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MD2 Cardiovascular > Arrhythmias > Flashcards

Arrhythmias Flashcards

1
Q

Palpitations: what hx questions?

A
  • character (rapid/forceful/missed beats)
  • how rapid?
  • get them to tap out rhythm
  • onset/offset
  • precipitants
  • relieving
  • assoc (e.g. syncope, chest pain, dyspnoea, dizziness)
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2
Q

Which examination should be performed?

A

CV exam

  • HR (rate and rhythm) and BP
  • apex beat
  • murmurs
  • signs of heart failure
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3
Q

When to be concerned about these symptoms?

A
  • documented arrhythmia at time of symptoms
  • phx of cardiac disease
  • fhx of sudden cardiac death
  • severe symptoms
  • high risk work enviro
  • high level sporting activities
  • before/during pregnancy
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4
Q

What are the features of cardiac syncope?

A
  • onset: rapid and without warning
  • during: duration < 30 secs
  • spontaneous, rapid and complete recovery
  • may have an injury
  • assoc.: chest pain, palpitations, SOB
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5
Q

What is a first line investigation for palpitations?

A
  • 12 lead ECG
  • Holter monitor (24 hrs)
  • Echo
  • Blood tests: FBE (anaemia), U&E, Ca2+, Mg2+, TSH
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6
Q

What is the management of premature ventricular or atrial complexes (ectopics)?

A
  • these are usually benign so reassure pt and advice against caffeine
  • may require treatment with beta or Ca2+ channel blockers if frequent and symptomatic
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7
Q

What are the principles of management of AF?

A
  • rule out precipitant

- look for a cause

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8
Q

What are the management decisions in AF?

A
  • rate vs rhythm control

- stroke vs bleeding risk

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9
Q

How might stroke risk be assessed when deciding to anti-coagulate?

A
  • obtain a CHADS2 score, where each of the following gets 1 point and the S gets 2
    Congestive heart failure?
    Hypertension?
    Age >75 years?
    Diabetes?
    Stroke/TIA?
  • a score of 2 or more (high risk) is an indication for anticoagulation
  • a score of 1 point may be an indication for antiplatelets drugs
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10
Q

What are the ECG features of AF?

A
  • irregularly irregular
  • no P waves
  • absence of isoelectric baseline
  • variable ventricular rate
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11
Q

What is a supraventricular tachycardia (SVT)?

A
  • regular and narrow complex (100 bpm)
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12
Q

How can SVT be treated?

A
  • vagal manoeuvres
  • adenosine
  • verapamil (L-type Ca2+ channel blocker)
  • catheter ablation (success >95%)
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13
Q

What are 3 vagal manoeuvres?

A
  1. breath holding
  2. Valsalva manoeuvre
  3. Carotid massage
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14
Q

What is the most common cause of a SVT?

A

90% are caused by re-entrant circuits within the heart

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15
Q

What does the ECG look like after SVT reversion?

A
  • often normal but may show WPW pattern of delta waves (slurred QRS due to early ventricular excitation)
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16
Q

What are the ECG findings of ventricular tachycardia?

A
  • broad QRS complexes (>160 ms)

- HR >100

17
Q

Is sustained VT a cardiac emergency?

A

Yes, low CO may result in reduced myocardial perfusion resulting in degeneration to VF

18
Q

How is a haemodynamically unstable patient in VT managed?

A
  • immediate DC reversion
19
Q

How is a haemodynamically stable patient with VT managed?

A
  • may try pharmacological reversion with amiodarone

- sedate and DC shock

20
Q

What are the characteristics of a pt who is haemodynamically unstable?

A
  • hypotensive
  • chest pain
  • cardiac failure
  • decreased level of consciousness
21
Q

What are the causes of VT and which is most common?

A
  • re-entry (most common - due to an area of scarring)
  • triggered activity (early or late after-depol)
  • abnormal automaticity (impulse generation by a region of ventricular cells)
22
Q

What is sick sinus syndrome?

A

Abnormal sinus node function with resultant bradycardia and cardiac insufficiency

23
Q

What are some intrinsic causes of sick sinus syndrome?

A
  • intrinsic: fibrosis, infiltrative disease, congenital, ischaemia, cardiomyopathies
24
Q

What are some extrinsic causes of sick sinus syndrome?

A
  • extrinsic: drugs (beta and Ca2+ blockers, digoxin), autonomic dysfunction, electrolyte disturbance, hypothyroidism
25
Q

What is bradycardia-tachycardia syndrome?

A
  • a type of sick sinus syndrome
  • alternating brady with paroxysmal tachy often of supraventricular origin
  • there may be delayed recovery (e.g. sinus pause) which can cause syncope
26
Q

What are the clinical manifestations of brady-tachy syndrome?

A
  • recurrent pre-syncope and dizziness
  • syncope
  • fatigue
  • palpitations
27
Q

What is the treatment for brady/tachy syndrome?

A
  • correct extrinsic causes OR
  • pacemaker insertion (hard to treat without a pacemaker because drugs to control tachy will worsen brady)
  • once a pacemaker is inserted, can treat the tachycardia with beta or Ca2+ channel blocker
28
Q

What are the ECG findings of a first degree heart block?

A
  • prolonged PR interval (>200ms or one large square)

- every P wave is followed by a QRS

29
Q

What are the ECG findings of a second degree Mobitz type I (Wenckenach) heart block?

A
  • progressively lengthening PR interval and shortening RR until a QRS complex is missed
  • intermittently blocked P waves
30
Q

What are the ECG findings of a second degree Mobitz type II heart block?

A
  • no progressive lengthening of PR interval

- still has missed QRS complexes (i.e. not a slowed signal like mobitz I, but signal does not go through)

31
Q

What are the ECG findings of second degree high grade AV block?

A
  • high P:QRS ratio (>3:1)
  • PR interval constant
  • slow ventricular rate
32
Q

What are the ECG findings of third degree heart block?

A
  • absence of relationship between P wave and QRS complex “AV dissociation”
  • the atrial rate is faster than the ventricular rate which is of junctional or ventricular origin
33
Q

What are the indications for a permanent pacemaker (PPM)?

A
  • sinus node dysfunction (symptomatic bradycardia, sinus pauses >2s at day or >2.5 sec at night)
  • symptomatic 2nd or 3rd degree AV block
  • intermittent 3rd degree AV block

MD2 Cardiovascular (8 decks)

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