ARRHYTHMIAS Flashcards
Bradyarrhythmia
Heart rate <60
Tachycarrhythmia
Heart rate >100
Examples of bradyarhhythmias
Sinus bradycardia
Sinus pauses
AV Block
Types of tachyarrhythmias
Ventricular tachycardia
Supraventricular tachycardia
Examplesof tachyarhhythmias
Atrial fibrillation
Atrial flutter
Atrial Paroxysmal supraventricular tachycardia
Ventricular tachycardia
Ventricular fibrillation
ECG is not needed before treatment of arrhythmia
False
Causes of arrhythmias
Rheumatic heart disease
Valvular heart disease
Hypertensive heart disease
Ischaemic heart disease
Thyrotoxicosis
Hypothyroidism
Cardiomyopathies
Complete heart block
Electrolyte abnormalities
Pericardial disease
Drugs
Smoking, alcohol, coffee, tea, etc.
Pulmonary embolism
Post cardiac surgery
Idiopathic
Symptoms of arrhythmias
Palpitations
Dizziness
Chest discomfort/pain
Fatigue
Difficulty in breathing
Sudden collapse
Sudden death
Pulse deficit
apical rate faster than radial pulse rate; seen in fast atrial fibrillation or flutter
Arrhythmias with regular rhythm
Sinus tachycardia
Sinus bradycardia
Complete heart block
Supraventricular tachycardia
Ventricular tachycardia
Arrhythmias with regularly irregular beats
Supraventricular or
ventricular ectopic
beats
Arrhythmias with irregularly irregular beats
Atrial fibrillation
Atrial flutter (with variable
atrio-ventricular block)
Multiple supraventricular or
ventricular ectopic beats
Investigations in arrhythmias
ECG
Serum electrolytes
TFTs
Chest X-ray
Ambulatory ECG
Echaocardiography
Device used for ambulatory ECG
Holter monitor
Treatment objectives in arrhythmias
To control ventricular rate
To restore sinus rhythm
To relieve symptoms
To improve functional capacity and quality of life
To prevent or treat associated complications
To treat the underlying condition
To prevent stroke or systemic thromboembolism
To reduce morbidity and mortality
Non-pharmacological interventions in arrhythmias
Reassure the patient
Avoid excessive intake of alcohol, coffee or tea and cigarette
Massage of the carotid sinus on one side for a few seconds.
Electrical cardioversion
Purpose of carotid sinus massage
This may
terminate an attack of paroxysmal supraventricular tachycardia
Pharmacological treatment of fast atrial fibrillation or atrial flutter-for rate control
1st line
Atenolol or Bisoprolol or Metoprolol tartrate or Verapamil
2nd line
Digoxin
Dose of atenolol in atrial fibrillation or atrial flutter or PSVT
Atenolol, oral,
Adults
50-100 mg daily
Children
12-18 years; 25-50 mg daily
1 month-12 years; 12.5-50 mg daily
Dose for bisoprolol in atrial fibrillation or atrial flutter or PSVT
Adults
2.5-10 mg daily
Dose for metoprolol in atrial fibrillation or atrial flutter or PSVT
Adults
50-100 mg 8 or 12 hourly daily (max. 300 mg daily)
Dose for verapamil in atrial fibrillation or atrial flutter or PSVT
Verapamil, oral,
Adults
40-120 mg 6-8 hourly (max. 480 mg daily)
Dose for digoxin in atrial fibrillation or atrial flutter or PSVT
Digoxin, oral,
Adults
125-250 micrograms daily
Pharmacological treatment for paroxysmal supraventricular tachycardia
First line
Atenolol or Bisoprolol or Metoprolol tartrate or Verapamil
2nd Line
Digoxin