Arrhythmias - pathophysiology, presentation & investigation# Flashcards

1
Q

Features of arrhythmias

A
  • Asymptomatic
  • Palpitations, dyspnoea, chest pain, fatigue
  • Embolism
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2
Q

Investigation of arrhythmias

A
  • Document arrhythmia on ECG: 12 lead, 24 hour recording, event recorder
  • Blood tests esp thyroid function
  • Echocardiogram
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3
Q

Therapeutic approaches for arryhythmias

A

Rate control versus rhythm control:

  • DIgoxin/beta-blocker/Ca-antagonit plus warfarin versus class Ic/III drugs +/- DC cardioversion
  • Electrical approaches: pace & ablation of AV node, substrate modification e.g. pulmonary ostial ablation, maze procedures
  • Consider anticoagulation: based on the scoring system
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4
Q

Features of supraventricular tachycardia

A

AV-nodal re-entrant tachycardia

  • C/O palpitations, dyspnoea, dizziness
  • Good prognosis

AV re-entrant tachycardia (due to accessory pathway-WPW if overt):

  • Usually good prognosis
  • No treatment
  • Drugs (so-so) or RFA
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5
Q

Treatment for atrial flutter

A
  • Control ventricular rate & thromboembolic risk
  • Usually cardiovert
  • Prevent with AA drugs or RFA of cavotricuspid isthmus
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6
Q

Features of ventricular tachycardia

A
  • Palpitations, CP, dyspnoea, dizziness, syncope
  • Usually structural heart disease
  • Take bloods, echo, angio etc
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7
Q

What is Torsades de Pointes caused by?

A

Long QT syndrome

  • congenital or acquired
  • May cause TdP
  • Px drugs, pacing or ICD
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8
Q

Indications for ICD (implantable cardioverter defibrillator) therapy

A

Secondary prevention

  • Cardiac arrest due to VF/VT not due to transient or reversible cause e.g. early phase of acute MI
  • Sustained VT causing syncope or significant compromise
  • Sustained VT with poor LV function
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9
Q

What are indications for temporary pacing?

A
  • 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, postanterior MI, even when asymptomatic
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10
Q

Indications for permanent pacing

A
  • Symptomatic or profound 2nd/3rd degree AV block, particularly when cause 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-nodeablation
  • Alternating RBBB/LBBB
  • Syncope when bifascicular/trifascicular block and no other explanation
  • Sinus node disease associated with symptoms
  • Carotid sinus hypersensitivity/malignant vasovagal syncope
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