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Rakeem's Cardiology > Arrhythmias – Supraventricular Tachycardia (SVT) – Atrial Fibrillation > Flashcards

Arrhythmias – Supraventricular Tachycardia (SVT) – Atrial Fibrillation Flashcards

1
Q

Define supraventricular tachycardia (SVT) arrhythmia

A

An abnormality of the heart’s rate or rhythm, originating in the atria

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2
Q

What is Bradycardia/Bradyarrhythmia defined as?

A

< 60bpm

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3
Q

What is Sinus Bradycardia?

A

Caused by Sinus pauses, Sick Sinus Syndrome, Ischaemia and Infarction

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4
Q

What is Tachycardia/Tachyarrhythmia defined as?

A

> 100bpm

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5
Q

What are Supraventricular Tachyarrhythmias?

A

Occurring in the atria/above the ventricles

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6
Q

What are the types of SVT?

A

Atrial Fibrillation, Atrial Flutter, AVRT and AVNRT

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7
Q

What are types of AFib?

A
  • Paroxysmal AF
  • Persistent AF
  • Longstanding persistent AF
  • Permanent AF
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8
Q

What is paroxysmal AF?

A

Intermittent arrhythmias lasting minutes to days

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9
Q

What is persistent AF?

A

Lasts longer than 7 days, or less when treated

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10
Q

What is longstanding persistent AF?

A

Continuous AFib for a year or longer

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11
Q

What is permanent AF?

A

Severe AFib present all the time, no attempts to restore normal heart rhythm made

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12
Q

What is the pathophysiology of AFib?

A
  • Characterised by abnormal electrical activity within the atria, causing them to fibrillate and not pump blood effectively
  • There can be pooling of blood which can lead to thromboembolic events
  • Most common cardiac rhythm disorder
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13
Q

What is AFib most caused by?

A

cardiac remodelling (changes in the structure of the heart) in response to disease/damage

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14
Q

What does AFib often show on presentation?

A

asymptomatic

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15
Q

What shows on an ECG for AFib?

A

irregularly irregular pulse without p waves

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16
Q

What are symptoms for AFib?

A

Palpitations
Chest Pain
Shortness of Breath/Dyspnoea
Dizziness/syncope

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17
Q

What are signs of AFib?

A

Irregularly irregular pulse
Hypotension
Evidence of heart failure

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18
Q

What are risk factors for AFib?

A

Advancing age
Male sex
Family history
Hypertension
Heart conditions
Alcohol consumption
Smoking
Thyroid disorders
Chronic kidney disease (CKD)

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19
Q

What are complications of AFib?

A

Ischaemic Stroke
Heart failure
Cardiogenic Shock

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20
Q

What are investigations for AFib?

A
  • ECG
  • Bloods
  • CXR
  • Transoesophageal Echocardiogram
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21
Q

What is seen on an ECG for AFib?

A
  • “Irregularly Irregular” rate and no distinguishable p waves
  • Fibrillatory waves may be present or absent
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22
Q

What is seen in bloods results for AFib?

A

To determine causes:
- FBC for infection and electrolyte imbalances
- TFTs for hyperthyroidism
- Cardiac biomarkers and BNP for cardiac disease

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23
Q

Why is a CXR done?

A

Check for abnormality

24
Q

Why is a Transoesophageal Echocardiogram done?

A

To assess for cardioversion

25
Q

How long is acute AFib presentation?

A

<48hrs after symptoms

26
Q

What type of patients are usually seen for acute AFib?

A

Patients are usually younger and present with severe symptoms

27
Q

What are acute AFib symptoms?

A

Rapid pulse (>150bpm)
Low BP (Systolic BP < 90mmHh)
Loss of consciousness (Syncope)
Chest Pain
SOB (Dyspnoea)

28
Q

What are the aims for treating acute AFib?

A
  • Treat underlying conditions which may cause AF (e.g. MI, Pneumonia)
  • Control Ventricular rate (Using either 1st or 2nd line agents)
29
Q

What 2 treatments would you consider for acute AFib?

A
  • anticoagulants
  • DC or drug cardioversion
30
Q

Describe anticoagulant treatment for acute AFib

A

Heparin whilst the patient is assessed and then oral anticoagulation after AFib is confirmed

31
Q

Describe DC or drug cardioversion treatment for acute AFib

A
  • Use DC cardioversion in an acute setting
  • performed in ITU setting with sedation
  • shocked at 200J initially, if unsuccessful, try 2 further attempts at 360J
  • Thrombi are a contraindication for cardioversion
32
Q

What are the aims for treating chronic AFib?

A
  • Identify and treat reversible causes
  • Conduct echo to rule out structural heart disease
  • Control Ventricular rate or rhythm
33
Q

What are the 1st line rate control options for treating chronic AFib?

A

1st Line
- Beta Blocker OR Ca2+ Blocker (Using both is contraindicated; causes heart block)
- BB is generally preferred (Atenolol, Bisoprolol, Carvedilol etc.)

34
Q

What are the 2nd line rate control options for treating chronic AFib?

A

2nd Line
– Same as 1st line but add Digoxin or Amiodarone
- Digoxin cannot be used as the sole treatment for AF

35
Q

What are the rhythm control options for treating chronic AFib?

A
  • Flecainide
  • Amiodarone
  • Electrical Cardioversion
  • Catheter Ablation
36
Q

What is flecainide contraindicated in?

A

Contraindicated in LV dysfunction, LV hypertrophy

37
Q

What can amiodarone cause?

A

Can cause thyrotoxicosis; Excess T3 or 4

38
Q

Which type of patients is catheter ablation usually used in?

A

In younger patients with failed rhythm control using other options

39
Q

What is used to assess need for anticoagulation?

A

CHA2DS2-VASc

40
Q

What is used to assess bleeding risk?

A

ORBIT

41
Q

What does a CHA2DS2-VASc score of 0 mean?

A

Risk is low, No AC therapy needed

42
Q

What does a CHA2DS2-VASc score of 1 mean?

A

Risk is low-moderate, AC therapy considered

43
Q

What does a CHA2DS2-VASc score of 2+ mean?

A

Risk is moderate or high, AC therapy recommended

44
Q

What does an ORBIT score of 0-2 mean?

A

Risk is low, 2.4 bleeds per 100 patient-years (unit of measurement for risk)

45
Q

What does an ORBIT score of 3 mean?

A

Risk is medium, 4.7 bleeds per 100 patient-years

46
Q

What does an ORBIT score of 4-7 mean?

A

Risk is high, 8.1 bleeds per 100 patient-years

47
Q

What does CHA2DS2-VASc stand for?

A

C- Congestive HF +1
H- Hypertension +1
A2- Age 75+ +2
D- DM+1
S2- Previous stroke, TIA or thromboembolism +2
V- Vascular disease +1
A- Age 65-74 +1
Sc- Sex category (female) +1

48
Q

What does ORBIT stand for?

A

O - Older (75+) +1
R- Reduced Hb +2
B- Bleeding history +2
I- Insufficient kidney function +1
T- Treatment with antiplatelet agent +1

49
Q

What are 2 types of DOACs (Direct Oral Anticoagulants)?

A

Factor Xa inhibitors
Thrombin inhibitors

50
Q

What are examples of factor Xa inhibitors?

A

rivaroxaban, apixaban

51
Q

What is an example of thrombin inhibitors?

A

dabigatran

52
Q

What is preferred DOACs or warfarin?

A

DOACs

53
Q

Why are DOACs preferred over warfarin?

A
  • DOACs don’t require monitoring of INR (International normalised ratio; used to measure length of time to clot) unlike warfarin (Need to maintain a level of INR in an individual on warfarin)
  • DOACs have less drug interactions
  • DOACs have standardised dosing
54
Q

What are disadvantages of DOACs?

A
  • DOACs are less easily reversible; hard to stop the effects of DOACs if patient is bleeding
  • DOACs not recommended for use when structural heart disease present
55
Q

Summarise the treatment for paroxysmal AFib

A
  • 1st line – Sotalol/Bisoprolol (Beta Blockers)
    In youth, use Flecainide/Verapamil, avoid in elderly (negatively ionotropic)
  • 2nd line – Amiodarone
  • 3rd line – Digoxin; useful in LV dysfunction as it is positively ionotropic
  • Consider Anticoagulants
  • Consider DC Cardioversion + Amiodarone

Rakeem's Cardiology (24 decks)

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