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AY Cardiovascular > Arrthymia's > Flashcards

Arrthymia's Flashcards

1
Q

What is a ventricular arrthymia?

A

Origin is in ventricle

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2
Q

What are ectopic beats?

A

Beats or rhythms that originate in places other than the SA node

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3
Q

Name the supraventricular arrhthymias

A 
Tachycardia 
   - Atrial Fibrillation  
   - Atrial Flutter 
   - Ectopic atrial tachycardia
Bradycardia
   - sinus bradycardia 
   - sinus pauses
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4
Q

Name the AV node arrhthymias

A 
AVN re-entry 
WPW
AV block (1st, 2nd, 3rd degree)
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5
Q

Name the ventricular arrhthymias

A

Premature Ventricular Complex (PVC)
Ventricular Tachycardia
Ventricular Fibrillation
Asystole

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6
Q

What anatomical changes can cause arrhthymias?

A

LV hypertrophy
Accessory pathways
Congenital HD

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7
Q

What are the Utonomic causes of arrhythmias?

A

Sympathetic stimulation
(Nervousness, exercise, CHF, hyperthyroidism)

Increased vagal tone (bradycardia, heart block)

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8
Q

What is a supraventricular arrthymia?

A

Origin is above ventricle

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9
Q

Metabolic causes of arrhthymias

A

Hypoxia myocardium: chronic pulmonary disease, PE
Ischaemic myocardium
Electrolyte imbalances (K+, Ca2+, Mg2+)

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10
Q

Other causes of arrhythmias

Not anatomical, autonomic, metabolic

A

Inflammation
Drugs
Genetic

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11
Q

What are the physiological mechanism of arrhythmias?

A

Altered automaticity
Triggered activity
Re-entry

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12
Q

Symptoms of arrthymias

A 
Palpitations 
Dyspnoea 
Dizziness 
Syncope 
Worsening of existing condition
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13
Q

Investigations for arrhythmias

A 
ECG!!!!!!!!
CXR
Echocardiogram 
Stress ECG/24 hr monitoring 
EP study (induce arrthymia to study pathway)
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14
Q

How do you treat atrial ectopic beats?

A

Generally no treatment
B-adrenergic blockers may help
Avoid stimulants (caffeine, cigarettes)

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15
Q

Treatment for sinus bradycardia

A 
Atropine (if acute) 
Pacing if: 
- haemodynamic compromise 
- hypotension
- CHF 
- angina 
- collapse
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16
Q

Treatment for sinus tachycardia

A

Treat underlying cause

Beta blockers

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17
Q

Acute management of SVT

A

Vagal manoeuvres, carotid massage
IV adenosine
IV verapamil

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18
Q

Chronic management of SVT

A 
Avoid stimulants 
Radiofrequency ablation 
Anti arrthymia drugs (class II or IV)
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19
Q

What is ablation?

A

Selective cautery of cardiac tissue to prevent tachycardia, targeting either an automatic focus or part of a re-entry circuit

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20
Q

What is 1st degree AV block?

A

Not really “block”
Just longer P-R interval (> 0.2 sec)

Husband is late but comes home every night

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21
Q

Treatment of first degree AV block

A

None

Long term follow up re commended incase it progresses

22
Q

What is 2nd degree heart block (Mobitz type 1)?

A

Husband comes home later and later every night until one night he doesn’t come home at all (must come home at least twice)

23
Q

Treatment for 2nd degree heart block (Mobitz type I)?

A

Atropine

24
Q

What is 2nd degree heart block (Mobitz type II)?

A

Sometimes husband comes home but sometimes he doesn’t but when he does come home it’s always at the same time

25
Q

Treatment for 2nd degree heart block (Mobitz type II)?

A

Atropine

Sometimes requires pacing

26
Q

What is 3rd degree heart block?

A

Wife is no longer waiting at home. She and her husband are on different schedules and have no relationship. Each spouse has a regular individual schedule

27
Q

Treatment for 3rd degree heart block

A

Temporary or permanent pacing

28
Q

What do premature ventricular ectopics indicate?

A

May not have structural heart disease
Could be
- ischaemia heart disease
- hypertension with left ventricular hypertrophy
- inherited arrthymia syndromes (e,g, cardiomyopathy)

If worse on exercise need to investigate further

29
Q

Treatment for premature ventricular ectopics

A

Beta blockers

30
Q

Causes of VT

A

Coronary artery disease
Previous MI

Cardiomyopathy
Inherited arrthymia syndromes

31
Q

Characteristics of VT on an ECG

A

Broad QRS complexes
Large T waves
Regular rapid rhythm
Usually no visible p waves

32
Q

Acute treatment of VT

A

DC cardioversion if unstable
If stable consider pharmacological cardioversion (AADs)
Of unsure if Vt consider adenosine to make diagnosis

33
Q

Long term treatment for VT

A 
Correct ischaemia (revascularisation)
Anti-arrthymic drugs 
Implantable cardiovertor defibrillators (ICD)
34
Q

What is VF?

A

Chaotic ventricular electrical activity

Heart can’t pump

35
Q

Treatment of VF

A

Defibrillation

CPR

36
Q

What is AF?

A

Chaotic disorganised atrial activity

Irregular heartbeat

37
Q

What are the 3 forms of AF?

A

Paroxysmal ( 48 hours but can still be cardioverted to NSR)

Permanent

38
Q

Diseases associated with AF

A 
Hypertension 
CHF
Sick sinus syndrome 
Coronary heart disease 
Thyroid disease 
Valvular heart disease 
Cardiac surgery
39
Q

Symptoms of AF

A 
Palpitations 
Dizziness
Syncope 
Chest pain 
Dyspnoea 
Sweatiness 
Fatigue
40
Q

Where is the ectopic focus in AF?

A

Around the pulmonary veins

41
Q

Treatment of AF

A

Anti-arrhythmic drugs

Electrical cardioversion

42
Q

Examples of anti arrhthymic drugs used in AF

A

Digoxin
Betablockers
Verapamil, diltiazem

43
Q

What does AF look like on an ECG?

A

Absent P waves

44
Q

What are the classes of anti-arrhthymic drugs?

A

Class I: reduce NA channel current
(Flecainide, quinidine, lignocaine, propafenone)

Class II: Betablockers
(Propranolol)

Class III: Prolong action potential
Amiodarone, sotalol, dronedarone)

Class IV: ca channel antagonists
(Verapamil)

45
Q

What is TdP and how is it recognised on an ECG?

A

Distinct type of VT
Long QT interval
Wide QRS
Continually changing QRS morphology

46
Q

What can lead to TdP?

A

Hypokalemia
Drug induced prolongation of action potential
Renal impairment

47
Q

What indicates the need for anticoagulation in valvular AF?

A

Mitral valve disease (MS & MR)

48
Q

What indicates the need for anticoagulation in patients with non valvular AF?

A 
Age > 75 
Hypertension 
Heart failure 
Previous thromboembolism 
CAD/ DM
Diabetes
49
Q

What is atrial flutter?

A

Rapid and regular form of atrial tachycardia

50
Q

What is the treatment for atrial flutter?

A

RF ablation
Pharmacological therapy
Cardioversion
Warfarin (prevent thromboembolism)

51
Q

What rhythms are shockable?

A

VF

VT

52
Q

What arrthymias are not shockable?

A

Asystole (adrenaline 1mg)

PEA (adrenaline 1mg)

AY Cardiovascular (28 decks)

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