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Cardio > Arrhythmias > Flashcards

Arrhythmias Flashcards

1
Q

List the different brady-arrythmias

A

Sick sinus syndrome
AV block
RBBB
LBBB

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2
Q

What are the supraventricular tachycardias?

A

Atrial fibrillation

Atrial flutter

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3
Q

What are the different ventricular arrhythmias?

A

Ventricular fibrillation
Ventricular tachycardia
Torsades de pointes

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4
Q

What occurs in Wolff-Parkinson-White Syndrome?

A

In WPW the accessory patheway (Bundle of Kent) is used which causes premature ventricular contraction. This manifests with delta waves in an ECG (slurred upstroke) and widening of the QRS complex.

The PR interval is short.

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5
Q

What are the complications of WPW syndrome?

A 
Cardiogenic shock (due to atrial tachycardia) 
AVRT (atrio-ventricular re-entrant tachycardia)
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6
Q

What are Holter monitors?

A

An ECG monitor which a patient wears for 24h-7days a week while they go about their normal life

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7
Q

What is sick sinus syndrome?

A

Caused by sinus node fibrosis
Leads to either sinus bradycardia or tachyarrhythmias

Symptoms are syncope, palpitations, breathlessness and light headnedness

Some patients develop ‘tachy brady’ syndrome

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8
Q

What are the different narrow complex tachycardias (both regular rhythm and irregular)?

A 
Regular rhythm
Sinus tachycardia 
Focal atrial tachycardia 
Atrial flutter
AVRT

Irregular
Atrial fibrillation
Multifocal atrial tachycardia

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9
Q

What are the three main causes of AF?

A

Ischaemic heart disease
Rheumatic heart disease
Thyrotoxicosis

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10
Q

What are the types of AF?

A

Paroxysmal (<7 days)
Persistent (>7 days)
Permanent

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11
Q

What are the features of AF?

A

Irregularly irregular pulse
Tachycardia
No P waves

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12
Q

If a patient presents with AF and adverse signs (chest pain, heart failure, syncope), what is the management?

A

ABCDE
DC cardioversion
Amiodarone if unsuccessful

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13
Q

If a patient presents with AF <48h and is stable, what is the management?

A

Rhythm control: Heparin, DC cardioversion or amiodarone

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14
Q

If a patient presents with AF >48h and is stable, what is the management?

A

Rhythm control: anticoagulate for 3 weeks then DC cardioversion
Or
Rate control: Bisoprolol or diltiazem

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15
Q

How do you manage chronic AF?

A

Rate control: BB or diltiazem, if this fails add digoxin, if this fails add amiodarone

Rhythm control: elective DC cardioversion or flecainide

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16
Q

How do you manage paroxysmal AF?

A

Pill in the pocket (flecainide)

Anticoagulate

17
Q

What are the principles of anticoagulation in patients with AF?

A

Risk assess using CHADSVASc and HAS-BLED
Warfarin: target INR is 2-3
NOACs: RAD (rivaroxaban, apixaban, dabigatran)

18
Q

How do you treat AVRT secondary to WPW?

A

Flecainide,
Propafenone
or
Amiodarone

19
Q

What does torsades de pointes look like on an ECG?

A

VT with a varying axis

Increased QT interval can cause this

20
Q

If a patient presents with a supraventricular tachycardia with no adverse signs and with a regular rhythm, what is the management?

A

Continuous ECG trace
Vagal manoeuvres
If these fail, give adenosine

21
Q

If a patient presents with VT, has no adverse signs, and has a regular rhythm, what is the management?

A

Amiodarone

If no success or becomes unstable, DC cardioversion

22
Q

If a patient presents with a bradycardia with adverse features, what is the management?

A

Atropine

If not a satisfactory response, can increase atropine to 3mg or then do trancutaneous pacing or give adrenaline

23
Q

What are the investigations for palpitations?

A

12 lead ECG
TFTs
Urea and electrolytes
FBC

Holter monitoring

Loop recorders

24
Q

When taking a history of palpitations, what is important to ask in it?

A 
Family history of sudden unexplained death
Thyroid disorders
GI disorders
Anaemia
Lung disease
Anxiety
Cardiomyopathy

Thyroixine, TCAs, amlodipine

Caffeine

Take a pulse rate

25
Q

What are the red flag symptoms of palpitations?

A 
Chest pain
Acute dizziness or syncope
SOB
Hypotension
Focal neurological symptoms
26
Q

What are the side effects of quinidine?

A

quinidine toxicity (thrombocytopaenia, headache)

27
Q

What are the side effects of procainamide?

A

drug induced lupus

28
Q

What are the side effects of amiodarone?

A 
Pulmonary fibrosis
Hypo/hyperthyroidism
Peripheral neuropathy 
Corneal deposits
Liver cirrhosis
Prolonged QT
29
Q

When can flecainide be used?

A

in AF when NO structural abnormality is present

30
Q

What antibiotic can cause torsades de pointes?

A

Erythromycin/clarithromycin as this prolongs the QT interval

31
Q

What should post-stroke AF patients be started on?

A

Anticoagulation

Usually 5mg apixaban

32
Q

What is the most common cause of death following a MI?

A

Ventricular fibrillation

33
Q

When is rate control not offered first line in patients with AF?

A

If the patient with AF has;

1) A reversible cause of their AF
2) First onset AF
3) Coexistent heart failure

Cardio (10 decks)

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