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cardiovascular - RA > Arrhythmias > Flashcards

Arrhythmias Flashcards

1
Q

What are the two classes of arrhythmias described by where the arrhythmia arises?

A

Supraventricular

Ventricular

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2
Q

Supraventricular arrhythmias tend to have narrow QRS complexes. True/False?

A

True

Because the arrhythmia does not originate from ventricles

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3
Q

The AV node is the only point of electrical contact between the atria and ventricles. What may additionally be present to cause pathological conduction?

A

Fibrous ring

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4
Q

What are ectopic beats?

A

Beats/rhythms that originate outwith the SA node

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5
Q

Ectopic beats may not be dangerous. True/False?

A

True

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6
Q

Why might ectopic beats not be harmful?

A

Depends on where they originate - if in non-contractile areas, they are unlikely to affect cardiac output

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7
Q

Name the main supraventricular arrhythmias

A

SVTs: atrial fibrillation, atrial flutter, ectopic atrial tachycardia
Bradycardias: sinus bradycardia, sinus pauses

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8
Q

Name the main AV node arrhythmias

A 
AV node reentry
Accessory pathway
AV block (1st, 2nd, 3rd degree)
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9
Q

Name the main ventricular arrhythmias

A

Premature ventricular complex
Ventricular tachycardia
Ventricular fibrillation
Asystole

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10
Q

What are the 3 main physiological types of arrhythmia?

A

Altered automaticity
Triggered activity
Reentry (accessory pathway)

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11
Q

List the investigations you would do for arrythmias

A 
ECG/exercise ECG/24hr ECG
CXR
Echocardiogram
Event recorder
EP study (induce arrhythmia to map pathway)
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12
Q

How would acute SVT be managed?

A

Vagal manoeuvres, carotid massage
IV adenosine
IV verapamil

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13
Q

Give examples of some vagal manoeuvres

A

Holding your breath and bearing down (Valsalva)
Immersing face in ice-cold water (diving reflex)
Holding nose/unblocking ears

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14
Q

What is the treatment of choice for managing chronic arrhythmias?

A

Radiofrequency ablation

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15
Q

What is radiofrequency ablation?

A

Selective cauterisation of cardiac tissue to prevent tachycardia
Target reentry circuit or automatic myocite

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16
Q

Which drugs must be stopped before radiofrequency ablation?

A

Antiarrhythmic drugs 3-5 days beforehand

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17
Q

What is notorious for causing AV block in young people?

A

Cytomegalovirus

18
Q

Describe 1st degree AV block

A

PR interval increased (greater than 0.2s)

19
Q

Describe 2nd degree Mobitz 1 AV block

A

PR interval gets progressively longer, followed by dropped QRS

20
Q

Describe 2nd degree Mobitz 2 AV block

A

Lonely P waves not followed by QRS

N.B. PR interval not prolonged

21
Q

Describe 3rd degree AV block

A

P waves without QRS complexes

i.e. no association between atrial and ventricular systole

22
Q

What is typical of an ECG showing ventricular tachycardia?

A

Broad QRS complexes

23
Q

What is the difference between monomorphic and polymorphic VT?

A

In monomorphic VT, the QRS complexes look similar

24
Q

How would acute VT be treated?

A

DC cardioversion if unstable

Adenosine if unsure it’s VT

25
Q

What are the 3 classifications of AF?

A

Paroxysmal
Persistent
Permanent

26
Q

Define paroxysmal AF

A

Recurrent AF, lasting less than 48 hours

27
Q

Define persistent AF

A

AF lasting greater than 48 hours which can be cardioverted to normal sinus rhythm

28
Q

Define permanent AF

A

AF that is unable to be restored to normal sinus rhythm via pharma + non pharmacological methods

29
Q

What is meant by lone AF?

A

AF where a cause cannot be found

30
Q

What would a typical ECG of AF show?

A

Rate greater than 300bpm
Irregularly irregular
P waves absent

31
Q

What are the two management pathways for AF patients?

A 
Rhythm control (get back to NSR)
Rate control (accept AF, control ventricular rate)
32
Q

What pharmacological therapy can be used for rate control in AF?

A

Digoxin
B blockers
Verapamil, diltiazem

33
Q

How can NSR be restored in AF (rhythm control)?

A

Amiodarone

DC cardioversion

34
Q

Class I anti-arrhythmic drugs act on which phase of the AP and block which channels?

A

Act on phase 0

Block Na+ channels

35
Q

Name a class I anti-arrhythmic drug

A

Flecainide

Lignocaine

36
Q

Class II anti-arrhythmic drugs act on which phase of the AP and block which channels?

A

Act on phase 4

Block B receptors (B blockers)

37
Q

Class III anti-arrhythmic drugs act on which phase of the AP and block which channels?

A

Phase 3

Block K channels

38
Q

Name a class III anti-arrhythmic drug

A

Amiodarone

Sotalol

39
Q

Class IV anti-arrhythmic drugs act on which phase of the AP and block which channels?

A

Phase 2

Block Ca channels

40
Q

What would a typical ECG of atrial flutter look like?

A

Saw tooth baseline

Regular rhythm

cardiovascular - RA (17 decks)

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