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Year 4: Cardiology > Arrhythmias > Flashcards

Arrhythmias Flashcards

1
Q

definition of

  • bradycardia
  • tachycardia
A

bradycardia = < 60 bpm tachycardia = > 100 bpm

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2
Q

causes of sinus bradycardia

A

physiological

beta blockers

ischaemia

sick sinus syndrome

hypothermia

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3
Q

acute management of bradycardia

A

1st line: 500 micrograms atropine - can repeat doses up to 3g

2nd line options: isoprenaline / transcutaneous pacing if unstable

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4
Q

a narrow complex tachycardia (QRS <0.12s) originates where?

A

above the AV node - an ‘SVT’

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5
Q

what causes an SVT

A

an electrical signal re-entering the atria from the ventricles - creates a self perpetuating electrical loop

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6
Q

what are the main types of SVT

A
  1. Atrioventricular nodal re-entrant tachycardia: re-entry point is back through AV node
  2. Atrioventricular re-entrant tachycardia: re-entry point is an accessory pathway (e.g. Wolf Parkinson White)
  3. Atrial tachycardia: electrical activity originates somewhere other than SA node
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7
Q

1st line management for an SVT

A

vagal manœuvres - valsalva - carotid sinus massage

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8
Q

2nd line management for SVT

A

if vagal manoeuvre unsuccessful:

  • IV adenosine
  • IV verapamil in asthmatics

DC cardioversion if above unsuccessful

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9
Q

what is the accessory pathway called in Wolf Parkinson white

A

Bundle of Kent

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10
Q

ECG changes in Wolf Parkinson White

A

slurred upstroke of QRS - delta wave

short PR

left axis deviation (right sided pathway)

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11
Q

Definitive treatment of Wolf Parkinson White

A

radio frequency ablation

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12
Q

characteristic appearance of atrial flutter on ECG

A

Sawtooth baseline

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13
Q

characteristic appearance of atrial fibrillation on ECG

A

irregularly irregular

absent P waves

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14
Q

1st line drug for controlling rate in atrial fibrillation + flutter

A

beta-blocker

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15
Q

what patients are offered immediate cardioversion for AF?

A

If AF present for < 48 hours or severely unstable

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16
Q

options for cardioversion in AF

A

pharmacological:

  • flecainide
  • amiodarone if structural heart disease

electrical:

  • DC cardioversion
17
Q

what patients are suitable for delayed cardioversion in AF?

what must be done beforehand?

A

AF present for > 48 hours + stable

anticoagulate for 3 weeks prior

18
Q

what is first degree heart block

A

fixed prolonged PR interval (>0.2s)

19
Q

what is second degree heart block: Mobitz Type 1

A

gradual lengthening of PR interval until a QRS complex is dropped

20
Q

what is second degree heart block: Mobitz Type 2

A

fixed prolonged PR interval with QRS complexes dropped in

  • 2: 1 (every other p wave followed by QRS)
  • 3:1 ( 2 P waves with no QRS followed by 1 P wave with a QRS)
21
Q

what is 2:1 heart block

A

2 P waves for each QRS complex

( 1 P wave not followed by QRS, next P wave followed by QRS)

22
Q

what is third degree heart block

A

complete heart block

  • no relationship between P waves + QRS
23
Q

what types of heart block require pacing

A

Mobitz type 1 if symptomatic

Mobitz type 2 + 3rd degree – permanent pacing

24
Q

what is bifasicular heart block

A

RBBB with left axis deviation

25
Q

what is trifasicular block

A

RBBB + Left axis deviation + 1st degree heart block (fixed prolonged PR)

26
Q

ECG appearance of ventricular tachycardia

A

regular broad QRS

>100 bpm

no P or T waves

27
Q

management of VT in

  • stable patient
  • unstable patient
A

stable = amiodarone

unstable = DC cardioversion

28
Q

what is Torsades de Pointes

A

polymorphic VT that occurs in patients with long QT

precipitated by:

  • hypokalaemia / hypocalcaemia / hypomagnesmia
  • amiodarone, citalopram, macrolides
29
Q

management of torsades de pointes

A

correct electrolyte disturbances / remove causative drugs

magnesium sulphate infussion

defibrillation if VT occurs

30
Q

when does ventricular fibrillation occur

A

post MI

31
Q

What rhythms can be shocked

A

pulseless VT

VF

32
Q

what are ventricular ectopics

A

premature ventricular beats

  • individual random broad QRS complexes on background of normal ECG
33
Q

what is ventricular bigeminy

A

ventricular ectopic following every sinus beat

34
Q

what is an escape beat

A

a beat that comes late

35
Q

what is ventricular hypertrophy?

most common cause?

A

increase in left ventricle muscle mass not volume

hypertension

36
Q

voltage criteria for LVH

A

negative component in V2 and positive component in V5 must add to > 7

37
Q

affect of LVH on the heart

A

strain

  • shows as ST depression
  • blood supply cant match demand

Year 4: Cardiology (12 decks)

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