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Cardio > Arrhythmias > Flashcards

Arrhythmias Flashcards

1
Q

What is the only way pulses from the sinus node can get to the ventricles?

A

via the AV node

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2
Q

How is an arrhythmia named?

A

anatomical site or chamber of origin

mechanism eg fibrillation

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3
Q

d: fibrillation

A

heart going so fast its quivering, cant fill properly low CO

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4
Q

Name the Supraventricular Arrhythmias

A 
Supraventricular tachycardia
  Atrial Fibrillation
  Atrial Flutter
  Ectopic atrial 
   tachycardia

Bradycardia
Sinus bradycardia
Sinus pauses

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5
Q

Name the Ventricular Arrhythmias

A 
Ventricular ectopics or Premature Ventricular Complexes (PVC) 
Ventricular Tachycardia (VT)
 Ventricular Fibrillation (VF)

Asystole

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6
Q

Name the Atrio-ventricular Node Arrhythmias

A

AVN re-entry tachycardia (AVNRT)

AV reciprocating or AV Reentrant tachycardia (AVRT)

AV block :
1st degree
2nd degree
3rd degree

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7
Q

Name some of the causes of Arrhythmias

A 
abnormal anatomy
ANS
Metabolic
Inflammation
Drugs
Genetic
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8
Q

What is the abnormal anatomy that causes them?

A

left ventricular hypertrophy
accessory pathways
congenital HD

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9
Q

What is the ANS that causes them?

A

Sympathetic stimulation: stress, exercise, hyperthyroidism

Increased vagal tone causing bradycardia

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10
Q

What are the meatbolic changes that causes them?

A

Hypoxia: chronic pulmonary disease, pulmonary embolus
Ischaemic myocardium: acute MI, angina
Electrolyte imbalances: K+, Ca 2+, Mg2+

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11
Q

Name an inflammatory condition that causes arrhythmias

A

viral myocarditis

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12
Q

how do drugs cause arrhythmias?

A

direct electrophysiologic effects or via ANS

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13
Q

Name some genetic causes of arrhythmias?

A

mutations of genes encoding cardiac ion channels e.g. the congenital long QT syndrome

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14
Q

Name the 2 electrophysiological mechanisms that cause A?

A

Ectopic beats: Beats or rhythms that originate in places other than the SA node
Altered automaticity e.g. ischaemia, catecholamines
Triggered activity, e.g. digoxin, long QT syndrome
Re-entry : requires more than one conduction pathway, with different speed of conduction (depolarization) and recovery of excitability (refractoriness):
accessory pathway tachycardia (Wolf Parkinson White syndrome), previous myocardial infarction, congenital heart disease.

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15
Q

Name some abnormal physiologies that increase HR?

A 
hyperthermia
Hypoxia
Hypercapnia
Cardiac Dilation
Hypokalaemia, prolongs repolarization
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16
Q

Name some abnormal physiology that cause bradycardia/Heart block

A

Hypothermia

Hyperkalaemia

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17
Q

Symptoms of Arrhythmias

A 
Palpitations, ”pounding heart”
Shortness of breath
Dizziness
Loss of consciousness; ”Syncope”
Faintness: “presyncope”
Sudden cardiac death
Angina, heart failure
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18
Q

Name the Investigations for Arrhythmias?

A 
12 lead ECG (in tachycardia , during SR)
CXR
Echocardiogram
Stress ECG
Look for myocardial ischaemia, exercise related arrhythmias
24 hour ECG Holter monitoring
Event recorder: (capture the arrhythmia)
Electrophysiological (EP) study
Induce clinical arrhythmia to study mechanism and map arrhythmia
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19
Q

Name some types of arrhythmiae?

A 
normal sinus arrhythmia
sinus bradycardia
sinus tachycardia
Atrial Ectopic Beats
Regular Supraventricular tachycardia
20
Q

How do ectopic beats cause an arrhythmia?

A

origninates in places other than SA node

21
Q

Are ectopic beats a physiological/pathological cause?

A

physiological

22
Q

How is re entry a cause of arrhythmias?

A

requires more than one conduction pathway, with different speed of conduction (depolarization) and recovery of excitability (refractoriness)

23
Q

how many re entry be caused?

A

WPW previous MI or CHD

24
Q

Name the 4 H’s that INcrease HR? and the C

A

Hyperthermia, Hypoxia, Hypercapnia, Cardiac dilation, Hypokalaemia 4H’s.

25
Q

Name the 2 things that decrease HR and cause Heart Block/

A

Hypothermia

Hyperkalaemia

26
Q

describe triggered activity of an arrhythmia/

A

In terminal phase a small depolarization may occur (if big enough) may cause sustained train of depolarisations.

27
Q

symptoms of arrhythmias?

A

Palpitations, SOB, Dizziness, Syncope (pre-syncope), Cardiac death, Angina, HF.

28
Q

Name the investigations for arrhythmias?

A

ECG (24 hr), CXR, Echo, Stress ECG,

29
Q

What is sinus bradycardia treated with and what is it?

A

<60bpm, - treat with Atropine (acute), or pacing

30
Q

when is pacing used to treat sinus bradycardia?

A

if haemodynamic compromise

31
Q

what is sinus tachycardia + treated with?

A

> 100bpm, Treat underlying cause, B-blockers

32
Q

If you have Atrial Ectopic Beats, what are the symptoms and treatment?

A

asymptomatic – palpitations, no treatment

33
Q

What are the causes of regular supraventricular tachycardia?

A

caused by AV nodal re-entrant tachycardia (AVNRT), AV reciprocating tachycardia (AVRT), Ectopic atrial tachycardia (EAT)

34
Q

what are the effects of acute reg supraventricular tachycardia?

A

Increase vagal tone, slow AVN conduction [IV adenosine, IV verapamil]

35
Q

what is the advice given for chronic reg supraventricular tachycardia?

A

avoid sti mulants, B-Blockers, Anti-arrhythmic Drugs, Radiofrequency ablation

36
Q

How is VT treated if pulsing and if pulseless?

A

DC cardioversion if haemodynamically unstable, Pulseless VT requires Defibrillation

37
Q

What happens to the heart in VF?

A

loss of ability to pump

38
Q

How is VF treated?

A

Cardioversion if unstable, If stable use Anti-Arrhythmic drugs.

39
Q

What is the most common sustained arrhythmia?

A

atrial fibrillation

40
Q

what is paroxysmal AF?

A

sudden spasm <48hrs

41
Q

when is AF persistent?

A

> 48hrs and cardioverter to NSR

42
Q

when is AF permanent?

A

inability to restore NSR

43
Q

What congenital syndrome can cause polymorphic VT ( torsades des pointes), what is it triggered by and what are the symptoms?

A

Congenital Long QT syndrome
adrenergic stimulation
syncope and sudden death

44
Q

what does brugada syndrome pose a risk of?

A

Risk of polymorphic VT, VF, AF common, St elevation + RBBB in V1-3.

45
Q

What is Brugada syndrome triggered by?

A

Triggered by sleep, fever, excess alcohol.

46
Q

what is the advice for those with brugada syndrome?

A

Avoid anti-arrhythmics, psychotropics, analgesics, anaesthetics

Cardio (28 decks)

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