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Cardiovascular > Arrhythmias - Pathophysiology, Presentation and Investigation > Flashcards

Arrhythmias - Pathophysiology, Presentation and Investigation Flashcards

1
Q

What structures in the heart conduct depolarisation?

A

SA node, AV node and bundle of His

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2
Q

What does the P wave represent on an ECG?

A

Atrial depolarisation
Is small as atria muscle is thin

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3
Q

What does the QRS complex represent on an ECG?

A

Ventricular depolarisation
Ventricular muscle is thicker and wave is usually narrow

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4
Q

What does the T wave represent on an ECG?

A

Ventricle repolarisation

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5
Q

Describe how an ECG would look for patient experiencing ventricle ectopic beats?

A

QRS complex happens early and different morphology
Depolarisation also looks different
Broader QRS complex as depolarising outside of bundle of His

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6
Q

Describe atrial fibrillation

A

Heart condition that causes an irregular and often abnormally fast heart rate.
Relatively common and benign
Atria are not depolarising normally and show chaotic signals throughout

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7
Q

What does Atrial fibrillation look like on an ECG?

A

No P wave and AV node is bombarded frequently with signals
QRS complex is irregular
Patient pulse is irregular irregularly
Narrow QRS as ventricles depolarise

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8
Q

What is the presentation of atrial fibrillation?

A

Asymptomatic, palpitations, dyspnoea, chest pain, fatigue and embolism

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9
Q

What investigations can be used for atrial fibrillation?

A

Document arrhythmia on an ECG - 12 lead, 24 hr recording and event recorder
Blood test esp. thyroid function
Echocardiogram - shows underlying problem and if patients should be put on anticoagulant

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10
Q

What are some therapeutic approaches to atrial fibrillation?

A

Rate control vs rhythm control
BB/ Ca antagonists/ digoxin vs class Ic/II drugs and maybe DC cardioversion
Electrical impulses - pace and ablatio, and substrate modification
Consider anticoagulant - warfarin or NOACs

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11
Q

What are 2 types of supraventricular tachycardia?

A

AV- nodal re-entrant tachycardia
AV-nodal re-entrant tachycardia (accessory pathway)

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12
Q

Describe AV-nodal re-entrant tachycardia?

A

Most common
Is an electrical circuit
Drive atria and ventricles at same rate and time so narrow QRS complex and cant see P waves
Is benign

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13
Q

What are the symptoms of AV-nodal re-entrant tachycardia?

A

Palpitations, dyspnoea and dizziness

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14
Q

What is the prognosis of AV-nodal re-entrant tachycardia?

A

Good - no treatment
Drugs or RFA is frequent and symptoms re causing problem to patient

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15
Q

Describe AV re-entrant tachycardia - accessory pathway?

A

Conducts more rapidly than AV node and heart muscle is in wrong place
Usually lies on left
During tachycardia - accessory pathway directs back to atria retrospectively and can sometime pre-excite atria

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16
Q

What is the prognosis in patients with AV re-entrant tachycardia - accessory pathway?

A

Usually good
No treatment but sometime drugs or RFA

17
Q

What does an ECG look like for AV re-entrant tachycardia - accessory pathway look like?

A

No interval between P wave and QRS complex
Slurring reflects ventricular depolarisation beside the accessory pathway
Broad QRS complex as depolarisation is outside of bundle of His

18
Q

How does RFA help in patients with AV re-entrant tachycardia?

A

Pathway is burnt and loss of pre-excitation

19
Q

Describe atrial flutter

A

Atria beats too quickly
Does not involve re-entrant/ accessory pathway
Large conducting wave front going round in atrium
Atrial rate is rapid and can cause palpitations
RFA is best

20
Q

What does Atrial flutter look like on an ECG?

A

Saw tooth P wave - looks like continually conducting atrium

21
Q

What is treatment for atrial fibrillation?

A

Control ventricular rate and thromboembolic risk
Usually cardiovert
Prevent with AA drugs or RFA of cavotricuspid

22
Q

What is ventricular fibrillation?

A

Most important as can lead to sudden death
Abnormal rhythm and heart is beating faster
Cardiac arrest protocol

23
Q

What are signs of ventricular tachycardia?

A

Palpitations, Chest pain, Dyspnoea, dizziness and syncope

24
Q

What is treatment and prevention for ventricular fibrillation?

A

Cardiac arrest protocol, DC cardioversion or drugs
Px underlying cause and AA drugs or ICD for prevention

25
Q

What is Torsades de pointes?

A

A ventricular tachycardia, meaning that it is a fast heartbeat with the electrical activity from the ventricles

26
Q

Explain Torsades de pointes due to CHB/AF

A

Short long short RR intervals and prolonged repolarisation

27
Q

Explain long QT syndrome

A

Congenital - autosomal dominant or acquired (drugs)
May cause Torsades de pointes
Px drugs, pacing and ICD to prevent cardiac arrest

28
Q

What are some indications for ICD therapy?

A

Secondary prevention - cardiac arrest due to VF/VT not a transient or reversible cause, sustained VT causing syncope or significant compromise, and sustained VT with poor LV function

29
Q

What does an ICD do?

A

Antiachycardia pacing
And gives high energy shock - patient feels this

30
Q

Describe 2nd degree heart block/ Mobitz type I on an ECG

A

PR interval prolonged
Atria cant depolarise ventricle
PP interval remains constant

31
Q

Describe 2nd degree heart block/ Mobitz type II on an ECG

A

PR intervals are not fixes - 2nd and 8th waves not conducted through to ventricle
PP interval remains constant
Every so often p wave fails to conduct

32
Q

Describe complete heart block on an ECG

A

P wave rate is irregular and bear no relation to QRS complex ore ventricular activity
Many patients need paced

33
Q

What are some temporary Indications for pacing?

A

Intermittent or sustained symptomatic bradycardia, particularly syncope
Prophylactic when patient at high risk of developing severe bradycardia - 2nd or 3rd heart block

34
Q

What are some permanent indications for pacing?

A

Symptomatic or profound 2/3rd heart block (cause likely to disappear), Mobitz type II 2nd/3rd degree AV block is asymptomatic, AV block associated with neuromuscular disease or after AV-node ablation
RBBB/LBBB, syncope when bifascicular bloc, sinus node disease, carotid sinus hypersensitivity ad poor LV function with LBBB

Cardiovascular (33 decks)

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