Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

MD2 Foundation > Arrhythmias > Flashcards

Arrhythmias Flashcards

1
Q

What are the main presentations of arrhythmias?

A

Tachyarrhythmias present as palpitations
Bradyarrhythmias present as pre-syncope/syncope
Combination

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Why might a severe tachyarrhythmia present as pre-syncope?

A

Decreased ventricular filling time (shorter diastole) > decreased cardiac output

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the most common cause of rhythm disorders?

A

Ischaemic injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What characteristics of palpitations is it important to clarify with the patient?

A

Fast heartbeat
Missed beats
Irregular beats
Awareness of forceful beats

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Why do palpitations occur in ventricular ectopics?

A 
Heart pauses to compensate for extra heartbeat
Increased diastolic filling time
More blood in ventricle
More force to push blood out
Can feel that force
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What does the term cardiac origin mean?

A

Pathology limited to heart

Usually present with all symptoms of cardiac disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How do people with a systemic origin of arrhythmias present?

A

Don’t have classical symptoms of cardiac disease

Have symptoms of other systemic disease; eg: thyrotoxicosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How do you elicit a history of palpitations?

A 
Character
How rapid
Ask patient to tap out rhythm
Onset and offset
Precipitants and relieving factors
Associated symptoms
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are possible precipitants of palpitations?

A

Caffeine
Stressful situation
Lying in quiet room on left side

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What does having palpitations when lying in a quiet room on your left side suggest?

A

Ectopics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What relieving factors works classically in supraventricular tachycardia?

A

Valsalva manoeuvre > increases parasympathetic activity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the possible associated symptoms with palpitations?

A

Chest pain
Dyspnoea
Syncope/pre-syncope

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What specific things should you look out for in a cardiovascular exam when a patient presents with palpitations?

A

Heart rate and blood pressure
Apex beat
Murmurs
Signs of heart failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How can blood pressure indicate management in a patient presenting with palpitations?

A

Tachycardia with low blood pressure > more acute

Tachycardia with high blood pressure > have more time

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

If a patient presents with increased heart rate at rest, palmar erythema, and a hot and sweaty palm, what does this indicate?

A

Probably stressed

Uncommonly, thyrotoxicosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

If a patient presents with increased heart rate at rest, and sweaty and cold palms, what does this indicate?

A

Probably serious cardiac problem

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What does a regularly irregular heart rhythm indicate?

A

Unifocal ectopic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What does an irregularly irregular heart rhythm indicate?

A

Atrial fibrillation

Multifocal ectopic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What can you gather from an apex beat?

A

If in expected place but very forceful > left ventricular hypertrophy
If displaced > dilated heart

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

How does aortic stenosis cause arrhythmia?

A

Because of left ventricular hypertrophy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

How does mitral stenosis cause atrial fibrillation?

A

Dilates atrium > stretched cardiomyocytes > disrupts electrochemical signal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are the investigations for palpitations?

A

ECG in all patients
- Aim to document exact cardiac rhythm at time of palpitations
Echocardiogram
- Look for underlying structural heart disease
Stress testing/coronary angigography
- If suspicion of ischaemia
- Chest pain with palpitations
- To help determine coronary artery stenosis
Electrophysiology study
- If still can’t find cause of symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are the devices available for prolonged ECG monitoring?

A

Holter monitor - 24 hours
Event recorder - 7 days
Loop recorder - months-years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

If the morphology of the QRS complexes is different in an ECG of a person with ectopics, what does that suggest?

A

Multifocal ventricular ectopic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
How do you managed premature ventricular/atrial complexes (ectopics)?
Usually benign Reassurance to patient Cut down on caffeine intake Occasionally need to treat with beta blockers/calcium channel blockers if very frequent and symptomatic
26
What does atrial fibrillation look like on an ECG?
No P waves QRS complexes narrowed Varied R-R interval > irregularly irregular rhythm
27
What type of arrhythmia is atrial flutter?
Supraventricular tachycardia
28
What causes atrial flutter?
Really irritable automaticity focus in atrium Fires at 250-300 bpm Causes atria to contract at 250-300 bpm AV node acts as gatekeeper - Ventricles contract at slower rate; eg: 150 bpm, because of refractory period of AV node
29
What does atrial flutter look like on an ECG?
Multiple P waves - not each one followed by QRS complex - Represent irritable automaticity focus - In "saw tooth" pattern Regular R-R interval
30
What does 3:1 conduction in atrial flutter mean?
For every 3 P waves, there's 1 QRS complex
31
Where is atrial fibrillation common?
Older age groups Known cardiac disease Cardiovascular disease factors
32
What happens in atrial fibrillation?
Lose organised signal in atria > atrial spasming | Signal AV node erratically > irregularly irregular rhythm
33
What are the risk factors for atrial fibrillation?
``` Diseased atrial tissue - Age - Inflammation; eg: from surgery - Enlarged atria - Hypertension - Valve disease; eg: mitral stenosis - Some lung diseases - Previous atrial fibrillation Hormonal abnormalities; specifically thyroid Alcoholism ```
34
What is the natural history of atrial fibrillation?
``` Silent Paroxysmal - First detection - Without treatment, stops within 48 hours Persistent - Last >48 hours Long-standing persistent - 1+ year Permanent - Normal rhythm now atrial fibrillation ```
35
What causes the symptoms in atrial fibrillation?
Rapid heart rate
36
What are the symptoms of atrial fibrillation?
Palpitations Shortness of breath Chest pain, especially during exertion May be symptomatic
37
What condition(s) are you at an increased risk of having if you have atrial fibrillation?
Stroke | Peripheral embolus
38
How is atrial fibrillation managed?
Rule out precipitant; eg: - Hyperthyroidism - Infection Look for cause Decide whether to control heart rate or maintain sinus rhythm Evaluate risk of stroke and how best to manage - balance against risk of bleeding
39
What does rhythm control in atrial fibrillation mean?
Put back into sinus rhythm
40
Why may you choose rate control over rhythm control in atrial fibrillation?
If atrial fibrillation has been going on for >48 hours, don't want to reinstate atrial kick because probable thrombus will embolise
41
What are possible antiarrhythmic drugs that can be used to control the rhythm in atrial fibrillation?
Sotalol Flecainide - Contraindicated in structural heart disease Amiodarone
42
What are possible drugs that can be used to control the rate in atrial fibrillation?
Beta blockers Calcium channel blockers Digoxin
43
Why is rate control usually safer than rhythm control in atrial fibrillation?
Rhythm controlling agents can sometimes cause other significant arrhythmias
44
What does catheter ablation aim to do in atrial fibrillation?
Maintain sinus rhythm by preventing signals propagating from atrial fibrillation origin sites
45
Where are common ablation sites for atrial fibrillation?
Around pulmonary veins
46
What is supraventricular tachycardia?
Abnormally high heart rate at rest | Abnormal heartbeat starts at/above AV node
47
What are the signs and symptoms of supraventricular tachycardia?
``` Can be asymptomatic Palpitations Chest pain Anxiety Shortness of breath Dizzy - Due to decreased cardiac output > decreased cerebral perfusion ```
48
What causes 90% of supraventricular tachycardias?
Re-entrant circuits within heart
49
What is the most common re-entrant supraventricular tachycardia?
AV nodal re-entry tachycardia
50
What is Wolff-Parkinson White syndrome?
2 electrical pathways instead of 1 Example of accessory pathway - Usually connects atria directly to ventricles - Due to short refractory period, electrical signal goes in loop: atria > ventricles > atria
51
Why is the AV node targeted in treatment for supraventricular tachycardia?
Almost all involve AV node in pathway | Treatments aim to interrupt circuit
52
What is postural orthostatic tachycardia syndrome?
Increase in heart rate when moving from supine to erect position
53
What are the risk factors for supraventricular tachycardias?
``` Inherited conditions Structural abnormalities Coronary artery disease Heart failure COPD Pulmonary embolism Alcoholism Hypertension Some medications ```
54
How is supraventricular tachycardia treated acutely?
Similar to atrial fibrillation Vagal manoeuvres Adenosine IV verapamil
55
What should you warn your patient about before administering adenosine?
Flushing/feeling terrible for few seconds
56
How does adenosine work in treating supraventricular tachycardia?
Induces transient AV block
57
Why don't you need to anticoagulate in supraventricular tachycardia?
No risk of thromboembolism
58
What is the longer-term treatment for supraventricular tachycardia?
``` If symptoms rare/isolated episode - no pharmacological intervention "Pill in pocket" approach Pharmacological interventions - Beta blockers OR - Calcium channel blockers Catheter ablation ```
59
What is ventricular tachycardia?
Arises from ventricles Can reach up to 250 bpm Decreased filling time > decreased cardiac output Can lose pulse sometimes
60
What happens when the cause of ventricular tachycardia is focal?
``` Cells in ventricles irritated Irritation caused by - Hormones - Stress - Thyroid - Hypoxia - Stretch; eg: left ventricular hypertrophy Cells overfire ```
61
What happens when the cause of ventricular tachycardia is re-entrant?
Scar formation Disrupts normal electrical conduction Forms loop Excites ventricles
62
What are the signs and symptoms of ventricular tachycardia?
Shorthness of breath > hypoxia Chest pain > decreased myocardial perfusion Palpitations Lightheaded and dizzy > decreased cerebral perfusion - Can sometimes lose consciousness
63
Why is ventricular tachycardia a medical emergency?
Can become ventricular fibrillation
64
What happens in ventricular fibrillation?
Ventricular walls spasm > no blood circulating
65
What are the features of ventricular tachycardia on an ECG?
Wide QRS complexes | Tachycardia
66
What are the risk factors for ventricular tachycardia?
``` Coronary artery disease Electrolyte imbalance; eg: hyperkalaemia Myocardial infarction Hypertrophic cardiomyopathy Dilated cardiomyopathy ```
67
When should you worry about palpitations?
``` Documented cardiac arrhythmia at time of symptoms Past history of cardiac disease Evidence of cardiac disease on baseline tests Family history of sudden cardiac death Severe symptoms High risk work enviro High level sporting activities Before/during pregnancy ```
68
What are the most common types of syncope?
Neurocardiogenic (vasovagal) Cardiac Postural hypotension
69
What is syncope?
``` Transient Loss of consciousness, self-limited Onset relatively rapid Leads to fall Recovery complete, rapid, spontaneous ```
70
What questions should you focus on in a syncope history?
``` Prodrome Situation Collateral history = witnesses - Specific length of loss of consciousness - Pallor Recovery History of previous episodes ```
71
What are the common symptoms of neurocardiogenic syncope?
Pre-syncope symptoms - Diaphoresis - Headache - Nausea - Visual changes
72
What are the common signs of neurocardiogenic syncope?
Facial pallor Yawning Pupillary dilatation
73
What are the common precipitating events of neurocardiogenic syncope?
Fear Emotional distress Instrumentation Prolonged standing
74
What are the common symptoms of cardiac syncope?
``` May be no warning symptoms Rapid loss of consciousness Often associated injury May be exertional or occur when supine Associated with chest pain/palpitations Family history of sudden cardiac death Background of known cardiac disease ```
75
What is a significant orthostatic drop in blood pressure?
Between supine and erect - Difference of >20 mmHg in systolic OR - Difference of >10 mmHg in diastolic
76
What is heart block?
Arrhythmia where signal delayed/blocked
77
What is AV conduction block?
Signal delayed/blocked when trying to move from atria to ventricles
78
What is first degree AV conduction block?
Delayed... but still makes it | PR interval >0.2 s (5 small boxes)
79
What are the symptoms of first degree AV conduction block?
Asymptomatic
80
What is the treatment for first degree AV conduction block?
Identify electrolyte imbalances/causes from medications | Usually no further treatment
81
What is type 1 second degree AV conduction block?
Also called - Mobitz I - Wenckebach PR interval becomes progressively longer until blocked completely > "dropped beat" Eventually ventricles contract = ventricular escape beat
82
What are the symptoms of type 1 second degree AV conduction block?
``` Usually asymptomatic Sometimes - Lightheaded - Dizzy - Syncope ```
83
What is type 2 second degree AV conduction block?
Also called Mobitz II Intermittent dropped beats No progressive lengthening of PR interval Each time atria do conduct, PR interval stays same length Written as ratio of conducted:dropped; eg: 2:1 Mobitz II AV block Can't predict when next beat dropped
84
What are the symptoms of type 2 second degree AV conduction block?
Fatigue Dyspnoea Chest pain Syncope
85
What is third degree AV conduction block?
Signal completely blocked | Ventricles struggle along with escape beats at very slow rates
86
What are the symptoms of third degree AV conduction block?
``` Syncope Confusion Dyspnoea Severe chest pain Risk of death ```
87
What is the treatment of third degree AV conduction block?
Medication to increase heart rate; eg: atropine Transcutaneous pacing - Through electrodes on skin Permanent pacemaker
88
What are the indications for a permanent pacemaker?
``` Sinus node dysfunction - Symptomatic sinus bradycardia - Sinus pauses >2 sec (day) or >2.5 sec (night) Symptomatic 2nd/3rd degree AV block Intermittent 3rd degree AV block ```
89
How do you treat tachy-brady syndrome?
Difficult to treat without pacemaker - Can't control tachycardias without worsening bradycardias Once pacemaker implanted, use AV node blocking agents to control rapid heart rates

MD2 Foundation (42 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions