Arrhythmias

Question 1

What are the causes of arrythmias?

Answer 1

• Cardiac
  
  • MI
  • Coronary artery disease
  • LV aneurysm
  • Mitral valve disease
  • Cardiomyopathy
  • Pericarditis
  • Myocarditis
  • Aberrent conduction pathways
• Non-cardiac
  
  • Caffeine
  • Smoking
  • Alcohol
  • Pneumonia
  • Drugs
  • Metabolic imbalances
  • Phaeochromocytoma

Question 2

What are the drugs that cause arrythmias?

Answer 2

• Beta-agonists
• Digoxin
• L-dopa
• Tricyclics
• Doxorubicin

Question 3

What are the metabolic imbalances that cause arrythmias?

Answer 3

• K+
• Ca2+
• Mg2+
• Hypoxia
• Hypercapnia
• Metabolic acidosis
• Thyroid disease

Question 4

How do arrythmias present?

Answer 4

• Typically sudden onset palpitations
• Chest pain
• Syncope
• Hypotension
• Dyspnoea
• Pulmonary oedema
• They are also often asymptomatic and found incidentally on ECGs
  
  • AF

Question 5

What tests should be carried out in investigation of arrythmias?

Answer 5

• Blood tests
  
  • FBC
  • U&Es
  • TFTs
  • Glucose
  • Ca2+
  • Mg2+
• ECG
  
  • Look for signs of:
    
    1. heart block
    2. AF
    3. Atrial flutter
    4. Long QT
    5. Short PR interval
• Echo
  
  • Any structural heart changes
• 24 hour ECG, prolonged recording, alive cor app

Question 6

How are arrythmias treated?

Answer 6

• If the ECG trace is normal while the patient is having their palpitations, then reassure them
• If the ECG trace is not normal, then treatment depends on the diagnosis and type of arrythmia

Question 7

How are arrythmias managed?

Answer 7

• Conservatively - some can be treated by reducing alcohol intake
• Medical treatment - regular tablets or a ‘pill in the pocket’
• Interventional
  
  • Pacemakers
  • Ablation
  • Implantable cardioverter defibrillators