Arrhythmias

Question 1

Background

Answer 1

Arrhythmia is any condition where there is abnormal electrical activity of the heart.

Question 2

Signs and Symptoms / Diagnosis

Answer 2

Dizziness.
Palpitations.
Chest pain.
Fatigue.
Syncope.
Shortness of breath (dyspnoea).
Rarely, and in extreme cases, collapse and cardiac arrest.

Diagnosis:
Pulse check then ECG (checks electrical activity of heart)

Question 3

Treatment for different types

Answer 3

NON pharmacological more detail in pack. Briefly:
Electrical - can be drugs(amiodarone) or no drugs - electrical shock - restore normal rhythm - anticoagulation and sedation b4 shock.
Pacing - Pacemaker, ICDs
Ablation - Radiofrequency get rid of extra conduction pathways.

BNF:
ATRIAL FIBRILLATION -
Life threatening = emergency electrical cardioversion without delay of anticoagulant. CHECK DIAGRAM ON PHONE

ATRIAL FLUTTER -
Rate control and restore sinus rhythm.
Rate control - Diltiazem or Verapamil.
IV B-blocker or Verapamil for RAPID control.
Adjunct - Digoxin if needed.
Adjunct or ALT - Flecainide or propafenone - can slow flutter
Rhythm - duration of flutter >48hrs or unknown FULLY anticoagulated for 3 weeks THEN cardioversion then continue oral anticoagulation for 4 weeks.
For RAPID rhythm control = Direct current Cardioversion.
Recurrent flutter = Catheter ablation

Paroxysmal SUPRAVENTRICULAR TACHYCARDIA -
SELF LIMITING or face in ice cold water or carotid sinus massage. Use ECG with these techniques.

FAIL = IV adenosine. ALT IV verapamil (avoid if recent B-blocker use). FAIL/haemodynamically unstable - Direct current cardioversion.

Recurrent - Catheter ablation or prevention with CCBs, B-blocker, Flecainide or propafenone.

Arrhythmias post MI -
ECG 1st. Bradycardia - IV Atropine FAIL = IV adrenaline/epinephrine

Ventricular TACHYCARDIA-
Sustained VT but unstable -
Direct current cardioversion to restore sinus rhythm FAIL - IV Amiodarone and repeat Direct…
Sustained VT but Stable -
IV Amiodarone. FAIL = IV Flecainide, propafenone, lidocaine.
High risk cardiac arrest = maintenance = B-blocker/sotalol OR Amiodarone.

Question 4

Helpful classifications

Answer 4

supraventricular arrhythmias (e.g. verapamil)

both supraventricular and ventricular arrhythmias (e.g. amiodarone)

ventricular arrhythmias (e.g. lidocaine).

CCBs are only Verapamil or diltiazem No other for arrhythmias