arrhythmias

Question 1

treatment of sinus tachycardia

Answer 1

find and treat cause

Question 2

treatment of sinus bradycardia with haemodynamic compromise

Answer 2

atropine + pacing

Question 3

treatment of sinus arrhythmia

Answer 3

no treatment if asymptomatic
find and treat cause

Question 4

treatment of sinus pause/arrest

Answer 4

atropine + pacing

Question 5

treatment of AF

Answer 5

1. CCB/B-blocker (rate control, not both together)
2. • digoxin (rate control)
3. amiodarone, flecanide (pharmacological cardioversion, rhythm control)
4. synchronised cardioversion (rhythm control)

Question 6

who should have rate control as first-line treatment for AF

Answer 6

Everyone

Except in patient with:
A reversible cause for their AF
New onset atrial fibrillation (within the last 48 hours)
Heart failure caused by atrial fibrillation
Symptoms despite being effectively rate controlled

Question 7

when should rhythm control be offered in AF

Answer 7

A reversible cause for their AF
New onset atrial fibrillation (within the last 48 hours)
Heart failure caused by atrial fibrillation
Symptoms despite being effectively rate controlled

Question 8

treatment of atrial flutter

Answer 8

CCB/b-blocker/digoxin (rate control)
DC cardioversion (rhythm control)
Pharmacological cardioversion (rhythm control)

If haemodynamically unstable = DC cardioversion

Question 9

treatment for supraventricular tachycardia (AVRT, AVNRT (Wolff-Parkinson-White))

Answer 9

1. vagal manoeuvres
2. adenosine (x3 doses if doesn’t work)
3. verapamil or b-blocker
4. cardioversion (1st if haemodynamically unstable)

Question 10

treatment for VF

Answer 10

ALS, defibrillation (unsynchronised DC cardioversion)

Question 11

treatment for pulseless VT

Answer 11

ALS, defibrillation (unsynchronised DC cardioversion)

Question 12

treatment for monomorphic VT

Answer 12

DC cardioversion (synchronised)
amiodarone

Question 13

treatment for polymorphic VT (torsades de pointes)

Answer 13

magnesium sulfate
isoprenaline
b-blocker
pacemaker

Question 14

treatment for asystole

Answer 14

CPR
adrenaline

Question 15

treatment for PEA

Answer 15

find and treat cause
CPR + adrenaline

Question 16

treatment of 1st degree heart block

Answer 16

no treatment needed
rule out other pathology

Question 17

treatment of mobitz 1

Answer 17

no treatment needed

Question 18

treatment of mobitz 2

Answer 18

pacemaker
DO NOT GIVE ATROPINE

Question 19

treatment of 3rd degree heart block

Answer 19

pacemaker + atropine

Question 20

treatment of BBB

Answer 20

IV atropine + pacemaker

Question 21

what intracranial haemorrhage can cause torsades de pointes

Answer 21

subarachnoid haemorrhage

Question 22

when can AF patients undergo cardioversion without prior anticoagulation

Answer 22

if symptoms present for <48hrs

Question 23

when should an ECG be repeated post-thrombolysis for STEMI

Answer 23

60-90mins

Question 24

ST elevation in AVR is highly suggestive of…

Answer 24

3 vessel disease causing myocardial infarction

Question 25

causes of left axis deviation (7)

Answer 25

left anterior hemiblock
left bundle branch block
inferior myocardial infarction
Wolff-Parkinson-White syndrome* - right-sided accessory pathway
hyperkalaemia
congenital: ostium primum ASD, tricuspid atresia
minor LAD in obese people

Question 26

causes of right axis deviation (9)

Answer 26

right ventricular hypertrophy
left posterior hemiblock
lateral myocardial infarction
chronic lung disease → cor pulmonale
pulmonary embolism
ostium secundum ASD
Wolff-Parkinson-White syndrome* - left-sided accessory pathway
normal in infant < 1 years old
minor RAD in tall people