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JMS - Cardiology > Arrhythmias > Flashcards

Arrhythmias Flashcards

1
Q

BRADYCARDIAS Tx

  • If asymptomatic & rate >40bpm?
  • If symptomatic or rate <40bpm?

-

A

If asymptomatic & rate >40bpm – no Rx needed

If symptomatic or rate <40bpm → urgent
Rx the underlying cause: MI, drugs, thyroid, electrolytes etc…
IV atropine 0.6-1.2g (max 3g)

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2
Q

NARROW COMPLEX TACHYCARDIA

Sinus tachycardia?
- if necessary - what Tx?

A

Sinus tachycardia

Normal P wave followed by normal QRS
If necessary → rate control with B-blockers

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3
Q

NARROW COMPLEX TACHYCARDIA

AF?
Atrial Flutter?

A

AF

absent p waves, irregular QRS complexes

Atrial flutter

atrial rate ~ 260-340 bpm. Sawtooth baseline
Due to re-entrant circuit isually in the RA
Ventricular rate often 150 bpm (2:1 block)

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4
Q

NARROW COMPLEX TACHYCARDIA

AV nodal re-entry tachycardia?

AV re-entry tachycardia? (WPW)

A

AV nodal re-entry tachycardia

= P wave absent or immediately before/after QRS
Normal QRS

AV re-entry tachycardia

= e.g. Wolff-Parkinson-White syndrome
Short PR interval
Slurred upstroke of QRS – delta wave

AVNRT - ‘no’dal - no p WAVE

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5
Q

NARROW COMPLEX TACHYCARDIA - Tx

A

vagal massage

IV adenosine 12mg – if no response, another 12 mg after 1-2 minutes

Amiodarone – if adenosine CIed or not successful

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6
Q

AF

Signs?

ECG ?

A

Irregularly irregular pulse

Absent P waves, irregular QRS complexes

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7
Q

Acute AF (≤ 48h of duration) Tx

Haemod. Unstable?

Control ventricular rate ?

  • 1st line
  • 2nd line

Start WHAT until full risk of emboli assessed (CHAD2VASC2 score) for risk of stroke -

which score would you prescribe DOAC?

A

Haemod. Unstable → emergency DC cardioversion

control VR rate:

1st line – bisoprolol PO
2nd line – digoxin / amiodarone

START LMWH

risk >2

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8
Q

what would indicate long term anticoagulation?

A

if sinus rhythm wasn’t restored and there was no RFs

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9
Q

Paroxysmal AF?

Tx?

Prevention?

A

Self-limiting, <7d, recurs

Rx ”pill-in-pocket“: flecainide

Prevention: β-B, amiodarone, sotalol

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10
Q

A 60-year-old air hostess was recently diagnosed with atrial fibrillation for which she has just been started on atenolol. The cardiac team assess whether she needs any anticoagulation and calculate her CHA2DS2-VASc score to be 3. After talking to her they realise that she is often out of the country and thus would be unable to regularly attend her GP for any follow up. Which of the following would be the most appropriate in this case?

warfarin 
clopidogrel 
aspirin 
rivaroxaban 
no anticoagulation needed
A

rivaroxaban

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11
Q

A 71-year-old man who is known to have atrial fibrillation comes for review. He had a transient ischaemic attack two weeks ago and takes bendroflumethiazide for hypertension but is otherwise well. His latest blood pressure is 124/76 mmHg. You are discussing management options to try and reduce his future risk of having a stroke. What is his CHA2DS2-VASc score?

1
2
3
4
5
A

4

One point for hypertension, one point for being over the age of 65 years (but under the age of 75 years) and two points (‘S2’) for the recent TIA.

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12
Q

A 51-year-old man with a history of paroxysmal atrial fibrillation presents with palpitations. He has no other history of note and a recent echocardiogram was normal. An ECG confirms fast atrial fibrillation. In the notes you find a recent echocardiogram which shows no evidence of structural heart disease. Which one of the following agents is most likely to cardiovert him into sinus rhythm?

sotalol
procainamide
flecainide
digoxin

A

flecainide

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13
Q

Wendy, 48, presents to the Emergency Department after feeling faint earlier that day. She is found to be in atrial fibrillation. She is known to have structural heart disease as a result of an ill-functioning mitral valve, but is otherwise fit and healthy. What is the most appropriate treatment if pharmacological cardioversion is agreed upon?

diltiazem 
digoxin 
atenolol 
flecainide 
amiodarone
A

amiodarone

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14
Q

AF Pharmacological Cardioversion

NICE guidelines recommend:

‘f pharmacological cardioversion has been agreed on clinical and resource grounds for new-onset atrial fibrillation, offer:

  1. flecainide or amiodarone if there is no evidence of structural or ischaemic heart disease or
  2. amiodarone if there is evidence of structural heart disease.
A

learn other side

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15
Q

A 51-year-old female presents to the Emergency Department following an episode of transient right sided weakness lasting 10-15 minutes. Examination reveals the patient to be in atrial fibrillation. If the patient remains in chronic atrial fibrillation what is the most suitable form of anticoagulation?

aspirin
warfarin target INR 2-3
no anticoagulation
warfarin target INR 3-4

A

warfarin target INR 2-3

The CHA2DS2-VASc for this patient is 3 - 2 for the transient ischaemic attack and 1 for being female. She should therefore be offered anticoagulation with warfarin

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16
Q

A 54-year-old male with no past medical history is found to be in atrial fibrillation during a consultation regarding a sprained ankle. He reports no history of palpitations or dyspnoea. After discussing treatment options he elects not to be cardioverted. Examination of the cardiovascular system is otherwise unremarkable with a blood pressure of 118/76 mmHg. According to the latest NICE guidelines, if the patient remains in chronic atrial fibrillation what is the most suitable treatment to offer?

no treatment
warfarin
aspirin
dabigatran

A

no treatment

Young man with AF, no TIA or risk factors, no treatment is now preferred to aspirin

17
Q

Cardioversion of AF:

patients must either be anticoagulated or have had symptoms for

A

symptoms for < 48 hours

anticoagulated for at least 3 weeks
During this period rate-control (Bisoprolol) should be offered as appropriate

18
Q

An 80-year-old female presents to Emergency Department with headaches. On further questioning, the patient admits that she has been suffering from headaches, palpitations and dizzy spells for a few months.

Upon examination you notice she is afebrile and has an irregularly irregular pulse at a heart rate of 140 beats per minute, blood pressure = 120/80 mmHg and respirations = 20/min. You, therefore, suspect the lady is in atrial fibrillation (AF) and perform an ECG to confirm this.

What is the most appropriate first step in the management of her AF?

sotalol 
verapamil 
digoxin 
amiodarone 
bisoprolol
A

bisoprolol

19
Q

Learn CHA2-DS2-VAS Score

A 
Congestive heart failure 
Hypertension 
Age >75 (2 points) 
Diabetes 
Stroke/TIA (2 points)
Vascular disease 
Age 65-74
Sex: female

JMS - Cardiology (9 decks)

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