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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
Q

6 questions for identifying arrhythmias

A
  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
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26
Q

First line treatment for bradycardia w adverse signs

A

Atropine 500ug up to 3mg

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27
Q

What is atropine contraindiated in

A

Myasthenia gravis
Paralytic ileus

28
Q

What is sick sinus syndrome

A

Failure of sinus node -> depolarisation intermittently
Bradycardia and tachycardias

29
Q

Treatment sick sinus syndrome

A

Permanaent pacemarker if symptomatic
Antiarrhythmics - beta blockers
Anticoagulation - increased VTE risk

30
Q

AVNRT on ECG

A

Normal QRS complexes
P waves cant be seen or just after or before QRS

31
Q

Most common SVT and who seen in

A

AVNRT - twice as common in women than men
Young people

32
Q

What is an AVRT

A

Accessory pathway - antegrade or retrograde depolarisation
Most common is WPW

33
Q

Why does AVRT cause upsloping QRS

A

Accessory pathway allows depolarisation o ventricles before main electrical signal reaches AV node

34
Q

Risk in WPW

A

AF, VF

35
Q

Symptoms of AVRT/AVNRT

A

Rapid regular palpitations, abrupt onset and sudden termination
Dizziness
Dyspnoea
Central cehst pain and syncope
Worsened by exertion, coffee, tea or alcoohl

36
Q

When is VT more likely than SVT

A

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
Q

Acute management of SVTs haemodynamically unstable

A

Emergency cardioversion

38
Q

Long term management of SVTs

A

Radiofrequency ablation of accessory pathway via cardiac catheter
Flecanide, verapamil, sotalol and amiodarone

39
Q

Acute management of SVTs haemodynamically stable

A

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
Q

Emergency treatment of arrhythmias

A

Oxygen, IV access
Test and correction of magnesium, potassium, calcium

41
Q

Features of long QT syndrome

A

1 - exertional syncope
2 - syncope on stress, exercise or auditory sitmulus
3 - at rest or night
Sudden cardiac death
-> torasades de pointes

42
Q

Management long QT syndrome

A

Beta blockers
Avoid precipitating drugs
ICD if high risk

43
Q

Drugs -> long QT syndrome

A

Amiodarone, sotallol, 1a antiarrhythmics
TCAs, SSRIs
Chloroquine
mETHADONE
Terfenadine
Haloperdiol
Erythromycin
Ondanestron

44
Q

Congenital causes Long qt syndrome

A

Javell lange nielson - deafness - abnormal K+
Romano ward syndrome

45
Q

Other causes of long QT (not congenital or drugs)

A

Electroly - hypocalcemia, kaelmai, magnesia
Acute MI
hYPOTHERMIA
sah
myocarditis

46
Q

Management of VT

A

Adverse signs - cardiovert
Amiodarone - central line
Lidocaine - caution in LV dysfunction
Procainamide

47
Q

BPM in VT vs VF

A

VT - 100-250
VF>300

48
Q

When long term manage SVT

A

Symptoms -> affect QOL
Symptomatic WPW
Infrequent but sports, driver etc

49
Q

DC cardioverison antioag rules

A

3 weeks prior if >48 hrs AF
Urgent -> LMWH + oral anticcoag prior
Heparin post DC cardiovert + oral anticaog

50
Q

CHADVASC vs HASBLED when anticoagulate

A

> 2 CHADVASC = anticoagulate needed
3 HASBLED = high bleeding risk

51
Q

When do ratevs rhythm control AF

A

> 65, history IHD -> rate
<65, symptomatic, 1st presentation, lone AF or secondary to precipitant -> rhythm

52
Q

Side effects atropine

A

Bradycardia and AV block
Facial flushing, headache, chest pain or tightness
Bronchospasm, sense impending doom

53
Q

CIs atropine

A

Asthma
Second or third degree HB
Sick sinus syndrome unless pacemaker

54
Q

Amiodarone side effects

A

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
Q

CIs amiodarone

A

Sinus bradycardia
SAN block
Thyroid dysfunction
Iodine sensitivity

56
Q

Flecanide side effects

A

Dizzy, visual disturb, SOB, palpitations, proarrhtyhmic, headahce, fatirgue and dnausea - common

Rare - bronchospasm, heart block, bone marrow supression, increased V rate in AF

57
Q

Flecanide CI

A

Prev MI
CAD, LVSD, other structural HD
Interactions w beta blockers and CCBs

58
Q

Digoxin side effects

A

N+V, diarrhoea, blurre or yellow vision
V arrhtyhmias. narrow therapeutic index - common
Hypokalemia and renal impairment
Toxicity -> hyperkalemai

59
Q

CI digoxin

A

Sev renal impariemtn
accessory pathway arrhythmias
With amiodarone
Caution in LV obstruction
Dilatazem, verapamil, spirinolactone decrease renal excretion - plasma levels check

60
Q

CI for ACEis/ARB

A

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
Q

Side effects ACEi

A

Dry cough
Hyperkalaemia
Sudden renal function dererioration if renal artery stenosis
NSAids - loss of testa, rashes, hypersensitvityy

62
Q

CCB side effects

A

Flushing, dizzy, tachy, hypotension, ankle swell, headahce - vasodilating effects
Constipation w verapamil
Worsening HF - verapamil and dilatazem

63
Q

CCB CIs

A

AORTIC STENOSIS
beta blockers, LV failure, sick sinus syndrome, HF
WPW, post MI - verapamil

64
Q

Nitrates CI

A

Arotic/mitral stenosis
HOCM
Cardiac tamponade
Constrictive pericartitis

65
Q

Classes of antiarrhythmics

A

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
Q

Torsades de points drug treatment

A

IV magnesium sulphate

A- Resp and cardio (58 decks)

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