Arrhythmias Flashcards
What are the shockable cardiac arrest rhythms? (2)
VT
VF
What are the non-shockable rhythms in cardiac arrest? (2)
Asystole (no significant electrical activity)
Pulseless electrical activity (all electrical activity except VF and VT)
What is the treatment for tachycardia in an unstable patient? (2)
Consider up to 3 synchronised shocks
Consider an infusion of amioderone
What is the treatment of tachycardia caused by AF (narrow complex tachy)
Rate control with beta blocker or diltiazem (CCB)
What is the treatment of tachycardia caused by Atrial flutter (narrow complex tachy)?
Rate control with a beta blocker
What is the treatment of tachycardia caused by Supraventricular tachycardia (narrow complex tachy)? (4)
Treat with valsalva manoeuvres ,
adenosine (or verapamil),
carotid sinus massage,
direct current cardioversion
What is the QRS duration in a narrow complex tachycardia?
Under 0.12 seconds
What are the three narrow complex tachycardias?
AF
Atrial flutter
SVT’s
What is the QRS duration of a broad complex tachycardia?
Over 0.12 seconds
What is the treatment of tachycardia caused by VT(broad complex tachy)?
Amioderone infusion
What is the treatment of tachycardia caused by SVT with bundle branch block(broad complex tachy)?
Treat as normal SVT (cavalry manoeuvres and adenosine)
What should you do if the patient has a broad complex tachycardia which is irregular and may be an AF variation?
Seek expert help
What is the treatment of atrial flutter? (4)
Rate/rhythm control with beta blocker or cardioversion
Treat reversible underlying condition (hypertension, ischaemic heart disease, cardiomyopathy, thyrotoxicosis)
Radio frequency ablation of the re-entrant rhythm
Anticoagulant based on chadsvasc score
What conditions should you avoid giving adenosine in? (5)
COPD Asthma HF Heart block Severe hypotension
What should you warn patients of before administering adenosine?
They may feel like they are dying/ impending doom
What ECG changes are seen in WPW syndrome? (3)
Short PR interval (under 0.12 seconds)
Wide QRS complex (over 0.12 seconds)
Delta wave (slurred I patrol of QRS complex)
What groups of medications are contraindicated in WPW patients who develop AF or flutter?
Antiarrhythmics
They promote bypass of the AV nose down accessory pathway
What are causes of prolonged QT interval? (3)
Long QT syndrome (inherited)
Medications (antispsychotics, citalopram, flecanide, sotalol, amioderone, macrolides)
Electrolyte disturbances (hypokalaemia, hypomagnesia, hypocalcaemia)
What is the acute management of torsades de pointes (polymorphic VT)? (3)
Correct cause
Magnesium infusion (even if normal serum magnesium)
Defibrillation if VT occurs
What is the long term management of prolonged QT? (4)
Avoid meds that do it
Correct electrolyte disturbances
Beta blockers (but not sotalol)
Pacemaker or ICD
What is the management for ventricular ectopics? (3)
Check bloods for anaemia, electrolyte disturbances to thyroid abnormalities
Reassure and no treatment in otherwise healthy people
Seek expert advice in patients with heart conditions or other concerning features
What is the PR interval in first degree heart block?
Greater than 0.2 seconds
Which heart block has wickenback appearance on ECG?
Second degree heart block Mobitz type 1
What heart blocks has a risk of asystole? (2)
Second degree mobitz type 2
third degree heart blocks
What is the medication given for patients with a bradycardia or heart block who are unstable or at risk of asystole? What if there is no improvement?
Atropine
If no improvement then other inotropes such as noradrenalin and transcutaneous cardiac pacing
If asystole risk then temporary trans venous cardiac pacing, and permanent implantable pacemaker when available
What do you give for the management of hyperkalaemia? (2)
Calcium Gluconate (if K+ is over 6.5 or ECG changes)
Then insulin/dextrose infusion
