ARRHYTHMIAS

Question 1

Bradyarrhythmia

Answer 1

Heart rate <60

Question 2

Tachycarrhythmia

Answer 2

Heart rate >100

Question 3

Examples of bradyarhhythmias

Answer 3

Sinus bradycardia
Sinus pauses
AV Block

Question 4

Types of tachyarrhythmias

Answer 4

Ventricular tachycardia
Supraventricular tachycardia

Question 5

Examplesof tachyarhhythmias

Answer 5

Atrial fibrillation
Atrial flutter
Atrial Paroxysmal supraventricular tachycardia
Ventricular tachycardia
Ventricular fibrillation

Question 6

ECG is not needed before treatment of arrhythmia

Answer 6

False

Question 7

Causes of arrhythmias

Answer 7

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

Question 8

Symptoms of arrhythmias

Answer 8

Palpitations
Dizziness
Chest discomfort/pain
Fatigue
Difficulty in breathing
Sudden collapse
Sudden death

Question 9

Pulse deficit

Answer 9

apical rate faster than radial pulse rate; seen in fast atrial fibrillation or flutter

Question 10

Arrhythmias with regular rhythm

Answer 10

Sinus tachycardia
Sinus bradycardia
Complete heart block
Supraventricular tachycardia
Ventricular tachycardia

Question 11

Arrhythmias with regularly irregular beats

Answer 11

Supraventricular or
ventricular ectopic
beats

Question 12

Arrhythmias with irregularly irregular beats

Answer 12

Atrial fibrillation
Atrial flutter (with variable
atrio-ventricular block)
Multiple supraventricular or
ventricular ectopic beats

Question 13

Investigations in arrhythmias

Answer 13

ECG
Serum electrolytes
TFTs
Chest X-ray
Ambulatory ECG
Echaocardiography

Question 14

Device used for ambulatory ECG

Answer 14

Holter monitor

Question 15

Treatment objectives in arrhythmias

Answer 15

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

Question 16

Non-pharmacological interventions in arrhythmias

Answer 16

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

Question 17

Purpose of carotid sinus massage

Answer 17

This may
terminate an attack of paroxysmal supraventricular tachycardia

Question 18

Pharmacological treatment of fast atrial fibrillation or atrial flutter-for rate control

Answer 18

1st line
Atenolol or Bisoprolol or Metoprolol tartrate or Verapamil

2nd line
Digoxin

Question 19

Dose of atenolol in atrial fibrillation or atrial flutter or PSVT

Answer 19

Atenolol, oral,
Adults
50-100 mg daily
Children
12-18 years; 25-50 mg daily
1 month-12 years; 12.5-50 mg daily

Question 20

Dose for bisoprolol in atrial fibrillation or atrial flutter or PSVT

Answer 20

Adults
2.5-10 mg daily

Question 21

Dose for metoprolol in atrial fibrillation or atrial flutter or PSVT

Answer 21

Adults
50-100 mg 8 or 12 hourly daily (max. 300 mg daily)

Question 22

Dose for verapamil in atrial fibrillation or atrial flutter or PSVT

Answer 22

Verapamil, oral,
Adults
40-120 mg 6-8 hourly (max. 480 mg daily)

Question 23

Dose for digoxin in atrial fibrillation or atrial flutter or PSVT

Answer 23

Digoxin, oral,
Adults
125-250 micrograms daily

Question 24

Pharmacological treatment for paroxysmal supraventricular tachycardia

Answer 24

First line
Atenolol or Bisoprolol or Metoprolol tartrate or Verapamil

2nd Line
Digoxin