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Y1 - Cardiovascular > Arrhythmias > Flashcards

Arrhythmias Flashcards

1
Q

What are arrhythmias?

A

Abnormalities in the cardiac rhythm generated by abnormal electrical conduction, usually by ectopic beats

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2
Q

What are ectopic beats?

A

Beats that originate in places other than the SA node

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3
Q

What is re-entry?

A

Where there is more than one conduction pathway, with different speeds of conduction

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4
Q

What are the types of supra-ventricular arrhythmia?

A

Tachycardia:

  • Atrial fibrillation
  • Atrial flutter
  • Ectopic atrial tachycardia

Bradycardia:

  • Sinus bradycardia
  • Sinus pauses
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5
Q

Where do supra ventricular arrhythmias originate?

A

Within or above the AV node

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6
Q

What is sinus arrhythmia?

A

Where the heart is in sinus rhythm but the heart rate is irregular

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7
Q

What are the types of ventricular arrhythmia?

A

Ventricular ectopic
Ventricular tachycardia
Ventricular fibrillation
Asystole

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8
Q

Are supraventricular and ventricular arrhythmias narrow or broad complex?

A

Supraventricular - narrow complex

Ventricular - broad complex

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9
Q

What are the types of AV node arrhythmia?

A 
AV re-entry tachycardia
AV block (1st, 2nd or 3rd degree)
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10
Q

What are the causes of arrhythmia?

A 
Abnormal anatomy
Autonomic nervous system
Metabolic
Inflammation (viral myocarditis)
Drugs
Genetic
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11
Q

What are the ways in which abnormal anatomy can cause arrhythmia?

A

LV hypertrophy
Accessory pathways
Congenital heart defect

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12
Q

What are the ways in which the autonomic nervous system can cause arrhythmia?

A

Sympathetic stimulation: stress, exercise, hyperthyroidism

Increased vagal tone causing bradycardia

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13
Q

What are the metabolic causes of arrhythmia?

A 
Hypoxia (chronic pulmonary disease, pulmonary embolism)
Ischaemic myocardium (acute MI, angina)
Electrolyte imbalances (K+, Ca2+, Mg2+)
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14
Q

In what way can genetics cause arrhythmia?

A

Mutation of genes encoding cardiac ion channels, e.g. congenital long QT syndrome

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15
Q

What is atrial fibrillation?

A

Disorganised electrical activity, resulting in irregular ventricular response

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16
Q

What are the symptoms of atrial fibrillation?

A

Palpitations

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17
Q

What are the three types of atrial fibrillation, and how are they classed?

A

Paroxysmal - <48 hours
Persistent - >48 hours
Permanent - unable to return to normal sinus rhythm

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18
Q

What does an ECG show in atrial fibrillation?

A

No P waves
Irregularly irregular
Isoelectric line deviation
Ventricular rate 30-200bpm

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19
Q

What is the treatment to control rate in atrial fibrillation?

A

Combination of digoxin and a beta blocker/verapamil

AV node ablation

20
Q

What is the treatment to control rhythm in atrial fibrillation?

A 
Class I (disopyramide) or III (amiodarone)
DCCV
21
Q

When should you anti-coagulate in atrial fibrillation?

A

If prosthetic valves or CHADVAS score >2

22
Q

What is atrial flutter?

A

Atrial re-entry tachycardia, leading to rapid atrial rate.

Not all P-waves make it to the ventricles, so atria ‘flutter’

23
Q

What are the symptoms of atrial flutter?

A

Palpitations

24
Q

What does an ECG show in atrial flutter?

A

Sawtooth pattern
Multiple P waves before a QRS
Ventricular rate of approx 300bpm

25
Q

What is the treatment for atrial flutter?

A

Electrical cardioversion
Radiofrequency ablation
Class III drugs (amiodarone)

26
Q

What is Wolf-Parkinson White syndrome?

A

Atrial re-entry tachycardia with accessory excitatory pathway through the Bundle of Kent

27
Q

What are the symptoms of Wolf-Parkinson White syndrome?

A

Palpitations

Tachycardia

28
Q

What does an ECG show in Wolf-Parkinson White syndrome?

A 
Short PR interval
Sloping QRS (delta wave)
29
Q

What is the treatment for Wolf-Parkinson White syndrome?

A

DCCV
Beta blockers, calcium channel blockers
Catheter ablation

30
Q

What are the symptoms of ventricular tachycardia?

A 
Dizziness
Hypotension
Palpitations
Cardiac arrest
Patients usually have other heart conditions
31
Q

What does an ECG show in ventricular tachycardia?

A

Wide complexes
Polymorphisms (torsade de pointes)
Mountains

32
Q

What is the treatment for unstable ventricular tachycardia?

A

DCCV

33
Q

What is the treatment for pulseless ventricular tachycardia?

A

Defibrillation

34
Q

What is the treatment for stable ventricular tachycardia?

A

Amiodarone + class I (lignocaine)

35
Q

What is ventricular fibrillation?

A

Rapid irregular conduction with useless effect

Life threatening, cardiac arrest often follows

36
Q

What are the symptoms of ventricular fibrillation?

A

Syncope

Cardiac arrest

37
Q

What re the signs of ventricular fibrillation on ECG?

A

Wandering baseline
Irregular
Random waveforms
No identifiable QRS

38
Q

What is the treatment for ventricular fibrillation?

A

Defibrillation
Magnesium chloride
Implantable cardioverter defibrillator if long term

39
Q

What is 1st degree heart block?

A

PR interval longer than normal (>2 seconds)

Does not require treatment, just long term follow up

40
Q

What is 2nd degree heart block, Mobitz I?

A

Progressive lengthening of the PR interval, eventually resulting in a dropped beat

41
Q

What is 2nd degree heart block, Mobitz II?

A

Some missing P waves

42
Q

What is 3rd degree heart block (complete heart block)?

A

No action potentials from the SA node/atria get through, no connection between P wave and QRS

43
Q

What is there a risk of in a trial fibrillation?

A

Embolic stroke

44
Q

What are the signs of ectopic atrial tachycardia on ECG?

A

Varying PR and RR interval, some beats come early

45
Q

Which heart rhythms are shockable?

A

Ventricular tachycardia or fibrillation

46
Q

Which heart rhythms would you do CPR on?

A

Pulseless electrical activity
Asystole
Complete AV block

Y1 - Cardiovascular (11 decks)

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