Arrhythmias

Question 1

AF management

rhythm control

Answer 1

rhythm control:
cardioversion
- immediate if <48 hr
- delayed if >48hr and stable. anticoagulant 48 before as you could dislodge a clot and cause a stroke

1. pharmacological cardioversion
   flecanide
   amiadorone
2. electrical conversion
   rapidly shock the heart back into sinus rhythm using sedation/GA and cardiac defibrillator.

long term rhythm control
beta blockes
dronedarone
amiadorone

miff= AF = aMiadorone

Question 2

Paroxysmal AF mx

Answer 2

anticoagulant according to CHADVASc score

pill in the pocket- flecainide

Question 3

Acute management of stable patients with SVT

Answer 3

1. Valsalva manoeuvre
2. carotid sinus massage
3. adenosine (slows cardiac conduction by blocking the AV node so it resets to sinus rhythm. fast IV bolus into large proximal cannula initially 6mg then 12mg then a further 12mg)
4. alternatively, verapamil (ca2+ blocker)
5. direct current cardioversion

Question 4

treatment for bradycardia and AV node blocks

Answer 4

stable - observe
unstable / risk of asystole- atropine (500mcg IV)
no improvement
atropine 500mcg IV repeat up to 6 doses for a total of 3m
other inotropes (noradrenalin)
TCI using defibrillator

bradycardia= late = ate= atropine

Question 5

Atrial fibrillation management

rate control

Answer 5

rate control OR rhythm control
anticoagulant to prevent stroke

rate control is FIRST unless
- there is a reversible cause, <48 hr onset, causing HF, symptomatic despite effectively treating rate

rate control:
beta blocker (atenolol 50-100mg)
ca2+ channel blocker (diltiazem)
digoxin (sedentary)

Question 6

Coronary arteries

Answer 6

Left coronary artery (anterolateral)
LAD (anterior)
Circumflex (lateral)
RCA (inferior)

Question 7

Leads of the heart

Answer 7

Inferior= II, III, avF
Lateral= I, avL, V5-V6
Anterolateral= I, avL, V3-V6
Anterior= V1-V4

Question 8

anti arrhythmias MOA

Answer 8

amiadorone- K+ blocker

digoxin- decreases conduction through AV node

diltiazem- functions through blockade of ca2+ channels

flecanide- blockade of Na+ channel

metoprolol beta blocker

Question 9

management of supraventricualr tachycardia

Answer 9

e.g. wolff-parkinson white syndrome (shortened PR and delate waves)

manage with vagal manoeuvres such as carotid sinus manage or valsalva manouvere

if this fails, adenosine should be given

Question 10

amiadorone
adenosine
atropine

Answer 10

amiadorone: AF (miff)
adenosine: den= ten = fast
atropine: (late) bradycardia

Question 11

management of ventricular tachycardia secondary to MI

Answer 11

emergency DC cardioversion with synchronised shock

repeat up to three times then give amiadorone