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Y1 CARDIOLOGY > Arrhythmias > Flashcards

Arrhythmias Flashcards

1
Q

What are the two classes of arrhythmias described by where the arrhythmia arises?

A

Supraventricular

Ventricular

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2
Q

Supraventricular arrhythmias tend to have narrow QRS complexes. True/False?

A

True

Because the arrhythmia does not originate from ventricles

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3
Q

What are ectopic beats? How are they treated?

A

Beats/rhythms that originate outwith the SA node - typically present as palpitations
Avoid stimulants, B blockers, nothing

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4
Q

Ectopic beats may not be dangerous. True/False?

A

True

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5
Q

Why might ectopic beats not be harmful?

A

Depends on where they originate - if in non-contractile areas, they are unlikely to affect cardiac output

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6
Q

Name the main supraventricular arrhythmias

A

SVTs: atrial fibrillation (atria beat rregularly), atrial flutter (atria beat regularly but faster than usual), ectopic atrial tachycardia
Bradycardias: sinus bradycardia (<60 bpm), sinus pauses (SAN doesnt stimulate impulse)

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7
Q

Name the main AV node arrhythmias

A 
AV node reentry
Accessory pathway
AV block (1st, 2nd, 3rd degree)
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8
Q

Name the main ventricular arrhythmias

A

Premature ventricular complex (ectopic beat from purkinje fibres)
Ventricular tachycardia
Ventricular fibrillation
Asystole

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9
Q

What are the 3 main physiological types of arrhythmia?

A

Altered automaticity
Triggered activity
Reentry (accessory pathway)

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10
Q

List the investigations you would do for arrythmias

A 
ECG/exercise
ECG/24hr 
ECG
CXR
Echo
Event recorder
EP study (induce arrhythmia to map pathway)
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11
Q

How would acute SVT be managed?

A

Vagal manoeuvres, carotid massage, IV adenosine, IV verapamil

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12
Q

Give examples of some vagal manoeuvres

A

Holding your breath and bearing down (Valsalva)
Immersing face in ice-cold water (diving reflex)
Holding nose/unblocking ears

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13
Q

What is the treatment of choice for managing chronic arrhythmias?

A

Radiofrequency ablation

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14
Q

What is radiofrequency ablation?

A

Selective cauterisation of cardiac tissue to prevent tachycardia
Target reentry circuit or automatic myocite

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15
Q

Which drugs must be stopped before radiofrequency ablation?

A

Antiarrhythmic drugs 3-5 days beforehand

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16
Q

What is notorious for causing AV block in young people?

A

Cytomegalovirus

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17
Q

Describe 1st degree AV block

A

PR interval increased (greater than 0.2s)

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18
Q

Describe 2nd degree Mobitz 1 AV block

A

PR interval gets progressively longer, followed by dropped QRS

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19
Q

Describe 2nd degree Mobitz 2 AV block

A

Lonely P waves not followed by QRS - QRS wave dropped every nth time
N.B. PR interval not prolonged

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20
Q

Describe 3rd degree AV block

A

P waves without QRS complexesi.e. no association between atrial and ventricular systole

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21
Q

What is typical of an ECG showing ventricular tachycardia?

A

Broad QRS complexes

22
Q

What is the difference between monomorphic and polymorphic VT?

A

In monomorphic VT, the QRS complexes look similar

Polymorphic is disorganised (Torsades de Pointes)

23
Q

How would acute VT be treated?

A

DC cardioversion if unstable

Adenosine if unsure it’s VT

24
Q

What are the 3 classifications of AF?

A

Paroxysmal
Persistent
Permanent

25
Q

Define paroxysmal AF

A

Recurrent AF, lasting less than 48 hours

26
Q

Define persistent AF

A

AF lasting greater than 48 hours which can be cardioverted to normal sinus rhythm

27
Q

Define permanent AF

A

AF that is unable to be restored to normal sinus rhythm via pharma + non pharmacological methods

28
Q

What is meant by lone AF?

A

AF where a cause cannot be found

29
Q

What would a typical ECG of AF show?

A

Rate greater than 300bpm
Irregularly irregular
P waves absent

30
Q

What are the two management pathways for AF patients? What must you always consider?

A 
Rhythm control (get back to NSR)
Rate control (accept AF, control ventricular rate)
ANTICOAGULATION
31
Q

What pharmacological therapy can be used for rate control in AF?

A

Digoxin
B blockers
Verapamil

32
Q

How can NSR be restored in AF (rhythm control)?

A

Amiodarone
Class I and III anti-arrhythmics
DC cardioversion

33
Q

Class I anti-arrhythmic drugs act on which phase of the AP and block which channels?

A

Act on phase 0 - increase time spent in open and inactivated states to normalise beating frequency
Block Na+ channels

34
Q

Name a class I anti-arrhythmic drug

A

1C: slow rate - Flecainide
1B: rapid rate - Lignocaine
1A: moderate rate - Disopyramide

35
Q

Class II anti-arrhythmic drugs act on which phase of the AP and block which channels?

A

Act on phase 4

Block B receptors (B blockers)

36
Q

Class III anti-arrhythmic drugs act on which phase of the AP and block which channels?

A

Phase 3

Block K channels

37
Q

Name a class III anti-arrhythmic drug

A

Amiodarone

Sotalol

38
Q

Class IV anti-arrhythmic drugs act on which phase of the AP and block which channels? Give an example

A

Phase 2
Block Ca channels
Verapamil

39
Q

What would a typical ECG of atrial flutter look like?

A

Saw tooth baseline

Regular rhythm

40
Q

What are the typical symptoms of arrhythmia?

A 
Palpitations
SOB
Dizziness
Syncope/pre-syncope (faintness)
Chest pain
Fatigue
Sweatiness
Worsening angina, CHF
41
Q

In what situation is sinus bradycardia normal? How is it treated?

A

Athletes

Atropine acutely
Pacing if haemodynamic collapse

42
Q

In what situation is sinus tachycardia normal? How is it treated?

A

Anxiety, fever, hypotension, anaemia

B blockers, change medications

43
Q

What would Wolf Parkinson White syndrome look like on an ECG?

A

Broad QRS with slurred upstroke on R wave

‘Delta wave’

44
Q

How is heart blocked treated?

A

Ventricular pacing

45
Q

What are some causes of AF?

A 
Heart surgery
Hypertension
Alcohol abuse
Coronary HD
Thyroid D
Obesity/ athletes
Valvular HD
Familial
46
Q

What score is used to estimate the need for anticoagulation in AF?

A

CHAD2VASC score

47
Q

What would hyperkalaemia look like on an ECG?

A

Tall tented T waves

Wide QRS

48
Q

What is the most common cause of sudden cardiac death in young people?

A

Hypertrophic cardiomyopathy

49
Q

What drugs are used most commonly in SV arrhythmias?`

A

Adenosine
Digoxin
Verapamil

50
Q

What drug is used most commonly in V arrhythmias?

A

Amiodarone

Lignocaine

51
Q

What are some common side effects of anti-arrhythmic drugs?

A

Phototoxicity
Pulmonary fibrosis
Peripheral neuropathy
Thyroid abnormalities

Y1 CARDIOLOGY (16 decks)

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