Arrhythmias: AF, Bradyarrythmias, Tachyarrythmias, WPW, Heart Block, ARVC Flashcards
AF
- epidemiology
- types
- presentation
- investigations
Most common arrythmias
- recurrent - 2+ episodes
- paroxysmal - spontaneous termination
- persistent - no termination
- permanent - continuous, no cardioversion
Palpitations, SOB, chest pain
ECG - irregularly irregular pulse
AF
- management
- when to use rhythm or rate control
1st line - rate control
1st line - Bb OR rate limiting CCB
-Digoxin if HF/no physical activity
Rhythm control used if
- rate control :(
- AF from reversible cause
- HF from AF
- new onset AF
- atrial flutter and suitable for ablation
Rhythm control -
1st line - Bb OR amiodarone
2nd line - dronedarone post ECV
AF
- when to cardiovert
- AC use and timeframes
haemodynamically unstable - ECV
Rhythm control used - ECV/PCV (amiodarone/flecainide)
Onset U48hrs - AC and either CV
- heparin => stopped if AF stops within 48hrs
- lifelong DOAC if ischemic stroke risk
Onset 48hrs+ - AC and ECV
- AC 3wks pre ECV amiodarone/soltalol 4wks pre ECV if high risk of failure
- TOE to exclude LAA thrombus => heparin and immediate ECV
- AC 4wks post ECV
AF
-when to catheter ablate
AF not treated by/responding to meds
-ablate aberrant electrical activity between pulmonary vein and LA
AC 4wks before and during ablation
Post ablation - AC depends on CHADSVASc
- 0 = 2months AC
- 1+ = long term AC
Complications - cardiac tamponade, stroke, PV stenosis
AF
-when to AC
Considered in everyone with Hx of AF CHA2DS2VASc -0 or 1 female = no DOAC -1+ male or 2+ female = DOAC -valvular heart disease + AF = DOAC
Warfarin is 2nd line
WPW
- pathophysiology
- presentation
- investigations
Congenital accessory conducting pathway between atria and ventricles => AV reentry tachycardia
Accessory pathway not slowed down => VF
Palpitations, lightheaded
SOB, SOBOE
Syncope
ECG changes - confirm with cont monitoring
Short PR interval
Wide QRS with delta wave
Majority => LAD if right sided accessory pathway
RAD if left sided accessory pathway
WPW
-management
Definitive - radioablation of accessory pathway
Acute -
- valsalva => slow HR
- adenosine => block electrical signals
- cardioversion
Prevention
- avoid triggers
- amiodarone - rhythm control
Bradyarrythmias
- presentation
- causes
- investigations
- management
Can be asymptomatic
Lightheaded, syncope
Fatigue, SOBOE
High JVP
HR U50
-antiarrythmics - soltalol, digoxin, diltiazem, verapamil, amiodarone
Assess for underlying causes -12 lead ECG Bloods -TFT => hypothyroidism -metabolic panel => K, Ca abnormalities -toxicology => digoxin levels
Symptomatic - IV atropine
- ATLS
- once stable => treat underlying cause
- pacing may be needed
Heart blocks
-types and management
1st degree - PR elongation
2nd degree Mobitz - PR gets progressively longer until QRS dropped
2nd degree Wenckeback - regularly irregular dropping of QRS
-can progress to 3rd degree
3rd degree - no coordination between P and QRS
Treated only if symptomatic
- palpitations, syncope
- SOB, chest pain
1st line - stop causative meds
2nd line - PPM, ICD
Long QT syndrome
- pathophysiology, presentation
- causes
- management
Delayed repolarisation of ventricles => VT/torsade de pointes => SCD
- congenital
- amiodarone, soltalol
- TCA, SSRI
- erythromycin
- low Ca,K,Mg
- MI
Can be asymptomatic
Management
- 1st line - avoid drugs and triggers + give Bb
- ICD if high risk
Torsades de pointes
- associations and consequences
- management
Long QT => polymorphic tachycardia => VF and SCD
IV Magnesium sulphate
Arrythmogenic Right Ventricular Cardiomyopathy
- pathophysiology, presentation
- investigations
- management
AD condition - 2nd most common cause of SCD
-RV myocardium replaced by fatty and fibrous tissue => palpitations, syncope, SCD
ECG - V1-3 T inversion, epsilon wave
Management
- Soltalol
- ablation - prevent VT
- ICD
