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Cardiovascular system 16/17 > Arrhythmias > Flashcards

Arrhythmias Flashcards

1
Q

How do you calculate HR from the rhythm strip of an ECG?

A

Calculate how many big boxes are between each QRS complex, then divide 300 by this number to get the rate

e.g. 4 boxes, 300/4=75bpm

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2
Q

What are some symptoms and complications of arrhythmias?

A 
Sudden death
Syncope
Chest pain
Fatigue
Dizziness
Palpitations
Embolisms
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3
Q

How do you investigate possible arrhythmias?

A

12 lead 24hr ambulatory ECG monitoring
Blood tests - thyroid in particular
ECHO

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4
Q

Describe the therapy for arrhythmias

A 
Digoxin - AF
Beta blockers - lowers HR
Calcium antagonists
Warfarin or aspirin 
Anti-arrhythmic drugs
DC conversions
Pace and ablation of AV node
Anti-coagulation
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5
Q

Describe the Singh-Vaughan Williams classification of anti-arrhythmic drugs

A 
I - interferes with Na channel
II - anti-symp NS agents e.g. beta blockers
III - interferes with K+ efflux
IV - affects Ca channels and AV node
V - other/unknown mechanism
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6
Q

What is supraventricular tachycardia?

A

Abnormally fast heart rate (150-250bpm) arising from improper electrical activity in the upper part of the heart: re-entry or increased automaticity

Normal rhythm, P waves not discernable

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7
Q

How do you treat supraventricular tachycardia?

A

Often don’t require any treatment

Radiofrequency ablation to the abnormal electrical pathways of the heart, good success rate

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8
Q

What are the 4 main types of supra ventricular tachycardia?

A

Atrial fibrillation
Wolff-Parkinson-White syndrome
Paroxysmal supraventricular tachycardia
Atrial flutter

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9
Q

What is atrial flutter?

A

Common abnormal heart rhythm starting in the atria, associated with a fast HR (100+bpm), and is classified as a type of supraventricular tachycardia

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10
Q

What causes atrial flutter?

A

CVD disease - hypertension, CAD, CM
DM
Spontaneously with no cardiac defect

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11
Q

What is a complication of atrial flutter?

A

Can degenerate into atrial fibrillation

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12
Q

Describe the conduction and rhythm in atrial flutter

A

Atrial rate is typically 300bpm, while ventricular rate is 150bpm, meaning only one flutter in 2 is conducted

Abnormal rhythm, sawtooth flutter F waves

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13
Q

How can you transiently impair conduction to more easily identify atrial flutter?

A

Drugs

Carotid sinus massage

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14
Q

Describe the treatment of atrial flutter

A

Radiofrequency catheter ablation of re-entry circuit is often curative

Can be treated like AF

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15
Q

What is the most common arrhythmia?

A

Atrial fibrillation - seen in 5-10% of >65yo and paroxysmally in younger patients

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16
Q

Describe atrial fibrillation

A

Atrial activity is chaotic and mechanically ineffective, conducting a proportion of the AV impulses to produce an irregular ventricular response

Irregularly irregular pulse, fibrillation f waves, no P waves

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17
Q

What are some symptoms of atrial fibrillation?

A

Palpitations
Fatigue
Acute heart failure
No symptoms - incidental finding

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18
Q

Describe ventricular fibrillation

A

Very rapid and irregular ventricular activation (300-600bpm) with no mechanical effect and hence no cardiac output. No p waves

Pulseless, unconscious, respiration ceases (cardiac arrest) - medical emergency

19
Q

How do you treat those with ventricular fibrillation?

A

Immediate defibrillation (follow cardiac arrest protocol)

After revived, given ICD to reduce risk of sudden death

20
Q

Describe ventricular tachycardia and its symptoms

A

Rapid ventricular rate (120-250bpm), broad QRS complexes, no P waves preceding QRS (unassociated)

Palpitations, chest pain, dyspnoea, dizziness and syncope

21
Q

What two arrhythmias are more associated with underlying structural heart disease?

A

Ventricular tachycardia

Ventricular fibrillation

22
Q

When is ventricular tachycardia considered ventricular flutter

A

bpm >250

23
Q

What arrhythmias cause broad QRS complexes?

A

Ventricular tachycardia
Supraventricular tachycardia with BBB
Bundle branch blocks

Rule out with aid of ECG analysis

24
Q

How do you treat ventricular tachycardia?

A

Urgent DC conversion
IV lidocaine or amiodarone

Recurrence prevented with

  • beta blockers
  • other anti-arrhythmias
  • ICD
25
Q

What investigations are used for ventricular tachycardia?

A

ECG - rule our SVT with BBB
Bloods - thyroid
ECHO
Angiogram

26
Q

What is Torsades de Pointes?

A

Abnormal heart rhythm that can lead to sudden death, characterised by short-long-short RR intervals followed by TdP (looks like twirling party streamer)

Type of polymorphic ventricular tachycardia which can resolve itself or cause symptoms such as palpitations, syncope, pre-syncope and sudden cardiac death

27
Q

How do you treat Torsades de Pointes?

A 
Remove cause (e.g. drugs) if appropriate
Infusion of magnesium sulfate
Anti-arrhythmic drugs
Electrical therapy
Defibrillation
28
Q

What is long QT syndrome?

A

Prolonged ventricular repolarisation period that cause symptoms such as palpitations and syncope, that can degenerate into TdP or VF

29
Q

What causes long QT syndrome?

A

Congenital mutations in Na and K channels
Electrolyte disturbances
Variety of drugs

30
Q

How do you treat long QT syndrome?

A

Treat underlying cause
Remove drugs
IV isoprenaline

31
Q

When is ICD implantation indicated?

A

High risk of sudden cardiac death
Cardiac arrest due to transient or non-reversible cause
Sustained VT causing syncope
Sustained VT with poor lV function

32
Q

What are some common causes of heart block?

A

CAD
Cardiomyopathy
Fibrosis of conduction tissue of heart

33
Q

What is heart block?

A

Heart block is a disease or inherited condition that causes a fault within the heart’s natural pacemaker due to some kind of obstruction (or “block”) in the electrical conduction system of the heart, causing an abnormal rhythm where the heart beats too slowly

34
Q

Where does the block have to be for AV block?

A

Block in AV node or His bundle

35
Q

Where does the block have to be for left or right bundle branch block?

A

Lower conduction system e.g. Purkinje fibres

36
Q

Describe 1st degree AV block

A

Prolonged PR interval but rate is normal

37
Q

Describe 2nd degree type I AV block

A

Progressive PR elongation until QRS drops, then back to normal

38
Q

Describe 2nd degree type II AV block

A

Constant prolonged PR intervals, random QRS complexes dropped

39
Q

Describe 3rd degree AV block

A

Totally unrelated P and QRS waves

40
Q

Describe RBBB on ECG

A

Secondary r wave in VI

Slurred S wave in V5 and V6

41
Q

Describe LBBB on ECG

A

RSR pattern in LV leads (I, AVL, V4-6)

Slurred S in V1 and V2

42
Q

What are some indications for temporary pacing?

A

Intermittent/sustained symptomatic bradycardia

When at high risk of severe bradycardia e.g. 2nd/3rd degree AV block, post anterior MI

43
Q

What are some indications for permanent pacing?

A 
Symptomatic 2nd/3rd degree block
AV block with NMD
With AV ablation
RBBB/LBBB
Syncope
Sinus node disease
Carotid sinus hypersensitivity
Malignant vasovagal syncope

Cardiovascular system 16/17 (40 decks)

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