Arrhythmias

Question 1

Treatment of asymptomatic bradycardia >40bpm

Answer 1

No treatment needed
Stop any causative drugs if they are present
Check TFT

Question 2

Treatment of bradycardia

Answer 2

Give atropine 0.6-1.2mg IV
If no response then insert a temporary pacing wire

If necessary isoprenaline infusion or external pacing

Question 3

What is sick sinus syndrome?

Answer 3

Sinus node dysfunction causes bradycardia and or arrest
SA Node block or SVT alternating with bradycardia/asystole

Tachy-Brady syndrome

Question 4

Management of sick sinus syndrome

Answer 4

Pace if symptomatic

Question 5

Management of SVT

Answer 5

Vagotonic manoeuvres
Then
IV adenosine or verapamil if adenosine fails

Cardiogenic shock if compromised

Question 6

Adenosine - when and how work?

Answer 6

SVT

Blocks AV node temporarily - resets heart

Question 7

Maintenance therapy for SVT

Answer 7

Beta blocker or verapamil

Question 8

Management of acute AF (

Answer 8

Control ventricular rate with beta blocker or verapamil
Or use digoxin or amiodarone

DC shock if compromised or IV amiodarone

Start anti coagulation - LMWH

Question 9

Management of VT

Answer 9

Oxygen mask
Monitoring

IV amiodarone or lidocaine
Maintenance with amiodarone

If fails Dc cardio version

Question 10

Management of WPW

Answer 10

Ablation of accessory pathway

Question 11

Presentation of arrhythmias

Answer 11

Palpitations 
Chest pain
Presyncope or syncope 
Hypotension
Pulmonary oedema

Question 12

Management of VF

Answer 12

DC shock

Question 13

What is torsade de pointes?

Answer 13

looks like AF but VT with varying axis

Side effect of antiarrhythmics

Question 14

Treatment of torsade de pointes?

Answer 14

Magnesium sulphate 2g IV over 10mins

Overdrive pacing

Question 15

Management of chronic AF

Answer 15

Rate control - beta blocker or verapamil
Then digoxin
Then amiodarone

Anti coagulation

Can try cardio version

Question 16

Alternative drug for pharmacological cardio version

Answer 16

Felcainide

Question 17

Management of paroxysmal AF

Answer 17

Pill in pocket

Sotalol or flecainide

Question 18

Management of atrial flutter

Answer 18

Carotid sinus massage and IV adenosine - to reveal flutter

Treatment with amiodarone to restore sinus rhythm and amiodarone or soltalol to maintain it

Question 19

Acute AF anti-COAGULATION

Answer 19

use heparin until risk assessment done
Use warfarin of risk of emboli is high
If sinus rhythm obtained and no risk of emboli or risk of AF recurrence - then no anticoagulation is needed

Question 20

Chronic AF anticoagulation

Answer 20

Warfarin and aim for INR 2-3
Aspirin less good alternative if warfarin CI
Maybe dabigatran