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Cardiology > Arrhythmias > Flashcards

Arrhythmias Flashcards

1
Q

What is atrial flutter?

A

A form of SVT where a short circuit in the heart causes the atria to pump rapidly

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2
Q

What heart rate is seen in atrial flutter?

A

Atrial rate of 300 bpm
Ventricular rate of 150 bpm (but can be variable dependent on AV block)

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3
Q

What appearance does atrial flutter given on an ECG?

A

Sawtooth appearance

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4
Q

Why can the ventricular rate be variable in atrial flutter?

A

Dependant on how many impulses from the atria conduct through to the ventricles (a 2:1 ratio would result in 150bpm, a 3:1 ratio would result in 100bpm…)

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5
Q

What are the causes of atrial flutter?

A

COPD
Obstructive sleep apnoea
Pulmonary emboli
Pulmonary hypertension

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6
Q

What are the symptoms of atrial flutter?

A

Palpitations
Lightheadedness
Syncope
Chest pain

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7
Q

What is the treatment of atrial flutter in some haemodynamically unstable?

A

Direct current synchronised cardioversion + amiodarone

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8
Q

What is the first line management of atrial flutter?

A

Beta blocker or calcium channel blocker

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9
Q

What is the second line management of atrial flutter?

A

Cardioversion

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10
Q

What is supraventricular tachycardia?

A

Where abnormal signals from above the ventricles cause tachycardia

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11
Q

What is the pathophysiology of supraventricular tachycardia?

A

The electrical signals in the heart re-enter the atria from the ventricles - the electrical signal then travels down again through the AV node into the ventricles, causing a further ventricular contraction

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12
Q

What type of tachycardia is SVT?

A

Narrow complex tachycardia (QRS complex has a duration of less than 0.12 seconds)

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13
Q

What is paroxysmal SVT?

A

Where SVT reccurs and remits

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14
Q

What are the four types of narrow complex tachycardia?

A

Sinus tachycardia
SVT
AF
Atrial flutter

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15
Q

How does SVT appear on ECG?

A

Appears as a QRS complex, followed by a T wave, followed by another QRS complex

There are P waves present, but are buried in the T waves, and therefore cannot be properly seen.

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16
Q

What are the three types of SVT?

A

AV node re-entrant tachycardia
AV re-entrant tachycardia
Atrial tachycardia

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17
Q

What is AV node re-entrant tachycardia?

A

Most common type of SVT - where electrical signals re-enter atria through AV node

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18
Q

What is AV re-entrant tachycardia?

A

Where the electrical signal re-enters the atria through an accessory pathway (Wolff-Parkinson-White syndrome)

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19
Q

What is atrial tachycardia?

A

Not caused by the signal re-entering the atria, but by an abnormal atrial electrical activity

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20
Q

What is the accessory pathway called in Wolff-Parkinson-White syndrome?

A

Bundle of Kent

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21
Q

What are the ECG changes in Wolff-Parkinson-White syndrome?

A

Short PR interval
Wide QRS complex
Delta wave (slurred upwards stroke in the QRS complex)

22
Q

What are the stages of acute SVT management?

A

Stage 1 - vagal manoeuvres
Stage 2 - adenosine
Stage 3 - verapamil or beta blocker
Stage 4 - Synchronised DC cardioversion

23
Q

What are vagal manoeuvres?

A

Manoeuvres that stimulate the vagus nerve, increasing activity in the parasympathetic nervous system

24
Q

What are examples of vagal manoeuvres?

A

Blowing hard against resistance
Carotid massage (on one side only) - contraindicated in carotid artery stenosis

25
Q

How is adenosine given to patients with SVT?

A

Given as an IV rapid bolus into a central or lalrge vein - as it only acts for approx. 10 seconds

26
Q

Which patients is adenosine avoided in?

A

Asthma
COPD
Heart failure
Heart block
Hypotension

27
Q

What dose of adenosine is given in SVT?

A

Initially 6mg
then 12mg
then 18mg

28
Q

What is the definitive treatment of Wolff-Parkinson-White syndrome?

A

Radiofrequency ablation of the accessory pathway

29
Q

What is the most important complication of Wolff-Parkinson-White syndrome?

A

In combination with AF or atrial flutter, the chaotic atrial electrical activity can pass into the ventricles , causing a polymorphic wide complex tachycardia - leading to VF and cardiac arrest

30
Q

What is the management of paroxysmal SVT?

A

Long term medication - beta blockers, calcium channel blockers, amiodarone
Radiofrequency ablation

31
Q

What are the shockable rhythms?

A

Ventricular tachycardia
Ventricular fibrillation

32
Q

What are the non-shockable rhythms?

A

Pulseless electrical activity
Asystole

33
Q

What is narrow complex tachycardia?

A

A fast heart rate with a QRS complex of less than 0.12 seconds (3 small squares)

34
Q

What is broad complex tachycardia?

A

A fast heart rate with a QRS duration of more than 0.12 seconds or 3 small squares

35
Q

What are the types of broad complex tachycardia?

A

Ventricular tachycardia
Polymorphic ventricular tachycardia (such as torsades de pointes)
AF with bundle branch block
SVT with bundle branch block

36
Q

What is the pathophysiology of torsades de pointes?

A

When QT interval is too long, repolarisation of the heart muscles is prolonged

Waiting a long time for repolarisation can cause abnormal spontaneous depolarisation

When there are recurrent contractions without normal repolarisation, this is called torsades de pointes

37
Q

What does torsade de pointes look like on ECG?

A

Ventricular tachycardia, but the QRS complexes get progressively smaller, then larger, then smaller

38
Q

What are the causes of prolonged QT?

A

Long QT syndrome - inherited
Medications
Electrolyte imbalances

39
Q

What medications can cause prolonged QT syndrome?

A

Antipsychotics
Citalopram
Flecainide
Sotalol
Amiodarone
Macrolides

40
Q

What electrolyte imbalances can cause prolonged QT?

A

Hypokalaemia
Hypomagnesaemia
Hypocalcaemia

41
Q

What is the acute management of torsades de pointes?

A

Correct underlying cause
Magnesium infusion (even if normal serum magnesium)
Debrillation if VT occurs

42
Q

What is the management of prolonged QT?

A

Stop and avoid medications that cause prolonged QT
Correct electrolyte disturbances
Beta blockers
Pacemaker or implantable cardioverter defibrillator

43
Q

What are ventricular ectopics?

A

Premature ventricular beats caused by random electrical discharges outside the atria

44
Q

What is the appearance of a ventricular ecoptic on ECG?

A

An isolated, random, abnormal broad QRS complex on an otherwise normal ECG

45
Q

What is bigeminy?

A

When every other beat is a ventricular ectopic

46
Q

What is first degree heart block?

A

Delayed conduction through the AV node
- Causes a consistently long PR interval

47
Q

What are the types of second degree heart block?

A

Mobitz type 1
Mobitz type 2

48
Q

What is mobitz type 1 heart block?

A

Conduction through the AV node takes progressively longer until it fails
- Progressively longer PR intervals until one QRS complex is dropped

49
Q

What is mobitz type 2 heart block?

A

There is usually a set ratio of P waves to QRS complexes

50
Q

What is third degree heart block?

A

Complete heart block
- There is no association between the P waves and QRS complexes

Cardiology (16 decks)

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