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Cardiology > Arrhythmias > Flashcards

Arrhythmias Flashcards

1
Q

Cardiac arrest rhythms

A

Shockable:
Ventricular tachycardia
Ventricular fibrillation

Non-shockable:
Pulseless electrical activity (all activity except VF/VT including sinus rhythm without a pulse)
Asystole

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2
Q

Tachycardia treatment in unstable pt

A

3 synchronised shocks
Amiodarone infusion

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3
Q

Tachycardia with narrow complex

A

AF
Atrial flutter
Supraventricular tachycardia

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4
Q

Tachycardia with broad complex

A

Ventricular tachycardia
SVT with bundle branch block
AF variation?

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5
Q

Atrial flutter pathophysiology

A

Reentrant rhythm
Electrical signal recirculates atrium in self-perpetuating loop
Atrial contraction at 300bpm
Passess through AVN every 2nd lap due to long refractory period
Ventricular contraction at 150bpm

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6
Q

Atrial flutter associated conditions

A

Hypertension
Ischaemia heart disease
Cardiomyopathy
thyrotoxicosis

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7
Q

Atrial flutter ECG

A

sawtooth appearance of p waves

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8
Q

Atrial flutter treatment

A

Rate/rhythm control - beta blockers / cardioversion
Treat reversible cause
Radiofrequency ablation of reentrant rhythm
Anticoagulation based on CHA2DS2VASc score
No flecanide - 1:1 AV conduction - tachycardia

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9
Q

Atrial fibrillation pathophysiology

A

Disorganised electrical activity overrides SAN
Atrial contraction uncoordinated rapid and irregular
Irregular conduction of electrical impulses to ventricles
Irregularly irregular ventricular contractions
Tachycardia
Heart failure (poor filling duirng diastole)
Risk of stroke

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10
Q

AF presentation

A

Palpitations
SOB
Syncope
Associated conditions - stroke, sepsis, thyrotoxicosis

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11
Q

Irregularly irregular pulse differentials

A

AF
Ventricular ectopics - disappear when HR increases - exercise test

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12
Q

AF on ECG

A

Absent p waves
Narrow QRS tachycardia
Irregularly irregular ventricular rhythm

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13
Q

AF - valvular vs non-valvular

A

Valvular - moderate/severe mitral stenosis or mechanical heart valve - lead to AF
Non-valvular - any other valve pathology, and non-valve pathology

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14
Q

Causes of AF

A

mrs SMITH
Sepsis
Mitral valve pathology
Ischaemic heart disease
Thyrotoxicosis
Hypertension

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15
Q

AF principles of treatment

A

Rate / rhythm control
Anticoagulation to prevent stroke

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16
Q

AF rate control pathophysiology

A

Ventricles fill up by suction/gravity not atrial contraction
Heart rate below 100bpm = more time to fill up
First line

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17
Q

AF rate control options

A
  1. Beta blocker (atenolol 50-100mg OD)
  2. CCB (diltiazem) (not in heart failure)
  3. Digoxin (monitoring, risk of toxicity, only in sedentary people)
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18
Q

AF rhythm control indications

A

Reversible cause
New onset AF
Heart failure
Remain symptomatic despite rate control

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19
Q

AF immediate cardioversion indications

A

AF present for less than 48 hours
Haemodynamically unstable

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20
Q

AF delayed cardioversion indications

A

AF present for more than 48 hours
Stable

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21
Q

AF delayed cardioversion waiting

A

Anticoagulation for minimum of 3 weeks before
Otherwise clot mobilised - stroke
Rate control

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22
Q

AF pharmacological cardioversion

A

Flecanide
Amiodarone (if structural heart disease)

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23
Q

AF electrical cardioversion

A

Sedation/GA
Cardiac defibrillator

24
Q

AF LT rhythm control

A
  1. Beta blockers
  2. Dronedarone (if successful cardioversion)
  3. Amiodarone (heart failure of LV dysfunction)
25
Q

Paroxysmal AF

A

Intermittent
No longer than 48 hours
‘Pill in pocket’ approach if not underlying structural disease - flecanide
Anticoagulation

26
Q

AF anticoagulation

A

Blood stagnation in atrial appendage
Thrombus - embolus - ischaemic stroke
Reduces risk of stroke by 2/3rds
3% risk of bleeds

27
Q

Warfarin

A

Vitamin K antagonist
Prolongs prothrombin time
International normalised ratio (INR) = prothrombin time of normal adult vs prothrombin time of pt
Target INR = 2-3
INR affected by many antibiotics - influence P450 system in liver - influence warfarin
INR affected by diet (vit K / P450) - leafy green veg, cranberry juice, alcohol
Reversible with vitamin K
Half life of 1-3 days

28
Q

DOACs

A

7-15 hour half life
No monitoring
No major interactions
Equal at preventing strokes / bleed risks
Reverse:
Andexanet alfa (apixiban and rivaroxaban)
Indarucizumab (dabigatran)

29
Q

CHADSVASC

A

> 1 = consider anticoagiulation
Risk of stroke /TIA in pts with AF

Congestive heart failure
Hypertension
A2 = age>75 = 2
Diabetes
S2 = stroke/Tia = 2
Vascular disease
Age 65-74
Sex (female)

30
Q

ORBIT

A

Risk of major bleeding while on anticoagulations
Low Hb/haemocrit
Age 75+
Previous GI / intracranial bleeding
Renal function (GFR<60)
Antiplatelet medications

31
Q

HAS-BLED

A

Assess risk of bleeding
Hypertension
Abnormal renal and liver function
stroke
Bleeding
Labile INRs
Elderly
Drugs/alcohol

32
Q

Supra-ventricular tachycardias definiton

A

electrical signal reenters atria from ventricles
Self-perpetuating electrical loop
Narrow complex tachycardia

33
Q

SVT types

A

AVN reentrant tachycardia (through AVN)
AV reentrant tachycardia (accessory pathway - Wolff-parkinson-white syndrome)
Atrial tachycardia - other than SAN

34
Q

SVT acute management

A

Continuous ECG monitering
Valsalva manoeuvre - blow against resistance
Carotid sinus massage
Adenosine
Verapamil
Direct current cardioversion

35
Q

Adenosine

A

Slows cardiac conduction
Interrupts AVN / accessory pathway
Resets sinus rhythm
Rapid bolus into large proximal cannula
Asystole/bradycardia
Avoid if asthma, COPD, heart failure, heart block, hypotension
Warn pt about feeling of dying
6mg then 12mg then 12mg again

36
Q

SVT LT management

A

Beta blockers
CCB
Amiodarone
Radiofrequency ablation

37
Q

Wolff-Parkinson White Syndrome

A

Accessory pathway (bundle of Kent)
Radio frequency ablation of this = definitive treatment
ECG:
Short PR interval
Wide QRS complex
Delta wave
If AF/atrial flutter - electrical activity can pass onto ventricles via accessory pathway - polymorphic wide complex tachycardia (do not give antiarrhythmic medication in this case)

38
Q

Radiofrequency ablation

A

Catheter ablation
Heat applied to abnormal area
AF
Atrial flutter
SVT
WPW syndrome

39
Q

Torsades de pointes pathophysiology

A

Polymorphic ventricluar tachycardia
Prolonged QT interval (prolonged repolarisation)
Random spontaneous depolarisation (afterdepolarisations)
Ventricles stimulate recurrent contractions without normal repolarisation
Terminate or progress to VT - cardiac arrest

40
Q

Torsades de pointes ecg

A

QRS height gets progressively smaller, then progressively larger

41
Q

Causes of prolonged QT

A

Long QT syndrome
Antipsychotics
Citalopram
Flecanide
Sotalol
Amiodarone
Macrolide antibiotics
Hypokalaemia
Hypomagnesaemia
Hypocalaemia

42
Q

Torsades de pointes acute management

A

Correct cause
Magnesium infusion
Defibrillation if VT occurs

43
Q

Prolonged QT LT management

A

Avoid medications
Correct electrolyte disturbances
Beta blockers (not sotalol)
Pacemaker / implantable defibrillator

44
Q

Ventricular ectopics definition

A

Premature ventricular beats
Random electrical discharges outside of atria

45
Q

Ventricular ectopics ECG

A

individual, random, abnormal broad QRS complexes

46
Q

Bigeminy

A

Ventricluar ectopics occur after every sinus beat

47
Q

Ventricular ectopics management

A

Check for anaemia, electrolytes and thyroid abnormalitites
reassurance to healthy people
Seek expert advice if heart condition or symptoms other than palpitations

48
Q

First degree heart block

A

Delayed AV conduction
Every atrial impulse leads to ventricular contraction
PR interval > 0.2s

49
Q

Second degree heart block

A

Some atrial impulses do not make it to the ventricles

Wenckebach’s phenomenon (Mobitz type I):
Increasing PR interval
Until p wave no longer conducts to ventricles - absent QRS
PR interval then returns to normal

Mobitz type II:
Intermittent failure of AV conduction
Missing QRS complexes
3:1 block = every 3 p waves, a missing QRS
Risk of asystole

50
Q

Third degree heart block

A

Complete
No observable relationship between p waves and QRS
Risk of asystole

51
Q

AVN block/bradycardia treatment if unstable/risk of asystole

A
  1. Atropine 500mcg IV (anti-muscarinic - inhibit PNS - pupil dilation, urinary retention, dry eyes, constipation)
  2. Atropine repeated (up to 6 doses)
  3. Other inotropes (noradrenalin)
  4. Transcutaneous cardiac pacing
  5. Transvenous cardiac pacing
  6. Permanent implantable pacemaker when available
52
Q

Pacemaker indications

A

Symptomatic bradycardia
Mobitz type to AV block
Third degree heart block
Severe heart failure (biventricular pacemaker)
Hypertrophic obstructive cardiomyopathy (ICD)

53
Q

Pacemaker types

A

Single chamber - RA or RV
Dual chamber - RA and RV
Biventricular / triple chamber - RA, RV and LV - heart failure - cardiac resynchronisation therapy
Implantable cardioverter defibrillators - monitor and deliver shock if detect shockable arrythmia

54
Q

Pacemaker ECG

A

Sharp vertical line on all leads
Before p or QRS = single
Before both = dual

55
Q

Pacemaker info

A

Pulse generator and pacing leads
Implanted under left anterior chest wall / axilla
5 years
MRI compatible

Cardiology (15 decks)

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