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CVS clinical conditions > Arrhythmias > Flashcards

Arrhythmias Flashcards

1
Q

what are indications for temporary pacing?

A

intermittent or sustained symptomatic bradycardia, particularly if they experience syncope
prophylactic when patient is at high risk for developing severe brady cardia e.g. 2nd or 3rd degree AV block, pos anterior MI
(even if unsymptomatic)

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2
Q

what are the indications for permanent pacing?

A

symptomatic or profound 2nd/3rd AV block particularly when cause is unlikely to disappear
Mobitz type II 2nd/3rd degree AV block even if asymptomatic
AV block associate with neuromuscular disease
after (or in preparation for) AV- node ablation
alternating RBBB/LBBBB
SN disease associated with symptoms
carotid sinus hypersensitvity/ malignant vasovagal syncope

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3
Q

what is the abnormality with supra ventricular ectopics?

A

ectopics are beats which occur earlier than they should

SVE has a narrow QRS complex < 3 small squares

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4
Q

what are the 2 types of supra ventricular tachycardia?

A

atrioventricular nodal re-entrant tachycardia AVNRT

atrioventricular re-entrant tachycardia

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5
Q

what is the difference on ECG’s between AVNRT and AVRT?

A

P waves are absent in AVNRT because atrial and ventricular activity occurs simultaneously
in AVRT the atrial activity occurs after the ventricular activity so P wave occurs after the QRS complex

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6
Q

what is the aetiology of ventricular tachycardia?

A

VT is usually due to a structural heart disease

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7
Q

how might atrial fibrillation present?

A 
asymptomatic
palpitations
dyspnoea
chest pain
embolism
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8
Q

what are the investigations carried out in atrial fibrillation?

A 
bedside: ECG
FBC - anaemia?
U &amp; E - hypo/hyperkalaemia, hypomagnesium? 
TFT - hyperthyroidism?
CRP/ESR - infection?

CXR - pul oedema, heart failure?
Echo - thrombus?

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9
Q

what drugs are used for rate control?

A

beta blockers
calcium channel blockers
digoxin

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10
Q

what drugs are used for rhythm control?

A 
class Ic drugs i.e. flecainide 
class III drugs i.e. amiodarone
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11
Q

what are electrical treatments for arrhythmia?

A

direct current cardioversion
pace and ablation of AV node
substrate modification e.g. pulmonary vein ostial ablation
maze procedures

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12
Q

when someone receives cardioversion what drug do they have to be on ideally prior to the procedure?

A

anti-coagulants as there is high risk of embolism

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13
Q

what type of arrhythmia is atrioventricular block?

A

bradycardic arrhythmia

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14
Q

what is the abnormality on an ECG due to 1st degree AV block?

A

prolonged PR interval

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15
Q

name 3 types of 2nd degree AV blocks?

A

mobitz I
mobitz II
wenckbach

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16
Q

what are the abnormalities in the 3 types of 2nd degree AV block?

A

mobitz I = PR interval prolongation until P wave fails to conduct
Mobitz II = dropped QRS isn’t accomapnied by PR interval
Wenckback = every 2nd or 3rd P wave conducts to the ventricle

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17
Q

what is wenckbach 2nd degree AV block due to?

A

block in the AV node

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18
Q

what treatment is given to someone post MI which has caued Mobitz II AV block?

A

close monitoring

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19
Q

what treatment is given to someone post anterior MI which has caused mobitz II AV block?

A

permanent pacemaker

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20
Q

what is the treatment for 3rd degree block?

A

treatment depends on the aetiology

may require atropine and/or pacemaker

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21
Q

on an ECG, what does hypokalaemia and hyperkalaemia cause?

A

hypokalaemia causes T wave flattening and inversion & ST depression
hyperkalaemia causes tall tented T waves

22
Q

on an ECG what does hypocalcaemia and hypercalcaemia cause?

A

hypocalcaemia causes prolongation of QT interval

hypercalcaemia causes shortening of QT interval

23
Q

what is sick sinus rhythm?

A

SA node suppression

24
Q

what class of anti arrythmics is beta blockers?

A

class II

25
Q

what class of antiarrythmic drugs is flecainide?

A

class Ic

26
Q

what is the action of class I anti arrhythmic drugs?

A

fast/intermediate/slow Na channel blockade

27
Q

what class of anti arrythmics are used in treatment of atrial fibrillation?

A 
class Ic i.e. Flecainide
class III i.e. Amiodarone
28
Q

how does prolonged refractories such as Amiodarone work?

A

they block potassium rectifier currents that are responsible for the repolarisation of the heart in phase 3 of the cardiac action potentials

29
Q

what anti arrhythmic is used for treating life threatening tachycardias and fibrillations?

give an example.

A 
class III antiarrythmic (prolonged refractory drug)
i.e. Amiodarone
30
Q

what class of drug is digoxin?

A

anti arrhythmic

cardiac glycoside

31
Q

how does digoxin work?

A

positive ionotrope - improves the strength of contraction

inhibits the Na-K ATPase pump

32
Q

when using digoxin, what needs to be monitored?

A

potassium levels
drug levels
toxicity

33
Q

what are the symptoms of digoxin toxicity?

A 
nausea and vomiting
xanthopsia
bradycardia
tachycardia
arrhythmias i.e. VT and VF
34
Q

what are the side effects of amiodarone?

A 
hypo/hyperthyroidism
pulmonary fibrosis
slate grey pigmentation
corneal deposits
LFT abnormalities
35
Q

name 2 direct oral anti coagulants (DOAC)

A

rivaroxaban

apixaban

36
Q

what are the adverse effects from warfarin?

A 
bleeding
teratogenic (avoid in 1st and 3rd trimester)
can cause retroplacental bleeding and intracerebral bleeding
37
Q

how is warfarin monitored?

A

international normalised ratio (INR)

PT/APTT

38
Q

what is the therapeutic INR for warfarin?

A

2.5-4.0

39
Q

what drugs decrease warfarin activity?

A 
vitamin K
phenytoin
barbiturates
cholestyramine 
st johns wart
40
Q

what enzyme does warfarin inhibit ?

A

vitamin K epoxide reductase

41
Q

what are features of atrial fibrillation on EGC?

A

prolonged QRS complex
absent P waves
rate variable

42
Q

what are features of atrial flutter on ECG?

A

saw tooth appearance
rate > 300bpm
QRS regularity variability
QRS complex < 120ms

43
Q

what are features of wolf-parkinson white syndrome on ECG?

A

narrow PR interval
QRS complex > 120ms
delta wave on QRS

44
Q

what are features of wolf-parkinson white syndrome?

A

occurs in young age (20s)
precipitated by exercise
accessory electrical pathway

45
Q

what is the management for atrial fibrillation?

A

if onset < 48 hours
- rate and rhythm control

if onset > 48 hours

  • rate control
  • rhythm control in 3 weeks

rate control

  • beta blockers
  • CCB
  • digoxin (if heart failure)

rhythm control

  • flecainide
  • amiodarone
  • DC cardioversion
46
Q

what are causes of atrial fibrillation?

A 
advancing age 
heart failure 
anaemia
hyperthyroidism 
hyper/hypokalaemia 
hypomagnaesium 
infection
47
Q

what scoring system is used to determine the risk of thromboembolic event in a patient with AF?

A

CHA2DS2-VASc

48
Q

what is the CHA2DS2-VASc score used for?

A

to determine the risk of a a thromboembolic event in a patient with AF

used to determine if the require anticoagulation

49
Q

when would you give anticoagulation in AF?

A

male with CHAS2DS2-VASc score 1 or more

anyone with score 2 or more

50
Q

what are the classifications of AF?

A

first episode

paroxysmal: recurrent episodes that spontaneously resolve < 7 days
persistent: recurrent episodes lasting > 7 days
permanent: continuous and refractory to treatment

CVS clinical conditions (29 decks)

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