arrhythmias

Question 1

bradycardia

Answer 1

First degree AV block- nothing and Mobitz type 1 – Atropine/transvenous pacing only if symptomatic
Mobitz type 2 and 3rd degree heart – Pacemaker

Question 2

stable SVT

Answer 2

1) Vagal manoeuvres
2) IV adenosine
3) Long term – CCB or B-blocker

Question 3

Atrial fibrillation

Answer 3

Class 1 – Disopyramide (Ia), Lidocaine (Ib), flecainide (Ic), propafenone (Ic)
Class 2 – Propanalol, atenolol, esmolol
Class 3 – Amiodarone, Sotalol (also B-blocker), Dronedarone
Class 4 – Verapamil, Diltiazem
Rate – slow heart rate down by increasing AV node delay
Rhythm – restores sinus rhythm, prolongs action potential (III)
Management:
1) Rate control
a. B-blocker or CCB [verapamil]
b. Digoxin monotherapy for non-paroxysmal AF
2) Rhythm control - Cardioversion
a. Drugs - Amiodarone
b. Electrical – DC cardioversion
3) Stroke prevention
a. Warfarin
b. Dabigatran

Question 4

atrial flutter

Answer 4

1) Terminate flutter by cardiac ablation + Amiodarone
2) Adenosine – monotherapy

Question 5

unstable ventricular tachycardia

Answer 5

1) DC cardioversion + rhythm control drugs [Lignocaine (1) + Amiodarone (3)]

Question 6

ventricular fibrillation

Answer 6

1) Electrical defibrillation
2) Secondary prevention: ICD – Implantable cardioverter-defibrillators

Question 7

Torsades de pointes (TdP)

Answer 7

1) IV magnesium sulphate + Isoprenaline

Question 8

long QT syndrome

Answer 8

1) Underlying cause
a. Correct electrolyte disturbances
b. Stop causative drugs
2) Maintain heart rate with atrial/ventricular pacing
3) Magnesium sulphate + Isoprenaline
4) Long term: B-blocker + pacemaker therapy

Question 9

Brugada syndrome

Answer 9

1) ICD implant