Arrhythmias - Pathophysiology, Presentation & Investigation

Question 1

Presentation (6)

Answer 1

Asymptomatic
Palpitation
Dyspnoea
Chest pain
Fatigue 
Embolism

Question 2

Investigation (3)

Answer 2

• Document arrhythmia on ECG- 12 lead, 24-hour recording, event recorder
• Blood tests especially thyroid function
• Echocardiogram

Question 3

Therapeutic Approaches

Answer 3

Digoxin/beta-blocker/ca-antagonist plus warfarin (aspirin if low risk) for rate control
Class Ic/III drugs +/- DC cardioversion

Question 4

Other therapeutic approaches

Answer 4

Pace & ablation of AV node
Substrate modification
Consider anticoagulation

Question 5

Supraventricular Tachycardia (5)

Answer 5

• AV-nodal re-entrant tachycardia
• c/o palpitations, dyspnoea, dizziness
• Good prognosis
• No treatment
• Drugs or RFA (radio frequency ablation)

Question 6

ECG of Atrial Flutter (2)

Answer 6

Normal P wave is absent and replaced by two or more irregular sawtooth-like waves called flutters of ff waves
Normal QRS complex

Question 7

What kind of patient would experience a atrial flutter (10)

Answer 7

Patients over 40 years of age
COPD
Chronic heart disease
Chronic hypertension
MI
Myocardial Ischaemia
Hypoxaemia
Pulmonary embolus
Hepatic Disease

Question 8

What is ventricular fibrillation characterised by

Answer 8

• Characterised by multiple and chaotic electrical activities of the ventricles

Question 9

What may VF follow

Answer 9

PVCs
Ventricular tachycardia
Ventricular flutter

Question 10

Ventricular Tachycardia symptoms

Answer 10

Palpitation
CP
Dysponoea
Dizziness
Syncope

Question 11

What normally causes Ventricular Tachycardia

Answer 11

Structural heart disease

Question 12

Investigations for ventricular tachycardia (3)

Answer 12

Bloods
ECHO
Angiogram

Question 13

Termination of Ventricular Tachycardia (3)

Answer 13

Cardiac arrest protocol, DC cardioversion or drugs

Question 14

ECG of ventricular tachycardia (2)

Answer 14

3 or more PVC in a row

QRS complex is wide and bizarre

Question 15

Prevention of Ventricular tachycardia (3)

Answer 15

Treat underlying cause
AAA drugs
ICD

Question 16

Long QT syndrome (3)

Answer 16

• Congenital or acquired
• May cause Tdp
• PX drugs, pacing or ICD (implantable cardioverter defibrillator)

Question 17

Torsades de Pointes due to CHB/AF

Answer 17

short-long-short RR intervals & prolonged repolarisation

Question 18

Indications for ICD therapy (3)

Answer 18

Cardiac arrest due to VT/VF
Sustained VT causing syncope or significant compromise
Sustained VT with poor LV function

Question 19

Temporary indications for pacing (3)

Answer 19

Intermittent or sustained symptomatic bradycardia, particularly syncope
Prophylactic when patient at high risk for development of severe bradycardia e.g. 2nd or 3rd degree AV block, post anterior MI, even when asymptomatic

Question 20

Indications for pacing Permanent (4)

Answer 20

Symptomatic of profound 2nd/3rd degree AV block, particularly when cause is unlikely to disappear
Probably Mobitz type II 2nd/3rd degree AV block even if asymptomatic
AV block associated with NM disease
After (or in preparation for) AV-node ablation
Alternating RBBB/LBBB
Syncope when bifasicular/trifasiclar block and no other explanation
Sinus node disease associated with symptoms
Carotid sinus hypersensitivity/malignant vasovagal syncope