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A- Resp and cardio > Arrhythmias > Flashcards

Arrhythmias Flashcards

1
Q

What is the Levine scale used for?

A

Grading murmurs

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2
Q

What level of the Levine scale is a thrill present with?

A

4-6

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3
Q

Adverse effects of amiodarone

A

Thyroid dysfunction - hyper/o
Pulmonary fibrosis/itis
Liver fibrosis, hepatitis
Peripheral neuropathy, myopathy
Photosensitivity
Thrombophlebitis and injection site reactions
Bradycardia
Prolonged QT interval

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4
Q

What is thrombophlebitis

A

Inflammation of a vein related to a blood clot - superficial version of DVT

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5
Q

How can amiodarone effect an ECG?

A

Prolonged QT interval, bradycardia

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6
Q

How does amiodarone effect warfarin?

A

Decreased metabolism -> increased INR

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7
Q

How does amiodarone affect digoxin?

A

Increased levels - more effects

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8
Q

What is the primary pacemaker of the heart

A

Sinoatrial node

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9
Q

What is chronotropic incompetence

A

HR fails to pick up w exercise

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10
Q

What is given to speed HR in emergencies

A

Atropine

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11
Q

What is given for long term control of sick sinus syndrome

A

Pacemaker

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12
Q

What is a supraventricular tachycardia

A

Where electrical signals from the heart get stuck in a short circuit and loop around AV node or elsewhere

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13
Q

How is SVT terminated

A

Vagal manouveres eg blowing on syringe
IV adenosine
IV verapamil

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14
Q

What drugs block the AV node

A

Adenosine

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15
Q

Treatment for SVT

A

Adenosine in emergency
Beta blockers, catheter ablation for recurrent

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16
Q

How does SVT -> ECG

A

Fast rhythm, often not visible p waves

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17
Q

What is an AV node re-entry tachycardia

A

Atrium and ventricles simulataneously depolarise

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18
Q

What is AF

A

V fast and disordered atrial activity

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19
Q

What is a VT

A

Fast regular rhythm form ventricels

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20
Q

ECG of VT

A

Broad QRS
P waves not seen or unrelated to QRS

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21
Q

Caause of VT

A

Cardiac ischaemia or MI scar

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22
Q

What to do if patient with VT haemodynamically compromised

A

Cardiovert

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23
Q

What to do if patient with VT haemodynamically stable

A

Amiodarone

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24
Q

What is VF

A

> 300BPM irregular rate
QRS variable morphology
TREAT - defib

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25
6 questions for identifying arrhythmias
1. Are there QRS complexes - asystole 2. What is the rate of QRS - tachy or brady 3. Are the QRS regular or irregular 4. QRS narrow or broad - narrow = top chambers of heart/SVT. Broad - ventricles 5. visible/ditinct P waves? PR interbal 6. Relationship between P waves and QRS complexes
26
First line treatment for bradycardia w adverse signs
Atropine 500ug up to 3mg
27
What is atropine contraindiated in
Myasthenia gravis Paralytic ileus
28
What is sick sinus syndrome
Failure of sinus node -> depolarisation intermittently Bradycardia and tachycardias
29
Treatment sick sinus syndrome
Permanaent pacemarker if symptomatic Antiarrhythmics - beta blockers Anticoagulation - increased VTE risk
30
AVNRT on ECG
Normal QRS complexes P waves cant be seen or just after or before QRS
31
Most common SVT and who seen in
AVNRT - twice as common in women than men Young people
32
What is an AVRT
Accessory pathway - antegrade or retrograde depolarisation Most common is WPW
33
Why does AVRT cause upsloping QRS
Accessory pathway allows depolarisation o ventricles before main electrical signal reaches AV node
34
Risk in WPW
AF, VF
35
Symptoms of AVRT/AVNRT
Rapid regular palpitations, abrupt onset and sudden termination Dizziness Dyspnoea Central cehst pain and syncope Worsened by exertion, coffee, tea or alcoohl
36
When is VT more likely than SVT
History of IHD QRS >140ms AV dissociation (no p wave +QRS relation) Intermittent normal QRS RS >100ms Deep S wave V6 Concordant QRS direction V1-V6 eg all negative or positive
37
Acute management of SVTs haemodynamically unstable
Emergency cardioversion
38
Long term management of SVTs
Radiofrequency ablation of accessory pathway via cardiac catheter Flecanide, verapamil, sotalol and amiodarone
39
Acute management of SVTs haemodynamically stable
Vagal stimulatino - valsalva manuvre - blow into plunger Or right carotid sinus masage Adenosine - AV node blocking IV6mg->12mg->18mg IV verapamil or beta blocker eg metorpolol
40
Emergency treatment of arrhythmias
Oxygen, IV access Test and correction of magnesium, potassium, calcium
41
Features of long QT syndrome
1 - exertional syncope 2 - syncope on stress, exercise or auditory sitmulus 3 - at rest or night Sudden cardiac death -> torasades de pointes
42
Management long QT syndrome
Beta blockers Avoid precipitating drugs ICD if high risk
43
Drugs -> long QT syndrome
Amiodarone, sotallol, 1a antiarrhythmics TCAs, SSRIs Chloroquine mETHADONE Terfenadine Haloperdiol Erythromycin Ondanestron
44
Congenital causes Long qt syndrome
Javell lange nielson - deafness - abnormal K+ Romano ward syndrome
45
Other causes of long QT (not congenital or drugs)
Electroly - hypocalcemia, kaelmai, magnesia Acute MI hYPOTHERMIA sah myocarditis
46
Management of VT
Adverse signs - cardiovert Amiodarone - central line Lidocaine - caution in LV dysfunction Procainamide
47
BPM in VT vs VF
VT - 100-250 VF>300
48
When long term manage SVT
Symptoms -> affect QOL Symptomatic WPW Infrequent but sports, driver etc
49
DC cardioverison antioag rules
3 weeks prior if >48 hrs AF Urgent -> LMWH + oral anticcoag prior Heparin post DC cardiovert + oral anticaog
50
CHADVASC vs HASBLED when anticoagulate
>2 CHADVASC = anticoagulate needed >3 HASBLED = high bleeding risk
51
When do ratevs rhythm control AF
>65, history IHD -> rate <65, symptomatic, 1st presentation, lone AF or secondary to precipitant -> rhythm
52
Side effects atropine
Bradycardia and AV block Facial flushing, headache, chest pain or tightness Bronchospasm, sense impending doom
53
CIs atropine
Asthma Second or third degree HB Sick sinus syndrome unless pacemaker
54
Amiodarone side effects
Proarrhythmogenic in structurahl HD Contains iodine - can cause hypo or hyperthyroidism liver toxicity - monitor 6 monthly ProlongsQT interval Dzzled by lights Phototoxic skin reactions Slate grey skin Peripheral neuropathy PNeumonitis
55
CIs amiodarone
Sinus bradycardia SAN block Thyroid dysfunction Iodine sensitivity
56
Flecanide side effects
Dizzy, visual disturb, SOB, palpitations, proarrhtyhmic, headahce, fatirgue and dnausea - common Rare - bronchospasm, heart block, bone marrow supression, increased V rate in AF
57
Flecanide CI
Prev MI CAD, LVSD, other structural HD Interactions w beta blockers and CCBs
58
Digoxin side effects
N+V, diarrhoea, blurre or yellow vision V arrhtyhmias. narrow therapeutic index - common Hypokalemia and renal impairment Toxicity -> hyperkalemai
59
CI digoxin
Sev renal impariemtn accessory pathway arrhythmias With amiodarone Caution in LV obstruction Dilatazem, verapamil, spirinolactone decrease renal excretion - plasma levels check
60
CI for ACEis/ARB
Bilateral renal artery stenosis Pregnanyc Angioedema Sev renal failure Sev or symptomatic mitral or aortic stenosis HOCM Pregnancy not CI in ARB Caution in lvier impariment and elderly
61
Side effects ACEi
Dry cough Hyperkalaemia Sudden renal function dererioration if renal artery stenosis NSAids - loss of testa, rashes, hypersensitvityy
62
CCB side effects
Flushing, dizzy, tachy, hypotension, ankle swell, headahce - vasodilating effects Constipation w verapamil Worsening HF - verapamil and dilatazem
63
CCB CIs
AORTIC STENOSIS beta blockers, LV failure, sick sinus syndrome, HF WPW, post MI - verapamil
64
Nitrates CI
Arotic/mitral stenosis HOCM Cardiac tamponade Constrictive pericartitis
65
Classes of antiarrhythmics
Class I: membrane stabilising drugs (e.g. lidocaine, flecainide) Class II: beta-blockers Class III: amiodarone; sotalol (also Class II) Class IV: calcium-channel blockers (includes verapamil but not dihydropyridines)
66
Torsades de points drug treatment
IV magnesium sulphate

A- Resp and cardio (58 decks)

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