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Yr 5 Cardiology > Arrhythmias > Flashcards

Arrhythmias Flashcards

1
Q

What is an SVT?

A

Narrow complex tachyarrhythmia

Abnormally fast HR arising from atrium

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2
Q

What are the main types of SVT?

A

AF
Paroxysmal SVT
Atrial flutter
WPW Syndrome

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3
Q

What are the risk factors for an SVT?

A 
Prev SVT
Structural abnormality
Alcohol
↑T4
Caffeine
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4
Q

What are the signs of someone in SVT?

A 
Palpitations
SOB
Dizziness
Tachycardia 
Anxiety
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5
Q

What is seen on an ECG of SVT?

A

Narrow QRS complexTachycardia >140
WITH P waves (may merge into QRS)
WITHOUT P waves = AF

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6
Q

How is SVT managed?

A

Conservative for REGULAR SVT: Vagal manoeuvres/ carotid massage 10s per side
Chemical for REGULAR SVT: Adenosine 6mg IV rapid - flush w/20ml saline, repeat w/12mg x2
Definitive: Pathway ablation

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7
Q

What is WPW Syndrome?

A

Re-entrant tachycardia from accessory conduction pathway between Atria & ventricles
BUNDLE OF KENT

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8
Q

What does an ECG of someone with WPW syndrome look like?

A

Tachycardia
Wide QRS
Short PR
Delta waves in V1

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9
Q

How is WPW Syndrome treated?

A

REFER to cardiology

1) Flecanide/amiodarone
2) Accessory pathway ablation

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10
Q

What medications are best avoided in WPW Syndrome? Why?

A

Beta Blockers
CCB
Adenosine
Can precipitate VT/VF

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11
Q

What is AVNRT?

A

1st beat fast conduction
New beat goes through slow conduction
Causes retrograde re-entrant conduction
Tx: As narrow complex tachycardia

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12
Q

What is the mechanism behind AF?

A 
Disorganised electrical impulses
AV node responds intermittently
Atrial spasm
Abnormal ventricular rate
Ineffectively primed ventricles 
↓CO
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13
Q

What are the causes of AF?

A 
PIRATES:
P: PE
I: IHD & HF (MOST COMMON), MI
R: Resp disease
A: Atrial enlargement (MV disease) or myxoma,
T: Thyroid disease (hyper)
E: Ethanol (“Holiday heart” after binging), caffeine 
S: Sepsis or Sleep apnoea
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14
Q

What are the different types of AF?

A

Acute: Onset <48hours
Recurrent: >2 episodes
Paroxysmal: AF resolves spontaneously in 7d
Persistent: >2 episodes, not self-limiting, requires cardioversion
Permanent: >1yr cannot resolve w/cardioversion

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15
Q

How is AF investigated?

A

ECG: Irregularly irregular R-R intervals, absent P waves,
Bloods: TFTs, U&E, LFT, FBC, HbA1c
ECHO: LA enlargement, mitral valve disease

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16
Q

How is acute AF managed?

A

<48 hours!!
1) Cardioversion
Electrical: DC 120J shock under sedation
Chemical: Flecainide/ Amiodarone

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17
Q

What 2 groups of patients with stable AF are at risk of becoming unstable?

A

1) Patients with poor LV function

2) Whose where AF results very high HR (>150) leading to inadequate LV filling + ↓CO

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18
Q

What do the different CHADs-VASC scores correlate to in terms of treatment?

A

OFFER anticoagulant to ALL scoring >2
CONSIDER anticoagulant to MEN scoring 1
1) NOAC 2) Warfarin 3) Aspirin

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19
Q

What HAS-BLED score would indicate no anticoagulation?

A

> 2

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20
Q

When should Flecainide/ Amiodarone be used/ not used in chemical cardioversion?

A

F: If NO structural abnormalities & no ischaemia
A: If Are structural abnormalities

21
Q

How is AF presenting >48hours managed?

A

1) RATE Control: Beta-Blocker/ CCB
2) RHYTHM Control: Persistent AF- anticoagulate for 3w + Amiodarone for 4w before
THEN DC Cardioversion + Amiodarone for 12m after + anticoagulation 4w afterwards

22
Q

According to NICE who does not need to be rate controlled?

A
  • AF with reversible cause
  • HF primarily caused by AF
  • New onset AF (<48hrs)
  • Rhythm control strategy would be more suitable
23
Q

What surgery can be offered to someone in AF?

A 
LA ablation (rhythm control) if drugs failed
LA appendage occlusion
24
Q

If someone presents with AF + abdominal pain what diagnosis should be considered?

A

Mesenteric ischaemia!

25
What are the signs of Digoxin toxicity?
``` N&V&D Blurred/ yellow vision Confusion HypoK exacerbates Sx ECG: Prolonged PR, inverted T waves, ST depression, U waves ```
26
What is atrial flutter?
Re-entrant rhythm in L or R atrium causing an endless loop by over-riding SA node Contracts at >300bpm
27
What are the types of atrial flutter?
T1: Typical, 240-350 bpm, single circuit around tricuspid valve, counter clockwise T2: Atypical, >350 bpm, location less defined
28
What are the risk factors for atrial flutter?
``` Male ↑age CAD Valve dysfunction HTN Obesity OH- COPD Obstructive sleep apnoea Thyrotoxicosis ```
29
How is atrial flutter investigated?
ECG- GOLD STANDARD Bloods: TFT, FBC, ESR, U&E, LFT, Coag CXR: Signs of HF ECHO
30
How is acute unstable atrial flutter managed?
HF/Syncope/MI/Shock | DC Shock x3 → Amiodarone 300mg IV → Shock → Amiodarone 900mg
31
How is acute stable atrial flutter managed?
Vagal manoeuvres Adenosine 6mg Iv → 12mg x2 Rate control: BB/ CCB
32
How is atrial flutter for >48hours treated?
1) Catheter ablation 2) Anticoagulate + Amiodarone (4 wks) → DC shock → Anticoagulate (4wks) 3) Rate control 4) Pacemaker
33
What is the mechanism of VT?
Ventricular ectopic focus → Ventricular pacemaker cells overtake rate of SA node → Broad complex tachycardia w/ ≥ 3 premature ventricular contractions in succession at rate > 120bpm
34
What are the 2 types of VT?
Monomorphic: COMMON, Regular rhythm originating from single focus with IDENTICAL QRS complexes Polymorphic: Irregular rhythm, VARIATION in QRS complexes
35
What are the risk factors for VT?
``` IHD Trauma Hypoxia Acidosis Long QT HypoK/Ca/Mg ```
36
How does VT present?
``` Palpitations Dizziness SOB/ Resp distress Tachycardia Pallor !!! = HypoT, HF, MI, Syncope, Pulseless, Chest pain ```
37
How is VT investigated?
ECG: Regular tachycardia, Broad QRS, absent P waves Bloods: U&E!!, Ionised Ca2+, PO4-, Troponin
38
How is VT managed?
``` Oxygen IV Access 1) Amiodarone 300mg IV over 20-60mins THEN 900mg IV over 24hrs Replenish electrolytes Implantable cardioverter defibrillator ```
39
How is pulseless VT or VF treated?
Unsynchronised Defibrillation | CPR
40
Which patients with VT are eligible for a implantable defibrillator?
Sustained VT causing: Syncope OR EF <35% Prev cardiac arrest due to VT/VF MI
41
What are the complications of VT?
VF often proceeds! Torsades de pointes (Tx IV Mg) Congestive HF → ↓preload, due to fast ventricular rate → ↓blood flow to vital organs Cardiogenic Shock
42
What is VF?
MEDICAL EMERGENCY Ventricle muscle fibres fibrillate in uncoordinated, unsynchronised manner → insufficient blood pumping around body → cardiac arrest + sudden cardiac death
43
Which rhythms are shockable and which are not?
``` YES = VF & VT NO = PEA & Asystole ```
44
What are the risk factors for VF?
``` IHD/CAD MI Hypoxia AF Electric shock during cardioversion Long QT WPW Syndrome Electrolyte imbalance ```
45
How does VF present?
INITIAL: Chest pain, palpitations, fatigue THEN: Sudden loss of responsiveness, ABSENT breathing & pulse
46
How is VF investigated?
ECG: 500bpm, no P/QRS/T waves Bloods: CK, Trop, U&E, TFT
47
How is VF managed?
ALS: CPR 30:2 (continuous compressions when advanced airway support) 1st SHOCK: Stand clear, remove O2, defibrillator to 150J CPR for 2 mins 2nd SHOCK CPR for 2mins 3rd SHOCK CPR for 2mins ADRENALINE 1mg IV 10ml 1:10000 AMIODARONE 300mg IV Give Adrenaline after every alternate shock (5th, 7th, 9th..)
48
What are the reversible causes of cardiac arrest?
4 H's + 4 T's - Hypothermia - Hypoxia - Hyper/hypokalaemia - Hypovolaemia - Toxins - Tamponade - Tension PT - Thrombus (coronary/pulmonary)
49
How is refractory VF managed?
Consider Vasopressin: 40u bolus ADH | Output restored: Amiodarone 300mg IV → 900mg 24/h infusion

Yr 5 Cardiology (8 decks)

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