
A

Permanent pacemaker (PPM)

23
Q

How does atropine work?

A

Atropine is an antimuscarinic and works by inhibiting the parasympathetic nervous system (thereby increasing heart rate)

24
Q

How can you determine which type of pacemaker a patient has based on their ECG?

A
  • A sharp vertical line before EITHER the P wave OR the QRS complex = single-chamber pacemaker
  • A sharp vertical line before BOTH the P wave AND the QRS complex = dual-chamber pacemaker

cardiology (14 decks)

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