Arrhythmias Flashcards
What are the main types of supraventrucular arrhythmias?
Atrial fibrillation
Atrial flutter
Ectopic Heart Beat
What are the main types of ventricular arrhythmias?
Ventricular tachycardia
Ventricular fibrillation
Asystole
What type of arrhythmia is AV block?
AV node arrhytmia
What is an anatomical abnormality that can cause arrhythmia?
Left ventricular hypertrophy
accessory pathways
congenital heart disease
What alteration of the autonomic nervous system can cause arrhythmias?
sympathetic stimulation (stress, exercise etc.) Increased vagal tone
What are the metabolic causes of arrhythmia?
Hypoxia (from COPD)
ischaemic myocardium
electrolyte imbalances
what is an inflammatory cause of arrhythmia?
Viral myocarditis
What is an example of a genetic cause of arrhythmia?
long QT syndrome
Ectopic foci in muscle sleeves in the ostia of pulmonary veins that release signals which override SA node conduction is the mechanism of which arrhythmia type?
AF
AF lasting <48 hrs and is recurrent. what type of AF?
Paroxysmal
AF lasting >48 hrs (with the ability to be converted back to sinus rhythm) and is unlikely to undergo spontaneous cardioversion. what type of AF?
Persistent
AF that is long term and cannot be converted back to sinus rhythm. what type of AF?
perminant
what are some diseases associated with AF?
congestive heart failure hypertension obesity CHD congenital heart disease many more
What is lone AF?
idiopathic atrial fibrillation
thought to be related to genetics
increases chance of stroke in >75s
What are the main symptoms of AF?
palpitations dizziness syncope chest pain dyspnoea sweatiness fatigue
what is the atrial rate in AF typically?
> 300bpm
what rhythm is associated with AF?
irregularly irregular
what can effect the ventricular rate in AF?
AV node conduction
Sympathetic/parasympathetic tone
drugs that act on the AV node
how would you recognise atrial fibrillation on an ECG?
no P waves present
presence of F waves
what is the characteristic ECG appearance of atrial flutter?
“saw-tooth” F-waves
Cardiac output is decreased in atrial fibrillation. true or false?
TRUE
AF cannot lead to congestive heart failure. true or false?
FALSE
it can- especially with diastolic dysfunction
What type of drug is commonly prescribed in both cases of rhythm control and rate control of AF?
anti-coagulants- high thromboembolism risk
What drugs can slow AV node conduction?
Digoxin
B-Blockers (such as bisoprolol)
CCBs (such as verapamil, diltiazem)
What are the two types of cardioconversion for restoring NSR in AF?
Pharmacological
direct current/ electrical
what are the 3 main options to maintain NSR in AF?
anti-arrhytmic drugs
catheter ablation of atrial focus/ pulmonary veins
Surgery (maze procedure)
which VW classes of antiarrhythmics are used for rhythm control in AF?
IA, IB, IC
III
what VW classes of antiarrhythmics are used for rate control in AF?
II
IV
V
Which anti-arrhythmic class depress AP phase 0?
IA, IB, IC
which anti-arrhythmic class depress AP phase 4?
II
which anti-arrhythmic class affects AP phase 3?
III
which anti-arrhythmic class depresses phase 2 of AP?
IV
examples of IA antiarrhythmics?
quinidine sulfate
hydroquinidine
examples of IB antiarrhythmics?
lidocaine
mexilitene
tocainide
examples of IC antiarrhythmics?
flecainide
propafenone
examples of II antiarrhythmics?
Beta blockers: eg. bisoprolol
examples of III antiarrhythmics?
amiodarone
dronedarone
sotalol
examples of IV antiarrhythmics?
Calcium channel blockers: eg verapamil, diltiazem
examples of V antiarrhythmics?
digoxin
adenosine
magnesium sulphate (for torsades de pointes ONLY)
HR of 200-250 bpm irregularly irregular rhythm long QT interval wide QRS changing QRS morphology what does this indicate?
Torsades de Pointes
what would put you at a higher risk of thromboembolism?
valvular heart disease (mitral stenosis > mitral regurg.) over 75 y/o + female hypertension heart failure PMH of thromboembolism/stroke CHD + diabetes + >60 y/o thyrotoxicosis
what makes up the CHA(2)DS(2)- VAS score?
congestive heart failure hypertension age >_ 75 (2 points) diabetes stroke (2 points) vascular disease age 65-74 sex (female)
