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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
Q

What are the signs of Digoxin toxicity?

A 
N&amp;V&amp;D
Blurred/ yellow vision
Confusion
HypoK exacerbates Sx
ECG: Prolonged PR, inverted T waves, ST depression, U waves
26
Q

What is atrial flutter?

A

Re-entrant rhythm in L or R atrium causing an endless loop by over-riding SA node
Contracts at >300bpm

27
Q

What are the types of atrial flutter?

A

T1: Typical, 240-350 bpm, single circuit around tricuspid valve, counter clockwise
T2: Atypical, >350 bpm, location less defined

28
Q

What are the risk factors for atrial flutter?

A 
Male
↑age
CAD
Valve dysfunction
HTN
Obesity
OH- 
COPD
Obstructive sleep apnoea
Thyrotoxicosis
29
Q

How is atrial flutter investigated?

A

ECG- GOLD STANDARD
Bloods: TFT, FBC, ESR, U&E, LFT, Coag
CXR: Signs of HF
ECHO

30
Q

How is acute unstable atrial flutter managed?

A

HF/Syncope/MI/Shock

DC Shock x3 → Amiodarone 300mg IV → Shock → Amiodarone 900mg

31
Q

How is acute stable atrial flutter managed?

A

Vagal manoeuvres
Adenosine 6mg Iv → 12mg x2
Rate control: BB/ CCB

32
Q

How is atrial flutter for >48hours treated?

A

1) Catheter ablation
2) Anticoagulate + Amiodarone (4 wks) → DC shock → Anticoagulate (4wks)
3) Rate control
4) Pacemaker

33
Q

What is the mechanism of VT?

A

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
Q

What are the 2 types of VT?

A

Monomorphic: COMMON, Regular rhythm originating from single focus with IDENTICAL QRS complexes
Polymorphic: Irregular rhythm, VARIATION in QRS complexes

35
Q

What are the risk factors for VT?

A 
IHD
Trauma
Hypoxia
Acidosis
Long QT 
HypoK/Ca/Mg
36
Q

How does VT present?

A 
Palpitations
Dizziness
SOB/ Resp distress
Tachycardia
Pallor
!!! = HypoT, HF, MI, Syncope, Pulseless, Chest pain
37
Q

How is VT investigated?

A

ECG: Regular tachycardia, Broad QRS, absent P waves
Bloods: U&E!!, Ionised Ca2+, PO4-, Troponin

38
Q

How is VT managed?

A 
Oxygen
IV Access
1) Amiodarone 300mg IV over 20-60mins
THEN
900mg IV over 24hrs
Replenish electrolytes 
Implantable cardioverter defibrillator
39
Q

How is pulseless VT or VF treated?

A

Unsynchronised Defibrillation

CPR

40
Q

Which patients with VT are eligible for a implantable defibrillator?

A

Sustained VT causing:
Syncope OR EF <35%
Prev cardiac arrest due to VT/VF
MI

41
Q

What are the complications of VT?

A

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
Q

What is VF?

A

MEDICAL EMERGENCY
Ventricle muscle fibres fibrillate in uncoordinated, unsynchronised manner → insufficient blood pumping around body → cardiac arrest + sudden cardiac death

43
Q

Which rhythms are shockable and which are not?

A 
YES = VF &amp; VT
NO = PEA &amp; Asystole
44
Q

What are the risk factors for VF?

A 
IHD/CAD
MI
Hypoxia
AF
Electric shock during cardioversion
Long QT
WPW Syndrome
Electrolyte imbalance
45
Q

How does VF present?

A

INITIAL: Chest pain, palpitations, fatigue
THEN: Sudden loss of responsiveness, ABSENT breathing & pulse

46
Q

How is VF investigated?

A

ECG: 500bpm, no P/QRS/T waves
Bloods: CK, Trop, U&E, TFT

47
Q

How is VF managed?

A

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
Q

What are the reversible causes of cardiac arrest?

A

4 H’s + 4 T’s

  • Hypothermia
  • Hypoxia
  • Hyper/hypokalaemia
  • Hypovolaemia
  • Toxins
  • Tamponade
  • Tension PT
  • Thrombus (coronary/pulmonary)
49
Q

How is refractory VF managed?

A

Consider Vasopressin: 40u bolus ADH

Output restored: Amiodarone 300mg IV → 900mg 24/h infusion

Yr 5 Cardiology (8 decks)

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