Arrhythmias Flashcards
What is a tachycardia?
>100 bpm
What are the risk factors of arrhythmias?
- A - advanced age, acohol consumption
- B - high blood pressure
- C - high cholesterol
- D - diabetes
- E - lack of exercise
- F - family history
- G - gender (male)
- S - smoking
- caffeine
- OSA
- hyper/hypoparathyroidism
- thyrotoxicosis
- medications: antiarrhythmics, diuretics, digoxin
What are the management options for arrhythmias?
- antiarrhythmics
- catheter ablation
- pacemaker
What is a junctional escape beat?
when the Av node starts the impulse not the SA node
Name the 3 accessory pathways.
- Bundle of kent
- Mahaeim fibres
- concealed accessory pathways
What is Wolf-Parkinson-White (WPW) syndrome?
a re-entrant tachycardia caused by ventricular activation via the AV node and Bundle of His, then retrograde conduction via an accessory pathway to depolarise the atria
What are the ECG findings for Wolf-Parkinson-White syndrome?
short PR interval
delta wave (“sloping”)
What is this?
a delta wave, typical of WPW syndrome
How are arrhythmias classified?
Bradyarhythmias
- SA node block: sinus bradycardia
- AV node block:
- 1st degree block
- 2nd degree block: Wenckebach (Mobitz I), Mobitz II
- 3rd degree block
Tachyarrhythmias
- Supraventricular
- SVT
- Atrial flutter
- AF
- Ventricular
- VT
- VF
What is Sick Sinus Syndrome?
combination of tachycardia and bradycardia, common in the elderly
What are the characteristics of 1st degree block?
prolonged conduction (long PR interval)
What are the characteristics of Wenckebach heart block?
progressive lengthening and then dropped QRS complex
What are the characteristics of Mobitz heart block?
dropping of QRS complex every 2nd beat, with widened QRS complex and constant PR interval
What are the characteristics of 3rd degree heart block?
no relation between P waves and QRS complex. Can also have no QRS complexes and only P waves
What syndrome does this person have?
Marfan’s syndrome
What is this?
Atrial flutter
How do you prevent thromboembolism in atrial fibrillation?
- C - CCF
- H - HTN
- A - >65 years old
- D - diabetes
- S - stroke
each is equal to 1
if score is >2 then treat with warfarin, if < 2 treat with aspirin
How do you manage atrial fibrillation?
- rate control: beta-blockers, calcium channel blockers
- rhythm control: antiarrhythmics
- stroke prevention: aspirin/warfarin
What is Brugada syndrome?
previously described as SUND (sudden unexpected nocturnal death) in SEA men
it is a change in action potential difference between hte epicardium and endocardium
it predisposes to re-entrant tachyarrhythmias
it characteristically manifest as a STEMI during rest/sleep
What is atrioventricular nodal re-entrant tachycardia (AVNRT)?
a paroxysmal supraventricular tachycardia
more common in women than men
caused by one pathway to the AV node being faster causing a circuit
How do you manage AVNRT?
options are:
- drink cold water
- valsalva manoueveur
- beta-blockers
- calcium channel blockers
What is a Stokes-Adams attack?
syncope due to bradycardia or asystole
What is the definition of atrial fibrillation?
a heart condition where heart chambers are beating faster and more erratically than normal
What are the clinical features of atrial fibrillation?
Signs
- irregular pulse rate at approx 120-160 bpm (can go up to >200 bpm)
- hypotension
- increased JVP
Symptoms
- dizziness
- syncope
- palpitations
- SOB
What causes atrial fibrillation?
- all cardiovascular disease
- hyperthyroidism, increased PTH
- diabetes
- XSive alcohol intake
- advanced age
- respiratory diseases
What investigations would you do to rule out artrial fibrillation?
- ECG - absent P waves, irregularly irregular QRS complexes
- serum electrolytes - ?increased K+, decreased Mg2+
- troponin - elevated
- TFTs - ?thyrotoxicosis
- CXR - ?heart/resp disease
- TOE - ?valvular disease
