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cardiology > Arrhythmias > Flashcards

Arrhythmias Flashcards

1
Q

Causes of bradyarrhythmias

A 
Acute and chronic IHD
CAD
Valvular disease
degenerative primary electrical dsiease
sick sinus syndrome

Hypothyroidism
Elextrolyte imbalance (Hyperkalmeia)
Atunomic/neruologi causes
Autoimmunity

Drugs - BB and digoxin
Drug abuse
Situational - e.g bed rest

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2
Q

Treatment of bradyarrhythmias

A

In hemodynamically stable patietns:Atropine if condition of patient worsens

Unstable:

  • Give O2 in case of hypoxia
  • Administration of atropine also isoprenaline is necessary
  • External pacing

Pacemaker indications:

  • If no response to treatment
  • 2nd degree AV block or worse
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3
Q

Types of supra ventricular arrhythmias

A

MAT

  • Irregular, 100-200 BMP
  • Random firing form several foci
  • Very common in people with severe lung disease
  • Need 3 P-waves w/different morphology

AVNRT - AV nodal reentry tachycardia

  • Reentry inside the AV node.
  • The retrograde P-wave is hidden in the QRS (uncommon type)
    • Pseudo V1 and pseudo S in inferior leads (common type)
  • 200 BMP
  • Often triggered by premature atrial conduction
  • Women > men
  • severe palpitations and pounding in the neck
  • Terminated by IV adenosine or vagal manoeuvres
  • It can be controlled long term with β-blocker, vermeil
  • RFA

AVRT - AV reentry tachycardia

  • Retrograde conduction through the accessory pathway
  • bigger reentry circuit
  • Retrograde P-wave in the ST-T
  • Narrow QRS = Orthodromic ( down the AV -node)
  • Wide QRS = antidromic (down the accessory pathway)
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4
Q

Sinus tachycardia treatment and causes

A
  • Exercise, pregnancy or emotion
  • Anemia, cocaine, hyperthyroidism, pain, hypoxia, fever, infection, sepsis, shock, hypovolemia, cardiac tampnade, AHF, Pheochomocytoma

β-blocerks

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5
Q

Sinus nodal reentrant tachycardia treatment

A

β-blocker or CCB
Can also use ablation
P-wave on ECG is identical to sinus tachycardia

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6
Q

Atrial tachycardia treatment

A

Only for symptomatic patients:

  • β blokcers and CCB
  • Propafenone (Class 1C) or amidarone and stall (class III)
  • May be terminated by IV adenosine or by RFA
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7
Q

Atrial flutter

A

P-wave rate > 240 BMP
Caused by reentrant over large areas if the right or left atrium.
Synchornized DC restores sinus rhythm

Drug therapy is not very effective, but amidarone can be used.
Ablation and pacemaker is the palliative solution.

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8
Q

AVRT types

A

WPW

  • Bundle of kent
  • conducts impulses faster
  • Orthodromic - down the AV then back the accessory pathway. P wave that follows a narrow QRS
  • Antidromic - down the accessory then back up AV. QRS wider than usual, often with delta wave. Very dangerous with AF as all impulses can be conudcted to the ventricles VT -> VF!!

Lown.ganone-levine syndrome
- James bundle

Treatment: Ablation, propafenone ( slow conduction in the accessor pathway and AV-node)

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9
Q

Junctional tachycardia

A

usually < 140 BMP

β blockers and propafenone are effective drugs

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10
Q

Treatment for SVTs

A

To achieve AV block use:

  1. Physical maneuvers
    - Valsava - simules baroreceptors in arch of aorta
    - Carotid massage
  2. Drug treatment
    - Adenosine - AV-nodal blocking agent, short acting, can be replaced with verapamil.
  3. Electrical cardioversion
    - DC shock (synchonized cardioversion)
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11
Q

Atrial fibrillation

A
  • Irregulary irregular 300-600 BMP
  • multiple reentrant circuits within try, often foci in pulmonary vein.
  • main risk is embolic stroke, use WARFARIN
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12
Q

Symptoms on AF

A 
- Asymptomatic
chest pain
palpitations
↓ CO
dyspnea or faintness
irregular pulse
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13
Q

Causes of AF

A 
HT
LVF
CAD
mitral or tricuspid valve disease
HCM
COPD
Alcohol binge
hyperthyroidism
Acute MI
Acute pericardiits
myocarditis
PE
Cardiac surgery
Rare causeS:
- congenital heart disease
Vagal overactivity
pericardial effusion
cardiac metastases
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14
Q

AF investigations

A

ECG - irregular ventricular rate, escape beats
CXR- cardiomegaly, pulmonary edema, mitral stenosis
Lab: hypokalemia, renal impairment; check Ca and Mg, thyroid function, liver function, cardiac enzymes, drug levels (digoxin)
ABG . hypoxic, shock or acidosis
Echo; LV function, valve lesions, pericardial effusion, exclude thrombus before conversion

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15
Q

Treatment of AF

A 
Acute:
- DC
Drugs:  
- to control ventricular rate:1st line: β-blockers, CCB. 2nd line: digoxin
- rhythm control: stall, propafenone
- Heparin

Chronic

  • Medical: bb, CCB, digoxin, amidarone
  • Pacemaker - atrial pacing modes
  • Atrial defibrillators
  • Catheter and surgical ablation
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16
Q

Paroxymal AF

A

reccurent AF < 48h, convert spont to normal rhythm

Pill in pocket or BB, if this fails and no LV dysfunction: stall or amiodarone

17
Q

electrical Cardioversion

A

Synchonized eletrical cardioversion

  • Place on right of the sternum and one left to the left nipple.
  • Shock is delivered in synchronisation with the R-wave, to prevent delivery of the shock in the vulnerable period (which could induce V.fib)
  • Used for AF, A-flutter, sustained VT when there is pulse, junctional tachycardias

CI: digoxin toxicity, electrolyte disturbances, fever and ongoing met disturbances
Check thyroid function

Complications: Bradycardia, v-fib, thromboembolism, transient hypotension, skin burns, aspiration pneumonia

18
Q

Pharmacological cardioversion

A

Adenosine may chemically cardiovert the heart.

Antiarrhythmic drugs:
I: Na-chl blockers - lidocaine
II: BBs
III: Block outward K-chl - amiodarone
IV: CCBs which inhibit AP in AV ans SA node
19
Q

Ventricular arrhythmias

A 
Lack response to IV adenosine (takes SVTs back to sinus)
Causes:
- IDH/HF
- electrolyte dist
- Post MI
- hypotension/shock
-Hypoxemia
- Stimulants
  1. PVCs
  2. Accelerated idventricular rhythm
  3. Polymorphic VT -> torsades de pointes
  4. Ventricular tachycardia
  5. Ventricular fibrillation
20
Q

Non pharmacological treatments of arrhythmias

A

Ablation

  1. Radiofrequency RF
  2. Cooled RF
  3. Cryoablation
    - Indications: AVNRT, AVRT (WPW), A-flut, AT, PVC(monomorphic), AF.
    - Complications: Death, stroke, cardiac tampnade, AV-node block, MI, pneumothorax

ICD
Pacemaker
CRT - cardiac resynchronisation therapy
Electrical cardioversion

21
Q

Pacemaker - unternational code

A

International code:
1st letter: paced
2nd letter: sensed
3rd letter: I= inhibits, T=triggers, D=dual, 0=nothing
4th letter: added features of the device: R=rate responsiveness, M=multiprogrammable, C=communication, 0=neither
5th letter: antitachycardia functions: P=antitacycardia, S=shock (CV,DF), D=dual, 0=neither

22
Q

Indications for pacemaker

A 
Definite:
3rd degree AV block 
2nd degree AV block - symtpmatic
Bifascular or trifasciular
after STEMI w/high degree AV block
Symp sinus node dysf
Symp chronotropic incomp
Carotid sinus hypersens
Sustained VT

Relative indications:

  • High risk patients with long QT
  • symptomatic HCM with outflow obstruction
  • asymp 3rd degree AV block
23
Q

CRT

A 
Cardiac resynchronisation therapy
treat HF (NYHA III-IV)
In patients with ventricular conduction delay, coordination of wall motion in the left ventricle can improve by pacing LV and septum simultaneously -> improves CO and symptoms
Ventricular filling may be optimised by AV delay
24
Q

ICD

A

Used when there is risk for VT,V-fib and sudden death.
Have a lead in RV for pacing/sensing and defibrillator. May be a second lead in SVC

Use BB to prevent inappropriate shocking (e.g shock during sinus tachycardia)

Indications:

  • survivors of CA due to VF or VT
  • LEVF < 35% due to prior MI NYHA class II or III
  • DCM LVEF < 35% and NYHA II or III
  • HCM
  • Long QT
  • Brugada

cardiology (5 decks)

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