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Cardiovascular* > Arrhythmias > Flashcards

Arrhythmias Flashcards

1
Q

What is an arrhythmia?

A

Abnormality in the cardiac rhythm, generated by abnormal electrical conduction usually by ectopic beats

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2
Q

What are ectopic beats?

A

Conduction originating out-with the SA node

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3
Q

Categories of arrhythmias

A

Tachycardias, bradicardias

SVT, AV nodal, ventricular

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4
Q

Describe altered automaticity

A

Alteration (acceleration) of spontaneous cardiac rhythmicity even from on myocyte
Due to increased rate of diastolic depolarisation caused by increased sympth stimulation

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5
Q

Describe triggered activity

A

After depolarisations may reach threshold potential to produce an unwarranted action potential
Due to pacing, catecholamine electrolyte imbalances, hypoxia, medications eg. digoxin

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6
Q

Describe re-entry circuit

A

Fibrous ring surrounds inexcitable region of myocardium - creates bridge to allow premature, accelerated conduction to contractile myocardium
Due to congenital abnormality

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7
Q

Mechanisms by which arrhythmias develop

A

Altered automaticity
Triggered activity
Re-entry circuit

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8
Q

Causes of arrhythmias

A 
Heart conditions (IHD, HT, valve disease, cardiomyopathy, congenital defects)
Thyrotoxicosis, electrolyte imbalance, lung disease, substance misuse
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9
Q

Arrhythmia presentation

A

Palpitations, dizziness, syncope, fast/slow/irregular pulse, dyspnoea, chest pain

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10
Q

Arrhythmia tests

A

ECG (exercise, 24hr)
CXR, echo
EP study - induced arrhythmia

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11
Q

Arrhythmia treatment

A

Radio-frequency ablation
Cardioversion - electricity/drugs
Pacemakers

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12
Q

Anti-arrhythmic drug classifications

A

Class I, II, III, IV

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13
Q

AAD Class I

A

Na channel blockers (phase 0)

Slow conduction, prolong depolarisation

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14
Q

AAD Class I examples

A

Disopryramide, Lignocaine, Flecainide, Propafenone

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15
Q

AAD Class II

A

B-blockers (phase 4)

Slows HR

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16
Q

AAD Class II examples

A

Atenolol, Propanolol

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17
Q

AAD Class III

A

K channel blockers (phase 3)

Prolong repolarisation

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18
Q

AAD Class III examples

A

Amiodarone, Sotalol

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19
Q

AAD Class IV

A

Ca channel blockers (phase 2)

Slows HR

20
Q

AAD Class IV examples

A

Verapamil, Diltiazem

21
Q

Describe sinus bradycardia

A

Heart rate < 60, reg rhythm, QRS complexes far apart

Athletes may have it

22
Q

Causes of sinus bradycardia

A

Ischaemia/infarction of SA node
Fibrosis of atrium/SA node
Hypothermia/hypothyroidism
Drugs eg. b-blockers, verapamil

23
Q

What is fibrosis of the atrium/SA node called?

A

Sick sinus syndrome

24
Q

Sinus bradycardia treatment

A

Atropine

Pacing (perm if sick sinus)

25
Q

Describe heart block

A

AV block: block in AV/atrioventricular area

Bundle branch block: block in lower His bundle/purkinje fibres

26
Q

1st Degree heart block definition

A

Prolongation of PR interval (>0.2s)

27
Q

2nd Degree heart block definition

A

Intermittent block at the AVN (dropped beats)

Mobitz I and Mobitz II

28
Q

Mobitz I

A

Progressive PR interval prolongation, followed by dropped QRS

29
Q

Mobitz II

A

Dropped QRS but no PR prolongation
Pathological
Usually 2:1 or 3:1

30
Q

3rd Degree heart block

A

Complete heart block
No APs from SA node get through AV node
Regular rhythm - maintained by a junctional or ventricular escape rhythm
P waves don’t link to QRS

31
Q

Right bundle branch block

A

Deep S waves in I + V6

Tall R wave in V1

32
Q

Left bundle branch block

A

Deep S waves in V1
Tall R waves in I and V6
Abnormal Q waves

33
Q

Heart block treatment

A

IV atropine

Temp/perm pacing

34
Q

Where does supraventricular tachycardia arise from? What does this mean for the QRS complexes?

A

Atrium or AV junction

Therefore QRS complexes usually normal

35
Q

SVT tachycardia types

A

Atrial fibrillation

Atrial Flutter

36
Q

SVT tachycardia treatment

A
  1. Vagal manoeuvres, carotid massage
  2. IV adenosine
  3. IV verapamil
37
Q

AF characteristics

A

Irregularly irregular - Chaotic
Atrial rate >300
Absence of P waves

38
Q

3 Ps of AF

A

Paroxysmal - <48hrs
Persistent - >48hrs
Permanent - can’t be cardioverted to NSR

39
Q

AF treatment

A

ACUTE: Cardioversion + anticoagulation
Rhythm control: DC cardioversion, class I and III drugs
Rate control: Digoxin + b-blocker/verapamil combo, AV node ablation
Anticoagulation for prosthetic valves and CHA2DS2VASc score

40
Q

Atrial flutter characteristics

A

Atrial rate >300
Rapid re-entrant regular rhythm
Saw-tooth F waves (baseline)

41
Q

Atrial flutter treatment

A

Electric cardioversion
Radiofrequency ablation
Class III drugs

42
Q

What is ventricular tachycardia associated with?

A

Dizziness, hypotension, cardiac arrest

43
Q

Ventricular tachycardia characteristics

A

QRS complexes are rapid, wide, and distorted
The T waves are large with deflections opposite the QRS complexes
Usually regular rhythm
P waves are usually not visible
PR interval not measurable
Haemodynamically stable

44
Q

VT treatment

A

DC cardioversion if haemodynamic compromise
Pulseless VT = fibrillation
Amiodarone + Class I if CO and BP well maintained
Calcium chloride if hyperkalaemia
ICD if life-threatening

45
Q

What often follows VF

A

Cardiac arrest

46
Q

VF characteristics

A

Chaotic
Irregularly irregular
Shapeless, rapid oscillations with unorganised QRS complexes

47
Q

VF treatment

A

Defibrillation
Magnesium chloride
ICD

Cardiovascular* (10 decks)

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