Arrhythmias

Question 1

Clinical Presentation of Arrhythmias

Answer 1

Palpitations
sycope 
stroke
dyspnoea 
Chest pain
hypotension 
Asymptomatic

Question 2

Investigation of Arrhythmias

Answer 2

FBC - anaemia/infection?
U+Es - electrolyte disturbances
TFT - hyperthryroidism
Glucose - hypoglycaemia
Bone profile 

ECG - looking for AF/MI/IHD/Long QT
Echo - looking for structural disturbances - HCM/MS

Question 3

Causes of Atrial Fibrillation

Answer 3

Heart Failure, 
Alcohol, 
Hyperthyroidism
MI
Hypertension
electrolyte disturbances
PE

Question 4

Method of Rate controlling AF

Answer 4

Used in Permanent or persistent AF.
Used to control ventricular rate ensuring preload is met to maintain CO.
Aim for HR<90

Beta blocker or Rate limiting Ca blocker or Digoxin.

Question 5

Rhythm control of AF

Answer 5

used for younger patients, 1st presentation or symptomatic patients.

Echo performed - ensuring no thrombus, anticoagulation is important.

1st choice - Flecanide - if no structural disease
2nd choice - Amiordarone

AV node ablation can be used and Pulmonary vein/MAZE ablation options.

Question 6

Acute symptomatic AF Treatment

Answer 6

assess patient ABCDE,
O2 therapy,
check U+Es (correctable electrolytes)
Anticoagulation - LMWH.
Emergency cardioversion - IV amiodarone if defib not present.
Treat underlying cause - pneumonia/MI/hyperthyroidism etc

Post treatment anticoagulation calculated of CHADSVas score.

Question 7

Chronic Stable AF treatment

Answer 7

Rate control/Rhythm control depending on age.

Anticoagulation CHADSVasc etc calculated and Warfarin treatment given. INR>2-3 for life.

Question 8

Causes of Cardiac Arrest

Answer 8

Arrhythmias that lead to Cardiac arrest:

VF and Pulseless VT are shockable rhythms.

PEA(pulseless electrical activity) and asystole are non shockable.

Treatable causes of Cardiac Arrest:
Hypoxia
Hyperthermia
Hypovolaemia
Hyperkalaemia/hypokalaemia
(hypoglycaemia/acidosis) 

Tamponade
Tension pneumothorax
Toxins
Thromboembolis/PE