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Emergency medicine > Arrhythmias > Flashcards

Arrhythmias Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

Shockable rhythms

A

Ventricular tachycardia

Ventricular fibrillation

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2
Q

Non-shockable rhythms

A

Pulseless electrical activity

Asystole

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3
Q

Narrow complex tachycardias

A

Atrial fibrillation

Atrial flutter

Supraventricular tachycardia

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4
Q

Broad complex tachycardias

A

Ventricular tachycardia

SVT with bundle branch block

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5
Q

Treatment of stable AF

A

Rate control with beta blocker or diltiazem

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6
Q

Treatment of stable atrial flutter

A

Rate control with beta blocker

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7
Q

Treatment of stable SVT

A

Vagal manouevres and adenosine

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8
Q

Treatment of stable VT

A

Amiodarone infusion

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9
Q

Treatment of stable known SVT with BBB

A

Treat as normal SVT

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10
Q

Atrial flutter

A

Re-entrant rhythm where electrical signal re-circulates in self-perpetuating loop due to an extra pathway

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11
Q

Atrial contraction rate in atrial flutter

A

300bpm

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12
Q

Ventricular contraction rate in atrial flutter

A

150bpm

Signal makes its way into ventricles every second lap due to long refractory period in AV node

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13
Q

Conditions associated with atrial flutter

A

HTN

IHD

Cardiomyopathy

Thyrotoxicosis

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14
Q

Management of atrial flutter

A

Rate/rhythm control with beta blockers or cardioversion

Treat reversible underlying cause

Radiofrequency ablation of re-entry rhythm

Anticoagulation based on CHA2DS2VASc score

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15
Q

SVT

A

Electrical signal re-entering atria from the ventricles

Once signal is back in the atria it travels back through AV node and causes another ventricular contraction

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16
Q

Types of SVT

A

Atrioventricular nodal re-entrant tachycardia- re-entry point through AV node only

Atrioventricular re-entrant tachycardia- re-entry point is accessory pathway (WPW)

Atrial tachycardia- signal originates in atria somewhere other than sinoatrial node

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17
Q

Adenosine action

A

Slows cardiac conduction through AV node

Resets back to sinus rhythm

Needs to be given as rapid bolus

18
Q

Adenosine contraindications

A

Asthma

COPD

HF

Heart block

Severe hypotension

19
Q

Adenosine warnings

A

Causes brief asystole/ bradycardia

Scaring feeling of dying/ impending doom

20
Q

Adenosine dosing

A

6mg then 12mg then 12mg if no improvement between doses

21
Q

Long term management of paroxysmal SVT

A

Beta blockers, calcium channel blockers, amiodarone

Radiofrequency ablation

22
Q

Wolf parkinson white syndrome

A

Extra electrical pathway connect atria and ventricles (often called bundle of Kent)

23
Q

WPW ECG changes

A

Short PR interval

Wide QRS complex

Delta wave (slurred upstroke on QRS complex)

24
Q

Definitive management of WPW

A

Radiofrequency ablation

25
Q

Torsades de pointes

A

Polymorphic ventricular tachycardia

Height of the QRS complex progressively gets smaller then larger etc

26
Q

Causes of prolonged QT

A

Long QT syndrome (inherited)

Medications (antipsychotics, citalopram, flecanide, sotalol, amiodarone, macrolides)

Electrolyte disturbances (hypokalaemia, hypomagnesaemia, hypocalcaemia)

27
Q

Acute management of torsades de pointes

A

Correct the cause

Magnesium infusions (even if normal serum magnesium)

Defibrillation of VT occurs

28
Q

Longterm management of prolonged QT syndrome

A

Avoid medications that prolong QT interval

Correct electrolyte imbalances

Beta blockers (not sotalol)

Pacemaker or implantable defibrillator

29
Q

Ventricular ectopics

A

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

30
Q

Bigeminy

A

Ventricular ectopics are occurring so frequently that they happen after every sinus beat

ECG looks like normal sinus beat followed immediately by an ectopic, then normal, then ectopic etc

31
Q

Management of ventricular ectopics

A

Check bloods for anaemia, electrolyte disturbances and thyroid abnormalities

Reassurance and no treatment if otherwise healthy

32
Q

First degree heart block

A

Delayed AV conduction

Every atrial impulse leads to ventricular contraction

33
Q

Second degree heart block

A

Some atrial impulses do not make it through AV node

Instances where p waves do not lead to QRS complexes

34
Q

Mobitz type 1 (Wenckebach’s)

A

Atrial impulses become gradually weaker until doesn’t pass through AV node

Increasing PR interval and then drops P wave

35
Q

Mobitz type 2

A

Intermittent failure or interruption of AV conduction

Usually set ratio of p waves to QRS complexes

PR interval remains normal

Risk of asystole

36
Q

2:1 block

A

2 p waves for each QRS complex

Every second p wave is not strong enough to stimulate a QRS complex

37
Q

Third degree heart block

A

Complete heart block

No observable relationship between p waves and QRS

Significant risk of asystole

38
Q

1st line treatment for unstable bradycardias/ AV node blocks

A

Atropine 500mcg IV

39
Q

Treatment for unstable bradycardias if no improvement

A

Atropine 500mcg repeated (up to 6 doses)

Other inotropes (such as noradrenaline)

Transcutaneous cardiac pacing

40
Q

Treatment if patients high risk of asystole (Mobitz 2, complete heart block)

A

Temporating transvenous cardiac pacing

Permanent implantable pacemaker

41
Q

Atropine action

A

Antimuscarinic medication

Inhibits the parasympathetic nervous system

42
Q

Atropine side effects

A

Pupil dilatation

Urinary retention

Dry eyes

Constipation

Emergency medicine (48 decks)

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