Arrhythmias

Question 1

Two shockable rhythms

Answer 1

Ventricular tachycardia and ventricular fibrilation

Question 2

Two non-shockable rhythms

Answer 2

Pulseless electrical activity and asystole

Question 3

Treatment of tachycardia in an unstable patient

Answer 3

Consider 3 synchronicsed shocks or consider amiodarone infusion

Question 4

Treatment of atrial fibrilation in a stable patient

Answer 4

Rate control with beta blocker or diltiazem

Question 5

Treatment of atrial flutter in a stable patient

Answer 5

Contral rate with beta blocker

Question 6

Treatment of SVT in a stable patient

Answer 6

Vagal manoeuvres and adenosine

Question 7

Treament of ventricular tachycardia in stable patient

Answer 7

Amiodarone infusion

Question 8

What causes an atrial flutter

Answer 8

Re-entrant rhythm in either atria, which is where the signal re-circulates in a self-perpetuating loop due to an external pathway.

Question 9

bpm of atria in atrial flutter

Answer 9

Atrial contraction of 300bpm as signal goes around without interuption

Question 10

bpm of ventricles in atrial flutter

Answer 10

150bpm as the signal makes it into to ventricles every second lap due to long refractory period of AV node

Question 11

Appearance of atrial flutter on ECG

Answer 11

Sawtooth appearance - P wave after P wave

Question 12

Associated conditions with atrial flutter

Answer 12

Hypertension, ischaemic heart disease, cardiomyopathy, thyrotoxicosis

Question 13

Treatment of atrial flutter

Answer 13

Treat underlying condition, rate/rhythm control, radiofrequency ablation of re-entrant rhythm and risk score

Question 14

Cause of supraventricular tachycardia

Answer 14

electrical signal re enters the atria from the ventricles, then travels through AV node resulting in another ventricular contraction, causing a self-perpetuating loop

Question 15

ECG of supraventricular tachycardia

Answer 15

Narrow complex tachycardia of QRS <0.12, where T wave immediately follows a QRS

Question 16

Three main types of SVT

Answer 16

Atrioventricular nodal re-entrant tachycardia. Atrioventricular re-entrant tachycardia. Atrial tachycardia (other than SAN)

Question 17

Stepwise approach for treating stable patient with SVT

Answer 17

Valsalva manoeuvre, carotid sinus massage, adenosine, verapamil, direct current cardioversion

Question 18

How does adenosine work

Answer 18

Slows cardiac conduction primarily through the AV node, interupting the pathway

Question 19

When should you avoid giving adenosine to a patient

Answer 19

asthma, COPD, heart failure, heart block, severe hypotension

Question 20

How to administer adenosine

Answer 20

Fast IV bolus into a large proximal cannula. 6mg, then 12mg then further 12 is no improvement

Question 21

What is paroxysmal SVT

Answer 21

Situation where SVT reoccurs and remits in the same patient over time

Question 22

Prevention measures in patients with paroxsymal SVT

Answer 22

Medication - beta blockers, calcium channel blockers, amiodarone. Radiofrequency ablation

Question 23

Cause of Wolff-Parkinson White Syndrome

Answer 23

Extra electrical pathway connecting the atria and ventricles.

Question 24

Treatment of WPW syndrome

Answer 24

Radioferquency ablation of accessory pathway

Question 25

ECG changes in WPW syndrome

Answer 25

Short PR interval, wide QRS complex, delta wave (slurred upstroke on QRS compex

Question 26

When are most antiarrhythmic medications contraindicated in a patient with WPW syndrome

Answer 26

Combination of WPW syndrome and AF or atrial flutter

Question 27

What is torsades de pointes

Answer 27

Polymorphic ventricular tachycardia, occuring in patients with a prolonged QT interval

Question 28

Causes of prolonged QT interval

Answer 28

Long QT syndrome, medications and electrolyte disturbances

Question 29

Which medications can cause prolonged QT

Answer 29

antipsychotics, citalopram, flacainide, sotalol, amiodarone, macrolide antibiotics

Question 30

Which electrolytes disturbances can cause long QT

Answer 30

hypokalaemia, hypomagnesaemia, hypocalcaemia

Question 31

Acute management of torsades de pointes

Answer 31

Correct the cause, magnesium infusion, defibrilation if VT occurs

Question 32

Long term management of prolnoged QT syndrome

Answer 32

Avoid medications, correct electrolyte disturbances, beta blockers, pacemaker or implantable defibrilator

Question 33

What are ventricular ectopics

Answer 33

Premature ventricular beats caused by random electrical discharges from outside the atria.

Question 34

ECG of ventricular ectopies

Answer 34

Individual, random, abnormal broad QRS complexes on a backgruond of a normal ECG

Question 35

What is Brugada syndrome

Answer 35

Genetic condition involving sodium channels

Question 36

Symptoms of Brugada syndrome

Answer 36

Asymptomatic, palpitations, syncope,

Question 37

Cause of Brugada syndrome

Answer 37

Arrhythmias such as AV nodal re-entry tachycardias, VT or VF

Question 38

Diagnosis of Brugada syndrome

Answer 38

ECG and one of the following: VF/polymorphic VT, FHx of sudden cardiac death<45, syncope/ECG signs in family, inducible VT, nocturnal agonal breathing

Question 39

Management of Brugada syndrome

Answer 39

Avoidance of risks, ICD to reudce risk of sudden death from arrhythmias

Question 40

Risks to avoid in Brugada syndrome

Answer 40

Fever, excess EtOH, dehydration, electrolye imbalances, certain drugs

Question 41

What is Torsades de Pointes

Answer 41

Polymorphic VT that can occur in patients with a long QT interval

Question 42

Complications of Torsades de Pointes

Answer 42

Degenerate into VF, causing haemodynamic compromise

Question 43

Causes of Torsades de Pointes (TIIMMES)

Answer 43

Toxins, Inherited, Ischaemia, Myocarditis, Mitral valve prolapse, Electrolyte abnormalities, Subarachnoid haemorrhage

Question 44

Management of Torsades de Points in unstable patients

Answer 44

Direct current cardioversion

Question 45

Management of Torsades de Pointes in stable patients

Answer 45

IV magnesium sulphate, 2g over 1/2 mins