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Cardiology: Key Information > Arrhythmias > Flashcards

Arrhythmias Flashcards

1
Q

define an arrhythmia

A

abnormal heart rhythm

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2
Q

presentation of arrhythmias

A
  • palpitations
  • SOB
  • syncope and presyncope
  • angina
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3
Q

diagnosis of arrhythmias

A
  • ECG
  • echocardiogram
  • EP study (mechanism of arrhythmia)
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4
Q

define sinus arrhythmia

A

this is reflex changes in vagal tone during the respiratory cycle e.g. inspiration causes the heart rate to increase

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5
Q

define bradycardia

A

sinus heart rate of less than 60bpm

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6
Q

management for bradycardia

A
  • atropine

- second line is adrenaline or dobutamine

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7
Q

define sinus tachycardia

A

sinus heart rate of above 100bpm

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8
Q

management for sinus tachycardia

A

beta blockers

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9
Q

management for SVT

A

adenosine

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10
Q

define heart block

A

abnormally slow heart rate where conduction does not conduct through the AV node

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11
Q

First degree heart block

A

PR interval of longer than 0.2 seconds

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12
Q

management for first degree heart block

A

only if symptomatic

  • beta blockers
  • CCBs
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13
Q

mobitz type I

A

progressively lengthening PR interval until a beat is dropped

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14
Q

management for mobitz type I

A

only if symptomatic

  • beta blockers
  • CCBs
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15
Q

mobitz type II

A

2:1 or 3:1 ratio

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16
Q

management of mobitz type II

A

digoxin or
beta blockers or
CCBs or
(ICDs)

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17
Q

third degree heart block

A

no action potentials conduct through the AV node

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18
Q

management of third degree heart block

A

digoxin or
beta blockers or
CCBs or
ventricular pacing e.g. ICD

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19
Q

management of VF

A

defibrillation

ICD

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20
Q

management of haemodynamically unstable VT

A

synchronised cardioversion

amiodarone (second line is lidocaine)

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21
Q

management for torsades de pointes (polymorphic VT)

A

magnesium sulfate

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22
Q

management of polymorphic VT

A

beta blockers

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23
Q

management of VT if pre-existing structural heart disease

A

adenosine

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24
Q

management of VT after MI

A

procainamide

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25
Q

define WPW syndrome

A

this is AV re-entrant tachycardia which has a delta wave on ECG

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26
Q

management of unstable WPW

A

DC cardioversion

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27
Q

management of stable WPW

A

first line: carotid massage or valsalva manoeuvre
second line: adenosine
third line: pacemaker
fourth line: DC conversion

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28
Q

management of long QT syndrome (VT)

A
  • lifestyle avoiding strenuous sports e.g. swimming
  • beta blockers
  • ICD
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29
Q

management of Brugada syndrome

A

ST elevation in V1-V3

  • DC cardioversion
  • beta blockers
  • catheter ablation
30
Q

presentation of AF

A
  • irregularly irregular pulse
  • palpitations
  • syncope
31
Q

diagnosis of AF

A

ECG

absent P waves and atrial rate >300bpm

32
Q

management for haemodynamically unstable AF

A

DC cardioversion

33
Q

management for haemodynamically stable AF

A
  • beta blockers (or CCBs if heart failure)

- anticoagulation using CHA2DS2VAS score

34
Q

CHA2DS2VAS score

A 
congestive heart failure 1
hypertension 1
age 75 and above 2
diabetes 1
stroke 2
vascular disease 1
age 65-74 1
sex (female) 1
max. total = 9
35
Q

management of persistent or paroxysmal AF

A 
unstable = DCCV
stable = beta blockers or CCBs and anticoagulation
36
Q

ECG of atrial flutter

A

saw tooth baseline 150bpm

37
Q

management for unstable atrial flutter

A

synchronised cardioversion

38
Q

management for stable atrial flutter

A

beta blocker or CCB (verapamil) or amiodarone

anticoagulation

39
Q

how to define a narrow complex tachycardia?

A

> 100bpm

QRs <120ms

40
Q

how to treat AVRT and AVNRT?

A

transiently blocking the AVN without slowing conduction

41
Q

management of AVRT and AVNRT

A

vagal manoeuvres= carotid sinus massage, valsalva manoeuvre

IV adenosine

42
Q

what is the pathway of AVRT?

A

atria > ventricles > accessory pathway > atria

orthodromic

43
Q

management of AF + WPW

A

avoid AV node blockers such as diltiazem, verapamil and digoxin

use flecainide

44
Q

what are Stokes-Adams attacks?

A

loss of consciousness caused by AV node block (3rd degree)

45
Q

what is focal atrial tachycardia?

A

group of atrial cells acting as pacemaker, outpacing SAN so P wave shape is different

46
Q

what is the rate in atrial flutter?

A

300 times a minute, so ventricle contractions are a division (150,100,75)

NEEDS ANTICOAGULATION

47
Q

what are Stokes-Adams attacks?

A

loss of consciousness caused by AV node block (3rd degree)

48
Q

do you need to anticoagulate a patient if AF began 48 hours prior to admission before DC cardioversion?

A

yes as risks pushing clot to the brain

49
Q

acute management of AF

A 
DC cardioversion (120-150J)
amiodarone if fails
50
Q

management of stable AF that has been present for <48 hours

A

flecainide or cardiovert or amiodarone (if structural heart disease)

start heparin in case delayed

51
Q

management of stable AF that has been present for >48 hours

A

patient must be anticoagulated for at least 3 weeks (echo for intracardiac thrombi)

52
Q

management of paroxysmal AF

A

pill in pocket (sotalol or flecainide PRN)

53
Q

what is bigeminy?

A

ectopic every second beat

54
Q

what is trigeminy?

A

ectopic every 3rd beat

55
Q

what is a fusion beat?

A

normal beat fuses with a VT complex causing an unusual complex

56
Q

what is a capture beat?

A

normal QRS amongst a run of VT

57
Q

indications for a pacemaker

A 
AV block (stoke-Adams, asymptomatic, congenital)
mobitz type II
persistent AV block after anterior MI
symptomatic bradycardia
heart failure
drug resistance to tachyarrhythmias
58
Q

what is given prior to insertion of pacemaker?

A

antibiotics

59
Q

what drug may reveal underlying atrial flutter?

A

adenosine

60
Q

examples of narrow complex tachycardias

A 
AVNRT
AVRT
atrial tachycardia
AF
atrial flutter
pacemaker
61
Q

what does AVNRT have?

A

two input pathways (slow and fast)

62
Q

ECG findings in AVNRT

A

P wave visible within T wave

V1 and II best places to look

63
Q

direction in AVRT (WPW)

A 
retrogradely up the node (antidromic tachycardia)
delta wave (slurred upstroke QRS)
64
Q

how to generate AV block

A

vagal manoeuvres= carotid massage, valsalva, sudden immersion in cold water
adenosine

65
Q

caution in use of adenosine when?

A

asthmatic

66
Q

feature of ventricular tachycardias

A

broad QRS

67
Q

examples of ventricular tachycardias

A

VPCs
VT
ventricular escape rhythm
VF

68
Q

ventricular complex bigeminy

A

1 sinus beat coupled with VPC

69
Q

ventricular complex trigemeny

A

1 sinus beat coupled with 2VPC

70
Q

cardiac arrest rhythms

A 
VT
VF
complete AV block
PEA
terminal rhythm sequence
71
Q

ECG ventricular hypertrophy

A

R wave V5 orV6 >35mm (less in other criteria’s 20 in women and 28 in men)

Cardiology: Key Information (42 decks)

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