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Cardiology > Arrhythmias > Flashcards

Arrhythmias Flashcards

1
Q

What are the 2 shockable rhythms?

A

• Ventricular tachycardia
• Ventricular fibrillation

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2
Q

What are the 2 non-shockable rhythms?

A

• Pulseless electrical activity (all electrical activity except VF/VT, including sinus rhythm without a pulse)
• Asystole (no significant electrical activity)

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3
Q

How is ventricular tachycardia managed?

A

IV Amiodarone

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4
Q

How are polymorphic ventricular tachycardia’s managed?

A

IV magnesium

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5
Q

What are 3 main causes of bradycardia?

A

○ Medications (e.g., beta blockers)
○ Heart block
○ Sick sinus syndrome

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6
Q

What is sick sinus syndrome?

A

• Sick sinus syndrome encompasses many conditions that cause dysfunction in the sinoatrial node.

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7
Q

What often causes sick sinus syndrome?

A

○ It is often caused by idiopathic degenerative fibrosis of the sinoatrial node.

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8
Q

What 4 things can increase a persons risk of asystole?

A

§ Mobitz type 2
§ Third-degree heart block (complete heart block)
§ Previous asystole
§ Ventricular pauses longer than 3 seconds

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9
Q

What is the 1st line management in patients at risk of asystole?

A

IV atropine

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10
Q

How does atropine work?

A

• Atropine is an antimuscarinic medication and works by inhibiting the parasympathetic nervous system.

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11
Q

What are some side effects of atropine? (4)
Why are they caused?

A

Pupil dilation
Dry mouth
Urinary retention
Constipation

As parasympathetic nervous system is inhibited

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12
Q

What is the management of atrial flutter? (2)

A

Anticoagulantion based on chadvasc score
Radio frequency ablation of reentrant rhythm

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13
Q

What is classed as a prolonged QT interval in men? And in women?

A

○ > 440ms in men
○ > 460ms in women

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14
Q

What does a prolonged QT interval mean is happening in the heart?

A

prolonged repolarisation of the heart muscle cells (myocytes) after a contraction.

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15
Q

What is the mechanism of torsardes de pointes?

A

Long QT interval
Spontaneous depolarisation if repolarisation is taking a long time
• These abnormal spontaneous depolarisations before repolarisation are known as afterdepolarisations.
• These afterdepolarisations spread throughout the ventricles, causing a contraction before proper repolarisation.
• When this leads to recurrent contractions without normal repolarisation, it is called torsades de pointes.

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16
Q

What class of tachycardia is torsades de pointes?

A

Polymorphic ventricular tachycardia

17
Q

What can torsades de pointes turn into?

A

Can spontaneously resolve
Can progress to VT which can lead to cardiac arrest

18
Q

What is the management of QT prolongation? (4)

A

• Stopping and avoiding medications that prolong the QT interval
• Correcting electrolyte disturbances
• Beta blockers (not sotalol)
Pacemakers or implantable cardioverter defibrillators

19
Q

What are some causes of QT prolongation? (3)

A

• Long QT syndrome (an inherited condition)
• Medications, such as antipsychotics, citalopram, flecainide, sotalol, amiodarone and macrolide antibiotics
Electrolyte imbalances, such as hypokalaemia, hypomagnesaemia and hypocalcaemia

20
Q

What is the acute management of torsardes de pointes? (3)

A

• Correcting the underlying cause (e.g., electrolyte disturbances or medications)
• Magnesium infusion (even if they have normal serum magnesium)
Defibrillation if ventricular tachycardia occurs

21
Q

What is bigeminy?

A

• Bigeminy refers to when every other beat is a ventricular ectopic. The ECG shows a normal beat (with a P wave, QRS complex and T wave), followed immediately by an ectopic beat, then a normal beat, then an ectopic, and so on.

22
Q

What is the management of ventricular ectopics? (3)

A

• Reassurance and no treatment in otherwise healthy people with infrequent ectopics
• Seeking specialist advice in patients with underlying heart disease, frequent or concerning symptoms (e.g., chest pain or syncope), or a family history of heart disease or sudden death
• Beta blockers are sometimes used to manage symptoms

23
Q

What is first degree heart block?

A

where there is delayed conduction through the atrioventricular node.
○ Despite this, every atrial impulse leads to a ventricular contraction, meaning every P wave is followed by a QRS complex.
○ On an ECG, first-degree heart block presents as a PR interval greater than 0.2 seconds (5 small or 1 big square).

24
Q

How long is PR prolongation in first degree heart block?

A

PR interval greater than 0.2 seconds (5 small or 1 big square).

25
Q

What is second degree heart block?

A

where some atrial impulses do not make it through the atrioventricular node to the ventricles.
There are instances where P waves are not followed by QRS complexes

26
Q

What are the 2 types of second degree heart block and what are they?

A

i. Mobitz type 1 (Wenckebach phenomenon) is where the conduction through the atrioventricular node takes progressively longer until it finally fails, after which it resets, and the cycle restarts.

		ii. Mobitz type 2 is where there is intermittent failure of conduction through the atrioventricular node, with an absence of QRS complexes following P waves.
27
Q

What ecg changes are seen in mobitz type 1?

A

□ On an ECG, there is an increasing PR interval until a P wave is not followed by a QRS complex.
The PR interval then returns to normal, and the cycle repeats itself

28
Q

What are the ecg changes in mobitz type 2?

A

□ There is usually a set ratio of P waves to QRS complexes, for example, three P waves for each QRS complex (3:1 block).
□ The PR interval remains normal.

29
Q

What’s the main risk with mobitz type 2?

A

Asystole

30
Q

What is third degree heart block?

A

○ There is no observable relationship between the P waves and QRS complexes.

31
Q

What is the main risk with third degree heart block?

A

Asystole

32
Q

What drug is contraindicated in VT?

A

Verapamil

Cardiology (18 decks)

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