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SpM Cardiology > Arrhythmias > Flashcards

Arrhythmias Flashcards

1
Q

What are some of the cardiac causes of arrhythmias?

A

Ischaemic heart disease
Structural changes
Cardiomyopathy
Pericarditis

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2
Q

What are some of the non cardiac causes of arrhythmias?

A

Caffine, smoking, alcohol, pneumonia, Drugs e.g. beta agonists, digoxin etc, metabolic imbalance (K, Ca, Mg)

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3
Q

How do arrhythmias patients typically present?

A 
Palpatations
Chest pain
Hypotension
syncope
loss of consciousness
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4
Q

What tests should be done for suspected arrhythmias?

A

FBC, U and E, glucose, calcium, magnesium, thyroid stimulating hormone, ecg
24 hour ecg
Echo for structural disease
Exercise ECG can be done

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5
Q

What are the causes of bradycardia?

A 
Physiological e.g. active and young
Cardiac:
-degenerative changes causing fibrosis of conduction pathway
-post MI
-sick sinus syndrome (sinus node fibrosis)
-Iatrogenic (surgery)
-valve disease e.g. endocarditis
Non-cardiac:
-Vasovagal
-Endocrine - hypothyroid
-Metabolic - hyperkalaemia, hypoxia
Drug induced:
-Amiodarone, beta blockers, verapamil, digoxin
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6
Q

What is the management of bradycardia?

A

Perform 12 lead ecg
Check electrolytes and digoxin levels
Connect to cardiac monitor
address cause e.g. antidotes to medicines that caused it
if the patient has adverse signs e.g. shock, syncope then give atropine
If this fails after repeat doses then consider transcutaneous pacing

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7
Q

What dose of atropine should be given in bradycardia?

A

500mcg every 3-5mins up to 3mg max

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8
Q

What is the antidote to beta blocker overdose?

A

Glucagon

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9
Q

What kind of arrhythmia is typically caused by digoxin toxicity?

A

atrial tachycardia

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10
Q

How is digoxin toxicity treated?

A

With digoxin specific antibody fragments

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11
Q

What is the definition of a narrow complex tachycardia?

A

Rate of ECG of greater than 100bpm and qrs complexes of less than 120ms. These narrow qrs complexes are created via depolarisation from the normal route

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12
Q

What are some of the differentials for narrow complex tachycardia?

A

normal variant
Focal atrial ectopic
Atrial ventricular reenterant tackycardia (avrt)
Atrial vebtricular nodal reentry tachycardia (avnrt) -circuits within avn
Atrial fibrillation
Atrial flutter with variable block ( atrial rhythm regular but ventricular rhythm irregular)
Multifocal atrial tachycardia - often associated with COPD

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13
Q

What is the management of narrow complex tachycardia?

A

If the patient is compromised then direct current cardioversion
Identify and treat the underlying rhythm e.g. correcting hypoxia and hypercapnia in multifocal copd tachycardia
AVN blockade can be used if a reenterant current is being transmitted.

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14
Q

Which two methods can produce a transient AVN block to aid in diagnosis of re-entry tachycardia?

A

Vagal manoeuvres e.g. blowing into syringe
IV adenosine
If it is a re-entry current then this AVN block will allow sinus rhythm to resume

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15
Q

What is holiday heart syndrome?

A

Binge drinking can result in acute cardiac rhythms in people without underlying cardiac disease. Abstinence from drinking will cause if to resolve.

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16
Q

What is the definition of broad complex tachycardia?

A

This is a heart rate of greater than 100 and qrs complexes greater than 120ms. If there is no clear qrs then it is VF or asystole

17
Q

How should you manage a broad complex tachycardia?

A

Presume that it is VT rather than SVT because if you treat as SVT and give AVN blocking agents this can cause haemodynamic instability
Get help fast as the patient may be peri arrest
Identify underlying rhythm and if in doubt treat as VT
Cardiac monitor and monitor o2, give if <90%
Are there adverse signs (shock, chest pain/ischaemia on ecg, heart failure, syncope)
If yes get expert help and DC cardiovert
Correct any electrolyte imbalances e.g. hypokalaemia, hypomagnesaemia
If no adverse signs than need to assess rhythm

18
Q

What are the differentials for broad complex tachycardia?

A

VT - single ventricular ectopics, if greater than 3 together at >100bpm this is VT
SVT
Pre excited tachycardias e.g. wolff-parkinson-white

19
Q

After cardioversion how is broad complex tachycardia managed?

A

If VT then give amiodarone

If known history of SVT then can give adenosine however if misdiagnosed this will make VT worse

20
Q

What is torsade de pointes?

A

This is a broad complex tachycardia wih a constantly varying axis

21
Q

What is the definition of AF?

A

A chaotic, irregular rhythm at 300-600bpm, AV node responds intermittently hence an irregular ventricular rhythm

22
Q

What are the common causes of AF?

A

Hypertension, heart failure, IHD, PE, mitral disease

23
Q

What are the symptoms of AF?

A 
Can be asymptomatic
Chest pain
Palpatations
Dyspnoea
Faintness
Will feel a irregularly irregular pulse
24
Q

What will an ecg of AF show?

A

Shows there to be absent P waves and irregular qrs complexes

25
Q

What tests should be done for suspected AF?

A 
U and Es
Thyroid function tests
Cardiac enzymes
Echo
ECG
26
Q

What is the management for acute AF?

A 
If patient has adverse signs then ABCDE and get senior help for cardioversion
Choose rate or rhythm control
Give amiodarone for rhythm control
OR
Give beta blockers for rate control
Start heparin as anticoagulant
Correct electrolyte imbalances
27
Q

What is the management for chronic AF?

A

Main goals are rate control and anticoagulation
Beta blocker (bisoprolol) or rate limiting CA channel blocker first line (verapamil)
Do not give together
Can use rhythm contorl if symptomatic, younger, ccf or presenting for first time with AF
rhythm control: DC cardioversion or pharmacological with flecaine
PRN flecaine can be used for pill in pocket approach
Anticoagulate with either Doacs (apixiban) or Warfrin

28
Q

If AF was >48 hours ago what must be done before elective cardioversion?

A

Need to have three weeks of heparin anticoagulation

CAn use DOAC (apixiban) or warfarin in high risk of emboli

29
Q

What scoring system is used for embolic stroke risk and what are the components?

A 
CHA2DS2-VaSc
C-Congestive heart failure (1)
H-Hypertension (1)
A-Age 65-74 (1)
A-age over 74 (2)
D-Diabetes (1)
S-Previous stroke/thromboembolism (2)
Va-Vascular disease (1)
Sc - Sex Category - 1 if female
Score of 2 = annual stroke risk of 2.2%
30
Q

What is the scoring system and components for assessing risks of anticoagulation?

A 
Has-bled
Hypertension - 1
Abnormal renal/liver - 1 or 2
Stroke - 1 
Bleeding history or disposition - 1
Labile INR - 1
Elderly over 65 - 1
Drugs/alcohol - 1 or 2
31
Q

What are the indications for temporary cardiac pacing?

A 
Bradycardia unresponsive to atropine
After acute anterior MI causing:
-Complete AV block (3rd degree)
-Mobitz type 1
-Mobitz type 2
Suppression of drug resistant tachyarrhythmias by overactive pacing (SVT and VT)
Special situations e.g. drug overdose
32
Q

What are the indications for a permanent pacemaker?

A

Complete AV block (stokes adams attacks etc.)
Mobitz type II block
Symptomatic bradycardia
Persistent AV block after MI
Heart failure (cardiac resynchronisation therapy)

33
Q

What is cardiac resynchronisation therapy?

A

In heart failure it is biventricular pacing to improve synchronisation of contraction and reduce mortality

34
Q

What is wolff-parkinson white syndome?

A

This is caused by a congenital accessory AV conduction pathway. This leads to short PR interval and wide QRS. Can cause AVRT and can be treated by ablation of the pathway.

35
Q

What are the main causes of loss of consiousness?

A 
Traumatic
Non traumatic:
-Cardiovascular - Reflex syncope, postural hypotension, arrhythmic, structual heart disease
-Neurogenic - TIA, epilepsy
-Metabolic - intoxication, hypoglycaemia
36
Q

What sort of questions should you ask about a syncope episode?

A

Preceding symptoms - palpatations, abdominal discomfort, nausea
Immediately before - sitting/standing, activity
Afterwards - any confusion, weakness, disorientation

37
Q

How is valve disease assocaited with heart block?

A

Aortic valve is next to AV node so calcification can cause block and can also be caused by valve sugery

SpM Cardiology (7 decks)

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