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Cardiovascular > Arrhythmias > Flashcards

Arrhythmias Flashcards

1
Q

what are the 2 locations for arrhythmias

A

supra ventricular: SAN, atria, AVN or his

ventricular: ventricular muscle

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2
Q

name 3 supraventricular tachycardic arrhythmias…

A

A.fib, atrial flutter, ectopic atrial tachycardia (EAT)

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3
Q

name 2 supraventricular bradycardic arrhythmias…

A

sinus bradycardia, sinus pauses

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4
Q

name 3 supraventricular AVN arrhythmias…

A

AVN re-entry tachycardia (AVNRT), AV re-entrant tachycardia (AVRT), AV block

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5
Q

what are 4 ventricular arrhythmias…

A

ventricular ectopics/ premature ventricular complexes (PVC), ventricular tachycardia, ventricular fibrillation, asystole

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6
Q

what causes arrhythmias

A

anatomical: LV hypertrophy, accessory pathways, congenital heart disease
ANS: sympathetic stimulation e.g. stress
metabolic: hypoxia, ischaemic myocardium, electrolyte imbalance
inflammation: viral myocarditis
genetic: e.g. LQTS

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7
Q

what are the 5 pathological mechanisms that cause arrhythmias

A 
automaticity 
ectopic beats 
triggered activity 
tract pathway 
re-entry
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8
Q

what does automaticity consist of

A

occurs if latent pacemaker takes over SAN usually due to tissue damage e.g. hypoxia

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9
Q

what type of pathological mechanism for arrhythmia is beats that originate in places other than SAN?

A

Ectopic beats

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10
Q

“normal AP triggers abnormal oscillations in membrane potentials that reach threshold triggering a sustained train of premature APs” is…

A

Triggered activity

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11
Q

what are Tract pathways?

A

alternate electrical pathways to AVN that are faster than normal conduction

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12
Q

what type of arrhythmia do tract pathways usually cause

A

tachyarrhythmias

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13
Q

what is re-entry?

A

more than 1 conduction pathway which have different speeds

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14
Q

what can cause re-entry mechanisms

A

structural: MI scar, CHD
Functional: conditions that depress conduction velocity or prolong refractory period e.g. WPW syndrome

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15
Q

in what type of syndrome does pre-excitation (accessory pathway causes AP during repolarisation of heart) occur?

A

Wolf Parkinson White Syndrome

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16
Q

what 2 arrhythmias are life-threatening

A

Vtac & A.Fib

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17
Q

what are general presenting symptoms of arrhythmias?

A

asymptomatic, palpitations, SOB, dizziness, pre-syncope, syncope, tachy/brady, SCD, angina

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18
Q

what ix for arrhythmias?

A

12 lead ECG, exercise ECG, 24hr ECG

echo

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19
Q

sinus bradycarda…

  • how many bpm
  • aetiology
  • tx
A

<60bpm
physiological, drugs, ischameia
tx: acute- atropine, cardiac pacing if haemodynamically compromised

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20
Q

what does haemodynamically compromised mean?

A

hypotension etc

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21
Q

sinus tacycardia…

  • bpm
  • aetiology
  • tx
A

> 100bpm
physiological, drugs
tx: underlying cause, BBs

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22
Q

what findings may you find on the ECG of someone with supraventrcular ectopic beats?

A

narrow QRS complex

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23
Q

what is the pathological mechanism responsible for supraventricular tachycardias

A

re-entry, ectopic beats

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24
Q

what is the tx for supraventricular tachycardias ?

A

acute: inc vagal tone (valsalva monouvre, carotid massage), slow conduction to AVN (IV adenosine, verapamil)
chronic: BBs, anti-arrhythmic drugs. avoid stimulants

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25
Q

what is heart block

A

AVN conduction disease

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26
Q

causes of heart block?

A

ageing, acute MI, myocarditis, drugs, CHD, post aortic valve surgery

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27
Q

how many degrees of heart block are there?

A

3

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28
Q

what does 1st degree heart block mean?

A

no block, no tx

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29
Q

what are ECG signs of 1st degree heart block

A

PR interval is long (>0.2secs)

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30
Q

what does 2nd degree heart block mean?

A

intermittent conduction block at AVN

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31
Q

what are the 2 types of 2nd degree heart block?

A

Mobitz 1 & Mobitz 2

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32
Q

True/False…

Mobitz 1 shows a fixed PR interval then a dropped beat on ECG

A

False…
Mobitz 1 shows progressive lengthening of PR interval then a dropped beat
Mobitz 2 shows a fixed PR interval then a dropped beat

33
Q

what does 3rd degree heart block mean?

A

no AP get through to AVN ie. complete heart block

34
Q

what signs are there on ECG that show 3rd degree heart block?

A

no correlation between P wave & QRS complex

35
Q

no tx is given for 1st degree heart block, so for what types of heart block is tx given and what is it?

A

2nd Degree Heart Block Mobitz 2 & 3rd degree Heart Block

Tx= ventricular pacing

36
Q

what are the causes of ventricular ectopic or premature ventricular complex?

A

structural (LV Hypertrophy, HF), metabolic (Ischemia, CHD)

37
Q

tx for ventricular ectopic or premature ventricular complex?

A

BBs, ablation of focus

38
Q

what are causes for ventricular tachycardia?

A

pre-existing HD e.g. prev MI, cardiomyopathy

39
Q

what are the 4Ts & 4Hs of reversible ventricular tachycardia?

A 
4Ts= 
Thrombosis
Tension Pneumo 
Tamponade 
Toxins 
4Hs
Hypothermia
Hypoxia 
Hypovolaemia 
Hyper/Hypokalameia
40
Q

what arrhythmia would a finding of a wide QRS complex (>0.12) be?

A

Ventricular Tachycardia

41
Q

what is Tx for acute ventricular tachycardia

A

unstable: direct current cardioversion (DCC)
stable: AAD, amiodarone

42
Q

what tx is given for torsades de pointes?

A

IV Magnesium

43
Q

what is Tx for chronic ventricular tachycardia?

A

treat underlying, Congestive HF therapy e.g. ACEI, anti-arrhythmic drugs, ICD (implantable cardioverter defibrillator), VT catheter ablation

44
Q

what are the classes of ventricular tachycardia

A

monomorphic (1 circuit),

polymorphic (torsades de pointes)

45
Q

what is V.Fib?

A

chaotic ventricular activity causing heart to lose its pumping function

46
Q

what are 2 key sings of v.fib

A

pulseless, unconscious

47
Q

what is tx for v.fib

A

defibrillate & CPR

48
Q

what is asystole?

A

absence of ventricular contractions

49
Q

what are pacemakers usually used for

A

AVN disease

50
Q

when is catheter ablation usually used for

A

re-entry disease e.g. PVC or A.fib

51
Q

what is the most common arrhythmia?

A

Atrial fibrillation

52
Q

what are 3 classes of A.Fib

A

paroxysmal (<48hrs, recurrent),
persistent (>48hrs, cardioverted back to NSR)
permanent (inability to restore to NSR)

53
Q

what is a.fib?

A

chaotic atrial activity- irregular supra ventricular tachycardia

54
Q

where does a.fib ectopic foci originate?

A

ostia of pulmonary vein

55
Q

what are etiological diseases of a.fib?

A

HT, HF, Coronary HD, thyroid disease, valvular, congenital HD, cardiac surgery, COPD, septicaemia, pericarditis

56
Q

what is a common sign of a.fib

A

irregular pulse

57
Q

what does ECG show if a.fib present?

A

> 300bpm, irregular rhythm, ventricular rate is variable, absence of p waves but f waves may be present

58
Q

what is the 4 step tx for A.fib

A

Terminate AF through cardioversion
Control Rate
Control Rhythm
+ Anticoagulants

59
Q

what are the 3 ways in which AF can terminate?

A
  1. drugs
  2. direct current cardioversion (DCCV)
  3. spontaneous reversion to sinus rhythm
60
Q

how do you control rate and hence slow down AVN conduction through Rx?

A

digoxin, b-blockers, verapamil

61
Q

how does digoxin work

A

inc force of contraction of heart by inhibiting ATPase hence inc Ca++ movement into heart

62
Q

how do you gain control of the rhythm?

A

restore NSR via amiodarone or DCCV &

maintain NSR via amiodarone, catheter ablation of focus

63
Q

why MUST anticoagulants be given after A.fib?

A

A.fib poses an inc risk of thromboembolisms forming

64
Q

what is the biggest complication of A.fib?

A

PE and stroke

65
Q

what is the definition of congestive heart failure?

A

heart failure due to lost atrial kick and slow filling time

66
Q

what is atrial flutter?

A

rapid, REGULAR, atrial tachycardia

67
Q

True/False…

atrial flutters usually progress to AF?

A

True!

68
Q

what is a typical ECG of someone with an atrial flutter?

A

regular rate with saw tooth F wave

69
Q

tx for atrial flutter?

A

radio frequency ablation, BBs, cardioversion, anticoags to prevent thromboembolism

70
Q

what is cardiac arrest?

A

cessation of heart

71
Q

how to recognise someone in cardiac arrest?

A

unresponsive, no pulse, no breathing

72
Q

what are causes of cardiac arrest- think ABCDE…

A

A: CNS depression, blocked airway, swelling, muscle spasm
B: dec res drive, lung disorders (e.g. haemothroax)
C: 1y- ACS, arrhythmias, drugs, valvular HD. 2y- asphyxia, hypoxia, hypovolaemia, sepsis
D: hypoglycaemia
E: trauma

73
Q

how to assess A of ABCDE?

A

talking?, SOB?

74
Q

how to assess B of ABCDE?

A

look, listen, feel - chest expansion

75
Q

how to assess C of ABCDE?

A

general exam, BP, pulse, perfusion, bleeding

76
Q

how to assess D of ABCDE?

A

AVPU or GCS + Pupils

77
Q

tx for cardiac arrest

A

start CPR 30:2
shock if rhythm is VF/pulseless VT every 2 mins
administer adrenaline/amiodarone after 3rd shock and thereafter every 3-5mins

78
Q

when should you not shock?

A

asystole or PEA (pulseless electrical activity)

79
Q

True/False…

Cardioversion & Defibrillation are the same thing

A

True & False…
defibrillation is only applied to emergencies and only to VT and pulseless V.Fib

Cardioversion given only if pt has a pulse but is unstable or chemical cardioversion has failed

however- same in sense that both shock heart to try return arrhythmia back to NSR

Cardiovascular (12 decks)

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