Arrhythmias - Pathophysiology, Presentation & Investigation Flashcards
Presentation (6)
Asymptomatic Palpitation Dyspnoea Chest pain Fatigue Embolism
Investigation (3)
- Document arrhythmia on ECG- 12 lead, 24-hour recording, event recorder
- Blood tests especially thyroid function
- Echocardiogram
Therapeutic Approaches
Digoxin/beta-blocker/ca-antagonist plus warfarin (aspirin if low risk) for rate control
Class Ic/III drugs +/- DC cardioversion
Other therapeutic approaches
Pace & ablation of AV node
Substrate modification
Consider anticoagulation
Supraventricular Tachycardia (5)
- AV-nodal re-entrant tachycardia
- c/o palpitations, dyspnoea, dizziness
- Good prognosis
- No treatment
- Drugs or RFA (radio frequency ablation)
ECG of Atrial Flutter (2)
Normal P wave is absent and replaced by two or more irregular sawtooth-like waves called flutters of ff waves
Normal QRS complex
What kind of patient would experience a atrial flutter (10)
Patients over 40 years of age COPD Chronic heart disease Chronic hypertension MI Myocardial Ischaemia Hypoxaemia Pulmonary embolus Hepatic Disease
What is ventricular fibrillation characterised by
• Characterised by multiple and chaotic electrical activities of the ventricles
What may VF follow
PVCs
Ventricular tachycardia
Ventricular flutter
Ventricular Tachycardia symptoms
Palpitation CP Dysponoea Dizziness Syncope
What normally causes Ventricular Tachycardia
Structural heart disease
Investigations for ventricular tachycardia (3)
Bloods
ECHO
Angiogram
Termination of Ventricular Tachycardia (3)
Cardiac arrest protocol, DC cardioversion or drugs
ECG of ventricular tachycardia (2)
3 or more PVC in a row
QRS complex is wide and bizarre
Prevention of Ventricular tachycardia (3)
Treat underlying cause
AAA drugs
ICD
Long QT syndrome (3)
- Congenital or acquired
- May cause Tdp
- PX drugs, pacing or ICD (implantable cardioverter defibrillator)
Torsades de Pointes due to CHB/AF
short-long-short RR intervals & prolonged repolarisation
Indications for ICD therapy (3)
Cardiac arrest due to VT/VF
Sustained VT causing syncope or significant compromise
Sustained VT with poor LV function
Temporary indications for pacing (3)
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
Indications for pacing Permanent (4)
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
