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Cardio > Arrhythmias (done) > Flashcards

Arrhythmias (done) Flashcards

1
Q

How does a yung boi figure out the heart rate on an ECG

A

Count the number of large squares between the QRS complex to give you ‘X’

Divide 300 by ‘X’

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2
Q

Which type of arrhythmia is the most prevalent in hospital?

A

Atrial fibrillation

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3
Q

What is atrial fibrillation?

A

Chaotic electrical activity in the Atria causing fluttering muscle contractions of the atrial walls

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4
Q

What is the nature of an AFib rhythm and why?

A

Irregularly irregular

Chaotic nature of depolarisation of atria means conduction through the AV node is random

This means the ventricles contract randomly so you get irregular QRS complexes

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5
Q

Describe what an AFib ECG looks like

A

Fucking mental base line, but with irregularly irregular QRS complexes

Heart rate high but not baked as a cake, tends to be 100-175 bpm

The fact that there is still QRS complexes is important for telling between A fib and V fib etc

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6
Q

How does AFib present?

A

Often asymptomatic

if symptomatic then:

  • Palpitations
  • Dyspnoea SOB
  • Chest pain
  • Fatigue maybe dizziness

Can present with/due to complication

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7
Q

What risk is associated with AFib?

A

Embolism

Often manifesting in stroke

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8
Q

How do you investigate persistent AFib?

A

ECG - 12 lead, 24 hour recording

Blood test for hyperthyroidism

ECHO

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9
Q

How would you investigate paroxysmal AFib?

A

ECG event recorder = “Holter monitor” - ambulatory monitor that patient can wear which is more suitable if AFib is intermittent

Bloods - hyperthyroidism

ECHO

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10
Q

Why is thyroid levels in bloods important for AF investigation?

A

Hyperthyroidism can sometimes cause Arrhythmias

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11
Q

What surgical treatments are available for AFib?

Drug therapy is on the other deck

A

Radiofrequency catheter ablation:

  • Ablation of AV node (+ implantation of pacemaker)
  • Maze procedure
  • Pulmonary vein ostial ablation

DC cardioversion is also an option (ICD)

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12
Q

How does AV-nodal re-entrant tachycardia (a type of SVT) present?

A

palpitations
dyspnoea
dizziness

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13
Q

What does Supraventricular tachycardia look like on an ECG?

A

Regular
HR over 100 but not mental

Shape of SVT is quite characteristic so look it up or something

Main features:

  • S dip goes a wee bit lower than Q dip
  • Single large wave between each complex
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14
Q

Overt AV re-entrant tachycardia is known as what?

A

Wolff-Parkinson-White syndrome

WPW

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15
Q

How is WPW / AV re-entrant tachycardia corrected?

A

Radiofrequency catheter ablation

Drug treatment is a bit iffy so doubt you’ll be asked about it

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16
Q

What is atrial flutter?

A

Type of SVT in which the atria has rapid contractions

However, it is not as chaotic as AFib

17
Q

How does an ECG of Atrial flutter look?

A

Saw tooth P-wave appearance

Usually 1, 2 or 3 Saw tooth P waves between each QRS complex

18
Q

What causes Atrial flutter?

A

Re-entry loop in the right atrium which includes the “Cavotricuspid isthmus”

The loop causes rapid aortic contractions, but the AV node’s long refractory period means some of them aren’t conducted down to the Ventricles

19
Q

How is Atrial flutter treated?

A

Drugs - Control ventricular rate & thromboembolic risk

Usually cardiovert

Prevent with AA drugs or RFA of cavotricuspid isthmus

20
Q

What is ventricular fibrillation?

A

Rapid uncoordinated squirming contractions of the ventricles

Caused by a re-entrant loop in the ventricle

21
Q

How does VFib present?

A

Presents often as cardiac arrest - patient seriously unwell

22
Q

How is VFib treated?

A

Cardiac arrest protocol

Defibrillation & CPR

IV adrenaline 100microg and amiodarone if needed

23
Q

How does Vfib look on an ECG?

A

Fucking mental

No recognisable waves - just a big mess

24
Q

How does Ventricular Tachycardia present?

A 
Palpitations
Chest Pain
Dyspnoea
Dizziness
Syncope
25
Q

How is VT investigated?

A

ECG
Bloods (Thyroid)
ECHO
Angiogram

26
Q

What causes long QT syndrome?

A

Repolarisation phase is abnormally long in some of their heart cells

This means the time taken for the T wave to occur (which is caused by repolarisation) is longer

27
Q

What causes long QT syndrome?

A

Congenital or acquired

28
Q

What can be caused by long QT syndrome?

A

Torsades de Pointes

29
Q

How would you identify TdP on an ECG?

A

Short-long-short intervals between QRS complexes

30
Q

What are the indications for a patient to receive an ICD?

A

Cardiac arrest due to VF/VT not due to transient or
reversible cause eg early phase of acute MI

Sustained VT causing syncope or significant compromise

Sustained VT with poor LV function

31
Q

“Sick sinus rhythm” can happen to someone after what?

A

MI

32
Q

What is Sick sinus rhythm?

A

asymptomatic SA node suppression

Occasional really long gaps between heart beats

33
Q

What are the indications for temporary pacing?

A

intermittent or sustained symptomatic bradycardia,
particularly syncope

prophylactic when patient at high risk for development of severe bradycardia eg 2nd or 3rd degree AV block, post anterior MI, even when asymptomatic

34
Q

What are the indications for permanent pacing?

A

Symptomatic or profound 2nd/3rd degree AV block,
particularly when cause is unknown ± unlikely to disappear

Probably Mobitz type II 2nd/3rd degree AV block even if asymptomatic

AV block associated with neuromuscular diseases

After (or in preparation for) AV-node ablation

alternating RBBB/LBBB

syncope when bifascicular/trifascicular block and no other explanation

sinus node disease associated with symptoms

carotid sinus hypersensitivity/malignant vasovagal syncope

35
Q

What does first degreeHeart block look like on an ECG?

A

Long PR interval > 200ms

36
Q

What does Mobitz (2D) type 1 heart block look like on an ECG?

A

PR interval progressively grows until dropped beat

37
Q

What does Mobitz (2D) type 2 heart block look like on an ECG?

A

Occasional dropped QRS complex/beat but with consistent PR intervals

38
Q

What does third degree (complete) heart block look like?

A

P waves are regular and consistent and QRS complexes are also regular

But P waves and QRS complexes have no relation to each other as there is no conduction of depolarisation

So PR intervals are completely random

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