Arrhythmias Flashcards

1
Q

What is arrhythmia

A

Abnormal rate and rhythm due to an issue with the electrical conducting system

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2
Q

How are arrhythmias detected

A

ECG

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3
Q

What is the normal heart rate

A

60 to 100 bpm

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4
Q

What is it called when it is below 60bpm

A

Bradycardia

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5
Q

What is it called when above 100bpm

A

Tachycardia

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6
Q

What is paroxysmal AF

A

It stops within 7 days, usually without treatment

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7
Q

What is the treatment for paroxysmal AF

A

Pill in the pocket - patient manages this by taking an arrhythmic drug only when episode of AF starts

FAB (flecainide, amiodarone, BB)

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8
Q

What are some symptoms of arrhythmias

A

SOB, abnormal, fast, slow, irregular pulse and palpitations

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9
Q

What electrolyte imbalance can cause arrhythmias

A

Hypokalaemia

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10
Q

What is the aims of treatment for arrhythmias

A

Assess the risk of stroke, thromboembolism and balance these with bleeding risk and manage the symptoms

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11
Q

In AF acute presentation, what do you do when its life threatening?

A

Emergency electrical cardioversion (rhythm control)

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12
Q

In ACUTE NON LIFE threatening, what do you give when the time is less than 48 hours

A

Rate or rhythm control

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13
Q

In ACUTE NON LIFE threatening, what do you give when the time is more than 48 hours

A

Rate or rhythm but rate controlled is preferred (since it has been more than 48 hours)

If rhythm is preferred, then just do electrical cardioversion but should be delayed until 3 weeks of anticoagulation has passed.

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14
Q

What if 3 weeks of anticoagulation hasn’t passed?

A

Give heparin and give anticoagulant for 4 weeks

Doacs should be given, unless contraindicated i.e. renal failure in which warfarin should be given

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15
Q

What are some pharmacological cardioversions (rhythm)

A

Amiodarone, flecainide, dronedarone

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16
Q

What are some pharmacological rate controls

A

Beta blockers except sotalol

Verapamil, diltiazem and digoxin

DIVED BETA

17
Q

If the DIVED beta do not work in controlling symptoms, what can be used?

A

Dual therapy with BB and DD

Remember, verapamil should not be used with beta blockers

18
Q

What if even the dual therapy with BB DD does not work?

A

Consider rhythm control instead

FAB SPD

Flecainide (avoid in heart disease)

Amidarone

Beta blocker (first line)

Sotalol (not first line)

Propafenone (avoid in heart disease)

Dronedarone

19
Q

What is used in supraventricular arrhythmias?

A

Verapamil hydrochloride, adenosine

20
Q

What is used in ventricular arrythmias?

A

Lidocaine hydrochloride

21
Q

Supraventricular + ventricular arrhythmias

A

Amiodarone

22
Q

What is Torsade de pointes

A

Long QT prolongation

23
Q

Is torsade de pointes usually self limiting

A

Yes but if not controlled, can lead to death

24
Q

What antiarrhythmics can lead to QTC prolongation

A

Amidarone

Sotalol

Flecainide

25
Q

What antibiotics can lead to QTC prolongation

A

Quinolones, macrolides, aminoglycosides

26
Q

What antipsychotics can lead to QTC prolongation

A

Haloperidol

Risperidone

Quetiapine

27
Q

What antidepressants can lead to QTC prolongation

A

SSRIs

TCAs

28
Q

What antiemetics can lead to QTC prolongation

A

Ondansetron

29
Q

What can be given to reverse QTC prolongation

A

Magnesium sulphate

30
Q

Can sotalol prolong QTC

A

Yes

31
Q

What should be measured before giving Sotalol

A

Monitor ECG and measure QTC interval

32
Q

What should be corrected before giving sotalol

A

Serum electrolytes

Hypokalaemia
Hypomagnesemia
Hyperkalaemia

33
Q

What is Chadvass score

A

Stroke risk

Congestive HF - 1
Hypertension - 1
Age (75+) - 2
Diabetes - 1
Vascular disease - 1
Age 65-74 - 1
Stroke/TIA/VTE - 2
Sex (F) - 1

Offer anticoagulation if 2 or more

34
Q

What does ORBIT measure

A

Older than 74 - 1

Reduced haemoglobin -2

Bleeding history - 2

Inadequate renal failure -1

Treatment with antiplatelet - 1

0-2 = low
3 = med
4-7 = high

Bleeding risk

35
Q

What does HASBLED measure

A

Hypertension - 1
Abnormal liver/renal -1
Alcohol - 1
Stroke -1
Bleeding - 1
Labile INR -1
Elderly - 1
Drugs (antiplatelets and NSAIDs - 1)

3 makes you bleed