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Cardiology > Arrhythmias > Flashcards

Arrhythmias Flashcards

1
Q

What are the 2 shockable rhythms?

A

VF

VT

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2
Q

What are causes of narrow complex tachycardia?

A

AF
Atrial flutter
Supraventricular tachycardias

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3
Q

How do you treat AF?

A

Rate control with BB or diltiazem

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4
Q

How do you manage atrial flutter?

A

Control rate with BB or cardioversion
Radiofrequency ablation of reentrant rhythm
Antocoag based on CHA2DS2VASC

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5
Q

How do you manage supraventricular tachycardias in stable patients?

A
  1. Vagal manouvres (blow hard against resistance)
  2. Carotid sinus massage
  3. Adenosine or Verapimil
  4. Direct current cardioversion
    Monitor ECG throughout
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6
Q

How do you manage VT

A

Amiodarone infusion through central line
Lidocaine with caution if severe
Procainamide
If adverse( (low BP etc) cardioversion if drugs fail (impanted cardioverter)

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7
Q

What causes broad complex tachycardias?

A

VT

SVT with BBB

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8
Q

WHat causes atrial flutter?

A

Re-entrant rhythms in the atria

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9
Q

WHat speed is the atria stimulated at in atrial flutter?

A

300 bpm

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10
Q

What conditions is atrial flutter associated with?

A

HTN
Ischaemic heart disease
Cardiomyopathy
Thyrotoxicosis

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11
Q

What causes SVT?

A

Re-entrant circuits to the atria from the ventricles.

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12
Q

What does SVT look like on ECG?

A

QRS with T immediately after, then QRS again

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13
Q

What are the 3 kinds of SVT?

A

Atrioventricular nodal re-entrant (re-enters through AV node)
Atrioventricular re-entrant tachycardia- accessory pathway (WPW)
Atrial tachycardia- originally comes from somewhere other than SAN. Causes atrial rate of >100

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14
Q

How does adenosine work?

A

Slows cardiac condution through AV node, interrupting circuit and restting to sinus rhythm. Must be given as rapid bolus

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15
Q

When should adenosine be avoided?

A 
Asthma
COPD
heart failure
HEart block
Hypotension
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16
Q

How is adenosine given?

A

Rapid bolus into antecubital fossa
6 then 12 then 12mg
Patient will feel like going to die
Asystole or Brady period

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17
Q

How is chronic/recurrent SVT managed?

A

BB CCB

Radiofrequency ablation

18
Q

What is WPW?

A

An extra electrical pathway connecting atria and ventricles

19
Q

What is management of WPW?

A

Radiofrequency ablation

20
Q

What are ECG changes in WPW?

A

Short PR
Wide QRS
Delta wave

21
Q

What is contraindicated in WPW and why

A

BB
CCB
Adenosine
Reduce conduction through AV node making issue worse

22
Q

Radiofrequency ablation is curative for which arrythmias?

A

AF
Atrual flutter
SVT
WPW

23
Q

What is Torsades de pointes?

A

Polymorphic (multiple shape) VT. QRS appears to twist around baseline, height getting smaller then larger. Long QT. Caused by abnormal repolatisation (therefore caused by long QT)

24
Q

HOw do you manage Torsades de Pointes?

A

Self limiting
Acute- Mg infusion
Defibrillation if VT occurs

25
Q

What causes long QT?

A

Long QT inherited syndrome (Romano Ward)
Emotion or excercise
Antipsychotics
Citalopram
Sotalol, Flecainide, Amiodarone, Macrolides
Hypokalaemia, Hypomagnseium, Hypocalcaemia

26
Q

What is long term management of Long QT?

A

Avoid causative agents
Correct electrolyte disturbance
BB (not sotalol)
Pacemaker/Defibrillator implanted

27
Q

What are ventricular ectopics?

A

Random beats from random electrical discharges outside atria

Common

28
Q

What do ventricular ectopics look like on ECG?

A

Random broad QRS on otherwise normal ECG

29
Q

What are begemini ectopics?

A

So many ventricular ectopics that there are 2 QRS for each P

30
Q

How do you manage ventricular ectopics?

A

Reassurance
Check for electrolyte imbalance and anaemia
No treatment needed

31
Q

What is first degree heart block? (AVN)

A

Delayed conduction through AVN but still 1 QRS per P

Looks like long PR interval (1 big square, 5 small)

32
Q

What is second degree heart block?

A

Some atrial impulses dont make it through AVN- several patterns

33
Q

What is Mobitz type 1 block (Wenckebach’s phenomenon)

A

Atrial pulses get weaker and weaker until one doesnt pass through AVN, then goes back to being strong
On ECG increasing PR until P no longer conducts and QRS dropped, the restarts

34
Q

What is Mobitz type 2?

A

Intermittant failure of AVN so missing QRS, usually in a set ratio of p to qrs, ie 3:1
PR interval stays normal
Risk of asystole

35
Q

What is 3rd degree heart block?

A

Complete
No relationship between P and QRS
Big risk of asystole

36
Q

How do you manage stable bradycardia/AVN?

A

Observe

37
Q

How do you manage type 2 mobitz or complete heart block?

A

Atropine 500mcg IV
Then repeat if no improvement up to 6 times

Then Noradrenaline
Then Defibrillator/ transcuatenous pacing wire before permanent pacemaker

38
Q

What side effects does atropine cause?

A

Pupil dilation
Urine retention
Dry eyes
Constipation

39
Q

What causes RBBB?

A 
TOF
ASD
PE
PH
MI
RVH
40
Q

What causes LBBB?

A

Aortic stenosis
MI
HTN

41
Q

How is long QT managed?

A

BBs

42
Q

What should NOT be used in VT?

A

Verapimil

Cardiology (15 decks)

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