Arrhythmias Flashcards
List the different brady-arrythmias
Sick sinus syndrome
AV block
RBBB
LBBB
What are the supraventricular tachycardias?
Atrial fibrillation
Atrial flutter
What are the different ventricular arrhythmias?
Ventricular fibrillation
Ventricular tachycardia
Torsades de pointes
What occurs in Wolff-Parkinson-White Syndrome?
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.
What are the complications of WPW syndrome?
Cardiogenic shock (due to atrial tachycardia) AVRT (atrio-ventricular re-entrant tachycardia)
What are Holter monitors?
An ECG monitor which a patient wears for 24h-7days a week while they go about their normal life
What is sick sinus syndrome?
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
What are the different narrow complex tachycardias (both regular rhythm and irregular)?
Regular rhythm Sinus tachycardia Focal atrial tachycardia Atrial flutter AVRT
Irregular
Atrial fibrillation
Multifocal atrial tachycardia
What are the three main causes of AF?
Ischaemic heart disease
Rheumatic heart disease
Thyrotoxicosis
What are the types of AF?
Paroxysmal (<7 days)
Persistent (>7 days)
Permanent
What are the features of AF?
Irregularly irregular pulse
Tachycardia
No P waves
If a patient presents with AF and adverse signs (chest pain, heart failure, syncope), what is the management?
ABCDE
DC cardioversion
Amiodarone if unsuccessful
If a patient presents with AF <48h and is stable, what is the management?
Rhythm control: Heparin, DC cardioversion or amiodarone
If a patient presents with AF >48h and is stable, what is the management?
Rhythm control: anticoagulate for 3 weeks then DC cardioversion
Or
Rate control: Bisoprolol or diltiazem
How do you manage chronic AF?
Rate control: BB or diltiazem, if this fails add digoxin, if this fails add amiodarone
Rhythm control: elective DC cardioversion or flecainide
How do you manage paroxysmal AF?
Pill in the pocket (flecainide)
Anticoagulate
What are the principles of anticoagulation in patients with AF?
Risk assess using CHADSVASc and HAS-BLED
Warfarin: target INR is 2-3
NOACs: RAD (rivaroxaban, apixaban, dabigatran)
How do you treat AVRT secondary to WPW?
Flecainide,
Propafenone
or
Amiodarone
What does torsades de pointes look like on an ECG?
VT with a varying axis
Increased QT interval can cause this
If a patient presents with a supraventricular tachycardia with no adverse signs and with a regular rhythm, what is the management?
Continuous ECG trace
Vagal manoeuvres
If these fail, give adenosine
If a patient presents with VT, has no adverse signs, and has a regular rhythm, what is the management?
Amiodarone
If no success or becomes unstable, DC cardioversion
If a patient presents with a bradycardia with adverse features, what is the management?
Atropine
If not a satisfactory response, can increase atropine to 3mg or then do trancutaneous pacing or give adrenaline
What are the investigations for palpitations?
12 lead ECG
TFTs
Urea and electrolytes
FBC
Holter monitoring
Loop recorders
When taking a history of palpitations, what is important to ask in it?
Family history of sudden unexplained death Thyroid disorders GI disorders Anaemia Lung disease Anxiety Cardiomyopathy
Thyroixine, TCAs, amlodipine
Caffeine
Take a pulse rate
What are the red flag symptoms of palpitations?
Chest pain Acute dizziness or syncope SOB Hypotension Focal neurological symptoms
What are the side effects of quinidine?
quinidine toxicity (thrombocytopaenia, headache)
What are the side effects of procainamide?
drug induced lupus
What are the side effects of amiodarone?
Pulmonary fibrosis Hypo/hyperthyroidism Peripheral neuropathy Corneal deposits Liver cirrhosis Prolonged QT
When can flecainide be used?
in AF when NO structural abnormality is present
What antibiotic can cause torsades de pointes?
Erythromycin/clarithromycin as this prolongs the QT interval
What should post-stroke AF patients be started on?
Anticoagulation
Usually 5mg apixaban
What is the most common cause of death following a MI?
Ventricular fibrillation
When is rate control not offered first line in patients with AF?
If the patient with AF has;
1) A reversible cause of their AF
2) First onset AF
3) Coexistent heart failure
