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Cardiovascular system > Arrhythmias > Flashcards

Arrhythmias Flashcards

1
Q

What is meant by a supra-ventricular arrhythmia?

A

An arrhythmia in which the origin is supernal to the ventricles, including the SAN, Atrial myocardium, AV node or His origin

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2
Q

What are some examples of supra ventricular tachycardias?

A

Atrial fibrillation
Atrial flutter
Ectopic atrial tachycardia

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3
Q

What are some examples of supra ventricular bradycardias?

A

Sinus bradycardia
Sinus pauses

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4
Q

What are some examples of ventricular arrhythmias?

A

Ventricular ectopics or premature ventricular complexes
Ventricular tachycardia
Ventricular fibrillation
Asystole

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5
Q

What are some examples of Atrio-Ventricular Node arrhythmias?

A

AV Node re-entry tachycardia
AV reciprocating or AV re-entrant tachycardia
AV Block (1st, 2nd, 3rd degree)

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6
Q

What are some clinical causes of arrhythmias?

A

Abnormal anatomy allowing re-entry circuits
Autonomic nervous system
Metabolic causes
Inflammation
Drugs
Genetic

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7
Q

What are some examples of ways in which the autonomic nervous system can result in arrhythmia?

A

Sympathetic stimulation due to stress, exercise, hyperthyroidism
Increased vagal tone causing bradycardia

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8
Q

What are some examples of metabolic causes of arrhythmias?

A

Hypoxia - Chronic pulmonary disease, pulmonary embolism
Ischaemic myocardium - Acute MI, angina
Electrolyte imbalance

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9
Q

What is an example of an inflammatory cause of arrhythmia?

A

Viral myocarditis

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10
Q

What is an example of a genetic cause of arrhythmia?

A

Congenital long QT syndrome

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11
Q

What is meant by an ectopic beat?

A

A rhythm that originates in places other than the SA node

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12
Q

What occurs in Wolf Parkinson White syndrome?

A

An extra conduction pathway forms in the heart allowing the bypassing of the AV node, therefore decreasing the PR interval and predisposing the person to supraventrcular tachycardia

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13
Q

What are some example of conditions that increase the phase 4 (funny current) slope of the SA node, and thus increase heart rate?

A

Hyperthermia
Hypoxia
Hypercapnia (High CO2)
Myocardial stretch

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14
Q

What are some examples of conditions that decrease the phase 4 (Funny current) slope and thus decrease heart rate?

A

Hypothermia
Hyperkalaemia

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15
Q

What ate the 2 main classes of triggered activity?

A

Delayed After-depolarisations
Early After-depolarisations (Phase 2 and 3)

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16
Q

What are some examples of conditions that result from prolonged after-depolarisations?

A

Digoxin toxicity
Torsades du Pointes in long QT syndrome
Hypokalaemia

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17
Q

What occurs in re-entry?

A

An action potential fails to extinguish itself and reactivates a region that has depolarised. This can occur in the presence of an obstacle around which an action potential can travel (Circus entry)

18
Q

What are some common symptoms of arrhythmias?

A

Palpitations
Dyspnoea
Pre-syncope
Syncope
Shock
Sudden cardiac death
Angina
Heart failure
Anxiety

19
Q

What investigates can be performed on someone with a suspected arrhythmia?

A

12 lead ECG
Bloods
Chest X-ray
Echocardiogram
Stress ECG
24-hour ECG Holter monitoring
Event recorder (Press a button to turn on ECG when the patient feels an arrhythmia)
Electrophysiological study

20
Q

What can be done during an electrophysiological study?

A

The arrhythmia can be triggered to study its pathway and origin and then radio frequency ablation (Cauterisation of the origin to cause fibrosis) can be performed

21
Q

What is meant by normal sinus arrhythmia?

A

Variation in heart rate due to reflex changes in vagal tone during respiration
Inspiration reduces vagal tone and thus increases heart rate

22
Q

What are some causes of Sinus bradycardia?

A

Physiological e.g. in an athlete
Drugs such as ß-Blockers
ischaemia

23
Q

What is the treatment for acute sinus bradycardia, such as in an acute MI?

A

Atropine and pacing (If there is haemodynamic compromise)

24
Q

What are some causes of sinus tachycardia?

A

Anxiety
fever
Hypotension
Anaemia
Drugs

25
Q

What are the treatment options for sinus tachycardia?

A

ß-Blockers
Treatment of the underlying cause

26
Q

What are the 2 types of AV reciprocating tachycardia?

A

Orthodromic AVRT - Impulse travel from ventricular walls back to the AV node where it forms a circuit
Antidromic AVRT - Impulses travel from the AV node and directly into the ventricular wall, without the bundles of His

27
Q

What are some acute management strategies for supraventricular tachycardia?

A

Increase vagal tone - Valsalva, carotid massage
Slow AV node conduction - IV Adenosine and verapamil

28
Q

What are some chronic management strategies for supra ventricular tachycardia?

A

Avoid stimulants
Radiofrequency ablation and Electrophysiological study
ß-Blockers
Anti-arrhythmic drugs

29
Q

What are some causes of AV node conduction block?

A

Ageing
Acute MI
Myocarditis
Amyloidosis
ß-Blockers
Ca2+ channel blockers
Calcific aortic valve disease
Post-aortic valve surgery
Genetic - Lenore’s disease, myotonic dystrophy

30
Q

What is meant by 1st degree AV blocK?

A

AV nodal delay >0.2seconds, but without any symptoms

31
Q

What is meant by 2nd degree AV block?

A

Intermittent block at the AV node leading to a dropped beat

32
Q

What are the 2 types of 2nd degree heart block?

A

Mobitz type I
Mobitz type II

33
Q

What is meant by Mobitz type I 2nd degree heart block?

A

Progressive lengthening of the PR interval (AV node delay) leading up to a dropped beat

34
Q

What is meat by Mobitz type II 2nd degree heart block?

A

Constant 2:1 or 3:1 drop in beats
Requires permanent pacing

35
Q

What is meant by 3rd degree AV node block?

A

Complete loss of communication between the SA and AV node
Required ventricular pacing

36
Q

What are the 2 types of pacemaker?

A

Single chamber (Paces only the right atria or ventricle)
Dual chamber (Paces both RA and RV)

37
Q

What are the 2 types of ventricular tachycardia?

A

Monomorphic - Regular pattern for tachycardia
Polymorphic - Chaotic tachycardia with no clear pattern

38
Q

What is meant by ventricular fibrillation?

A

Chaotic ventricular electrical activity which causes the heart to fail to pump

39
Q

What is the treatment for ventricular fibrillation?

A

Defibrillation and CPR

40
Q

What are some acute treatment strategies for Ventricular tachycardia?

A

Direct current cardioversion
Correct triggers

41
Q

What are some chronic treatment strategies for ventricular tachycardia?

A

Revascularisation
Anti-arrhytmic drugs (Associated with worse outcomes on their own)
Implantable cardiovertor defibrillator
catheter ablation

Cardiovascular system (45 decks)

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