Arrhythmias Flashcards
What would the heart rate be in tachyarrhythmias?
> 100 bpm
Where do narrow complex tachycardias usually originate from?
Supraventricular
What are the possible arrhythmias associated with narrow complex tachycardias?
Atrial fibrillation
Atrial flutter
Supraventricular tachycardia
Junctional tachycardia
What is the commonest sustained arrhythmia?
AF
What results from the rapid chaotic firing in AF?
Loss of atrial mechanical contraction
Irregular often rapid ventricular response
What are the symptoms of AF?
Palpitations
Breathlessness
Chest pain
Fatigue
What therapies are used for symptom control in AF?
Rate control - beta-blockers, CCBs, digoxin
Restore sinus rhythm - electrical/pharmacological cardioversion
Maintain sinus rhythm - flecainide, amiodarone, sotalol, dronedarone
Which drugs can be used for pharmacological cardioversion in AF?
Flecainide, amiodarone
What are the longer term treatment options for AF?
Catheter ablation
Permanent pacemaker +/- AV node ablation
Around what bpm would the atrial activity be in atrial flutter?
300
What are the symptoms of atrial flutter?
Palpitations
Breathlessness
Chest pain
What longer term management would be used in atrial flutter?
Anti-arrhythmic drugs directed at rate/rhythm control
Catheter ablation at cavotricuspid isthmus
What is the most common supra-ventricular tachycardia?
AV nodal reentry
How would AV nodal reentry present?
Sudden onset palpitations possibly associated chest pain, breathlessness
May report neck pulsation
What acute management is used for AV nodal reentry?
Vagal manoeuvres
Adenosine
What causes the QRS complex to be broad in broad complex tachycardias?
Ventricle is not depolarised through His-Purkinje system
What are the arrhythmias that can cause broad complex tachycardias?
Ventricular tachycardia
Supraventricular tachycardia with BBB or pre-excitation
What diseases of the ventricles can cause ventricular tachycardia?
MI
Cardiomyopathy
If independent atrial activity can be seen on the ECG, what is the diagnosis?
Ventricular tachycardia
What is the acute treatment of ventricular tachycardia?
DC cardioversion +/- sedation
Antiarrhythmic drugs - amiodarone, beta-blockers
What usually causes QT prolongation in polymorphic VT?
Drugs or electrolyte imbalance
What happens in ventricular fibrillation and what is the treatment?
Rapid chaotic activity, no CO
Urgent cardioversion
Who should be offered an ICD?
Survivors of out of hospital arrest
Irreversibly severely impaired LV function +/- non sustained VT
What are the exclusions when considering ICD?
Severe HF
Co-morbidities likely to limit life expectancy
