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CVS Pathologies > Arrhythmias and Therapy > Flashcards

Arrhythmias and Therapy Flashcards

1
Q

What is FIRST-DEGREE AV Block?

A

Disease of Electrical Conduction System:

Delay in the Impulse being Conducted through the AV Node

*PR Interval Prolongation (>0.2secs)

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2
Q

What is SECOND-DEGREE AV Block: MOBITZ I/WENCKEBACH?

A

Almost Always a Disease of AV Node

ECG Features:

1) Progressive Prolongation of PR Interval (>0.2secs) on Consecutive Beats
2) Followed by a Non-Conducted P Wave or ‘Dropped’ QRS Complex

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3
Q

What is SECOND-DEGREE AV Block: MOBITZ II?

A

Almost Always a Disease of the His-Purkinje System

ECG Features:

1) Intermittent Non-Conducted P Waves/Dropped QRS Complexes
2) PR Interval Remains Constant

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4
Q

What is THIRD-DEGREE or COMPLETE Heart Block?

A

Complete Absence of AV Conduction

ECG Features:

1) Atrial and Ventricular Conduction Rates are Independent From One Another
2) P Waves Bear No Relation to QRS Complexes

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5
Q

Describe ATRIAL FIBRILLATION (AF):

A

Type of Supraventricular Tachycardia

Disorganised Atrial Activity and Contraction

ECG Features:

1) Irregularly Irregular Rhythm
2) Atrial Rate >350bpm
3) No P Waves - Fibrillatory Waves Mimic P Waves
4) Variable Ventricular Rate

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6
Q

Describe ATRIAL FLUTTER:

A

Type of Supraventricular Tachycardia

Caused by Re-Entry Circuit within the Right Atrium

ECG Features:

1) Narrow QRS Complex Tachycardia
2) Atrial Rate = 250-350bpm
3) “Saw-Tooth” Pattern of Flutter Waves
4) Regular Ventricular Rate

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7
Q

How would a patient with AF PRESENT?

A

May be Asymptomatic

Possible Symptoms:

1) Palpitations
2) Dyspnoea
3) Chest Pain
4) Fatigue

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8
Q

What INVESTIGATIONS would be used to diagnose AF?

A

1) ECG
2) FBC - specifically Thyroid Function
3) Echocardiography

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9
Q

What is the purpose of CLASS I ANTI-ARRHYTHMIC (AA) drugs?

A

*Na+ Channel Blockers, i.e. Disopyramide

1) Manipulate Phase 0 of Non-Pacemaker Action Potentials (AP)
2) Can Delay the Onset of Depolarisation and Repolarisation of the Ventricles
3) Can Prolong Effective Refractory Period (ERP) between Heart Beats (Class Ia)

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10
Q

What is the purpose of CLASS II AA drugs?

A
  • Beta-Blockers, i.e. Atenolol and Bisoprolol
  • < HR

1) < Sympathetic Stimulation
2) Block Beta-1 Receptors at the SA and AV Nodes
3) Delay Phase 4 Depolarisation of Pacemaker APs
4) < SA Node Firing
5) Slow AV Node Conduction

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11
Q

What is the purpose of CLASS III AA drugs?

A
  • K+ Channel Blockers, i.e. Amiodarone

1) Manipulate Phase 3 of Non-Pacemaker APs
2) Prolong Repolarisation of the Ventricles
3) Prolong ERPs between Heart Beats

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12
Q

What is the purpose of CLASS IV AA drugs?

A
  • Calcium Channel Blockers, i.e. Verapamil and Diltiazem (Rate-Limiting)
  • < HR
    1) Depress Phase 4 Depolarisation of Pacemaker APs
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13
Q

What is the purpose of DIGOXIN?

A

*Cardiac Glycoside

1) Inhibits Na+/K+ ATPase Pump
2) +ve Inotrope - Improves Strength of Contraction
3) Allows More Ca2+ to be Available

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14
Q

What COHORT is Digoxin commonly prescribed to?

A

Elderly for Rate Control

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15
Q

What are the ISSUES surrounding Digoxin use?

A

Used by Elderly, often with Renal Impairment

Causes Toxicity due to Prolonged Half-Life

Has many Side-Effects, i.e. Nausea; Bradycardia; Arrhythmias

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16
Q

What is the TREATMENT for Digoxin TOXICITY?

A

Digiband

17
Q

What are the ISSUES surrounding AMIODARONE use?

A

Interacts with Other Drugs, i.e. Digoxin

Many Side Effects Causing Tissue Abnormalities, i.e. Thyroid; Pulmonary Fibrosis

18
Q

Why is it IMPORTANT to ANTICOAGULATE patients with AF?

A

> Risk of Clotting in RA due to Impaired RA Contractility

> Risk of Stroke and/or Peripheral Emboli

19
Q

Other than AF, under what CIRCUMSTANCES would ANTICOAGULATION be INDICATED?

A

DVT/PE

After Surgery

Prolonged Immobilisation

20
Q

Name a SIGNIFICANT ORAL ANTICOAGULANT:

A

Warfarin

21
Q

What are Warfarin’s MECHANISMS of ACTION?

A

Inhibits Clotting Factors II, VII, IX and X

Vit K Antagonist

22
Q

What are the ISSUES surrounding Warfarin use?

A

Drug Interactions

Can > Warfarin Activity - Promote Bleeding

Can < Warfarin Activity - Promoting Clotting

23
Q

How can Warfarin effects be MONITORED?

A

1) Regular International Normalised Ratio (INR)

2) CHADS2 Score

24
Q

How can Warfarin SIDE EFFECTS be ATTENUATED?

A

1) Be Aware of Alterations in Therapy
2) Patient Education
3) < Alcohol Intake

25
Q

What might be a SAFER ALTERNATIVE to Warfarin in ANTICOAGULATIVE THERAPY?

A

Dabigatran or Rivaroxaban

26
Q

Describe WOLFF-PARKINSON-WHITE (WPW) Syndrome:

A

Accessory Pathway (Bundle of Kent) Used Instead of AV Node to Conduct Impulses Between Atria and Ventricles

Can Facilitate Atrial and Ventricular Arrhythmias

Also, a Type of Re-Entrant Tachycardia via Accessory Pathway

27
Q

Explain SUPRAVENTRICULAR TACHYCARDIAS (SVTs):

A

Abnormally Fast Heart Rhythm

Arising from Improper Electrical Activity Above the Ventricles

Ex) AF; Atrial Flutter; WPW

28
Q

Describe VENTRICULAR TACHYCARDIA (V Tach):

A

Abnormally Fast and Regular Heart Rhythm

Arising from Improper Electrical Activity Provided to the Ventricles

29
Q

What are the SYMPTOMS of V Tach?

A

1) Palpitations
2) Chest Pain
3) Dyspnoea
4) Dizziness
5) Syncope

30
Q

What INVESTIGATIONS would be used to diagnose V Tach?

A

1) ECG
2) FBC
3) Angiography

31
Q

What MANAGEMENT can help to PREVENT V Tach?

A

1) Diagnose and Treat the Underlying Cause

2) Implantable Cardiac Defibrillator and/or AA Drugs

32
Q

How can ACUTE V Tach be TERMINATED?

A

1) Cardiac Arrest Protocol

2) DC Cardioversion or AA Drugs

33
Q

What are the TREATMENTS for AF?

A

1) AA Drugs - Rate Control (1st Line = Beta-Blocker)
2) Radiofrequency Ablation
3) Anticoagulation

34
Q

What is the TREATMENT for VENTRICULAR FIBRILLATION (V Fib)?

A

Cardiac Arrest Protocol

35
Q

Describe the PREVALENCE of AF within the POPULATION:

A

1) > Risk 60 and Above

2) Highest Amongst the > 75 Cohort

36
Q

Explain SINUS ARREST:

A

Transient Suppression of the SA Node; Electrical Impulses Cannot be Conducted to Myocardial Tissues

CVS Pathologies (11 decks)

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