Arrhythmias

Question 1

Bradycardia definition

Answer 1

Heart rate of <60bpm

Question 2

Causes of bradycardia

Answer 2

• Cardiac- MI, myocardial ischaemia
• Non cardiac- Vasovagal response
• drug toxicity (digoxin, beta blockers, CCB)
• Hypothermia
• Hypothyroidism

Normal for athletes to have sinus bradycardia

Question 3

Presentation of bradycardias

Answer 3

• syncope
• dizziness
• chest pain
• hypothyroidism
• SOB
• exercise intolerance

Question 4

Treatment of Bradycardias

Answer 4

• If asymptomatic and rate >40 BPM no treatment required
• ABCDE Approach
• Look for cause (drugs, sick sinus syndrome, hypothyroidism)
• If rate <40 or patient is asymptomatic then follow algorithm
  
  • Give atropine 500ug IV and repeat every 3-5 min to a total of 3mg
  • cautious in ACI or myocardial infaction (worsen ischaemia)
  • If no response then insert pacing wire

Question 5

tachyarrhythmias definition

Answer 5

HR >100BPM

Question 6

Causes

Answer 6

Cardiac - IHD, Valvular disease, HF, Cardiomyopathy, congenital heart disease

Extra-cardiac - drugs, alcohol, stress, hyperthyroidism, infection/sepsis, metabolic hyperkalaemia

Question 7

Symptoms of tachyarrthymias

Answer 7

• asymptomatic
• palpitations
• SOB
• chest pain
• syncope or pre syncope

Question 8

Signs of tachyarrthymias

Answer 8

• fast pulse
• irreular pulse
• low blood pressure
• signs of acute heart failure

Question 9

Classifications of tachyarrhythmias

Answer 9

• Broad complex >0.12 - slower ventrocular depolarisations that arise from the ventricles
• narrow complex <0.12- slower ventricular depolarisation initiate from above the ventricles (supraventricular)

Question 10

Broad complex tachyarrthmias

Answer 10

• VT
• Torsades
• VF

Question 11

Narrow complex tachyarrhytmias

Answer 11

• Sinus tachy
• atrial tachya
• reentrant tachy
• AF
• Atrial flutter