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Cardiology - Renee > Arrhythmias > Flashcards

Arrhythmias Flashcards

1
Q

Associated risk factors of AF

A

Increasing AGE greatest risk factor
M > F
HTN, Valvular HD - MS+++, HOCM, Hyperthyroidism, Obesity, DM

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2
Q

What is the associated increased in all cause mortality from AF. Why?

A

1.5-2x increase in mortality

Due to stroke and other thromboembolic disease, heart failure

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3
Q

Pathogenesis of AF

A

Left atrial stretch
Increase risk with family history
Inflammation
Metabolic syndrome

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4
Q

AF mechanisms

A

1st stage: Arrhythmic foci extending into the pulmonary veins –> recurrent paroxysmal AF lasting <24hrs

2nd stage: Arrhythmic burden +/- other cardiac factors –> remodeling –> persistent AF

3rd stage: Gross electrical and structural remodeling –> permanent AF

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5
Q

Management of new onset AF <48hrs

A

REVERT!!!
TTE, Renal functions and TFTs should be done
Anticoagulate as per CHAD2S

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6
Q

Management of AF >48hrs/???

A

TOE, revert and anticoagulate for at least 6 weeks

Anticoagulate for 4-6 weeks then revert

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7
Q

? Urgent Cardioversion?

A

Unstable patient haemodynamics

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8
Q

Sinus rhythm maintenance for paroxysmal AF?

A

Sotalol - MAINTENANCE NOT REVERSION. Causes fatigue
Amiodarone - Effective BUT SIDE EFFECTS = Thyroid, pulmonary, hepatic and occular
Flecainide - Very effective at reverting. Can’t use in pts with structural heart disease. Side effects of GIT and dysthesias, and can cause A flutter

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9
Q

Rate Vs. Rhythm control

A

Not relevant to recent AF
Not relevant to symptomatic AF
Not relevant to anticoagulation
PERSISTENT ASYMPTOMATIC AF- AFFIRM trial

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10
Q

AF Rate control agents?

A

Beta blockers
Calcium calcium blocker- NOT IN HF
Digoxin
Aim <110 bpm

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11
Q

AF Ablation?

A

For symptomatic AF refractory to meds
60-70% successful
Does not improve outcomes

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12
Q

Mechanism of atrial flutter

A

Macro re-entrant circuit in the RA between the IVC and tricuspid valve
Counterclockwise motion –> downward p waves in ii, iii and aVF

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13
Q

Treatment for Atrial Flutter?

A

Ablation
Success in 90%
Anticoagulate as per AF

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14
Q

Risk stratification for anti-thromboembolism therapy?

A 
CHADS2
CCF =1
HTN =1
Age >75yrs =1
DM =1
Previous stroke =2

Score of 0 = nothing
Scores 1-2 = 2% risk = anticoagulate
Scores 3+ = 4% risk = anticoagulate

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15
Q

Anticoagulate with what?

A

NOAC or Warfarin
Not aspirin
No NOAC for valvular heart disease

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16
Q

AV nodal reentry tachycardia

A

2 conduction pathways in the AV node with the slow pathway blocked by the refractory period
When a premature complex occurs –> conduction through the slow pathway –> retrograde p wave –> tachycardia

17
Q

Prevention of AVNRT

A

Verapamil

EPS

18
Q

Treatment of AVNRT

A

Vagal maneuvres
Adenosine
CCBs
B blockers

19
Q

Different manifestations of WPW

A
  1. Accessory pathway
  2. Orthodromic tachycardia - long QRSP. Down slow and up fast
  3. Antidromic Tachycardia = wide complex tachycardia - looks like VT. Down fast pathway and up slow pathway –> Torsades
20
Q

Investigation of WPW

A

Exercise test to assess pathway conduction. Loss of delta wave <130bpm is predictor of low risk

21
Q

Different kinds of VT

A
  1. Associated with structural HD - post MI, ischaemic and non-ischaemic cardiomyopathy, myocarditis and infiltrative cardiac diseases
  2. Not ass. with structural heart disease
22
Q

Treatment of VT with structural heart disease

A

= AICD!!!

23
Q

Primary prophylaxis with IHD

A

Post AMI = beta blockers –> reduction by 30%

AICD for EF <35% >40 days post AMI.

24
Q

Primary prevention in non-ischaemic cardiomyopathy

A

Optimise medical therapy
Beta blockers
CRT for QRS >120ms
CRT for class 4 heart failure

25
Q

Commonest cause of SCD <35yrs

A

HOCM

26
Q

Diagnosis of HOCM

A

ECG !!! Inverted T waves V4-V6. Still negative in 10%

Genetic tests - genes found in 60% of cases = used to screen other family members

27
Q

? AICD for HOCM

Average risk .05% but range from 0-10%

A 
Family hx of SCD
Unexplained syncope
nsVT on monitoring
IVS> 30mm
Abnormal BP during exercise
28
Q

Arrhythmogenic RV cardiomyopathy genetics

A

Mutations in genes coding desmosomal proteins
Identified in 40-60%
Not diagnostic - incomplete penetrance

29
Q

Diagnosis of Cardiac Sarcoidosis

A

Cardiac MRI

Aneurysms and enhancements

30
Q

Genetics of long QT syndrome

A 
LQTS1 = KCNQ1
LQTS2= KCNQ2
LQTS3 = SCN5A

Autosomal dominant
70-80% positive gene test

31
Q

When do events occur in LQTS?

A

LQTS1 - events in exercise
LQTS2- load noise
LQTS3- events during sleep or rest

BIGGEST RISK WHEN QT >500

32
Q

Management of LQTS

A

Beta blockers for all

AICD for high risk and previous events

33
Q

Brugada Syndrome

A

Diagnosis on ECG - downsloping ST segment
Peak prevalence of SCD in 4th decade
Elicit with flecainide challenge

34
Q

Other Syndromes

A

Catecholaminergic polymorphic VT
Short QT syndrome
Idiopathic VT

35
Q

1st degree heart block

A

PR >0.2 secs
Benign
Unless bifascicular block –> advanced block

36
Q

2nd degree heart block

A

Type 1:

  • Increasing PR interval –> dropped QRS
  • No indication for PPM

Type 2:

  • No variation in PR interval - non conducted P waves
  • PPM if very bradycardic
37
Q

3rd degree heart block

A

PPM unless asymptomatic and rate >40

38
Q

Pacing in heart failure

A

LVEF <50% = bi-ventricluar pacing

Results in less death and heart failure hospitalisations

39
Q

How do you distinguish between constrictive pericarditis and restrictive cardiomyopathy?

A

Tissue Doppler imaging

Constrictive PC = fast and large E wave
Restrictive CM = slow and small E wave

Cardiology - Renee (6 decks)

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