Arrthymia's Flashcards by Alison Young

What is a ventricular arrthymia?

Origin is in ventricle

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What are ectopic beats?

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

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Name the supraventricular arrhthymias

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

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Name the AV node arrhthymias

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

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Name the ventricular arrhthymias

Premature Ventricular Complex (PVC)
Ventricular Tachycardia
Ventricular Fibrillation
Asystole

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What anatomical changes can cause arrhthymias?

LV hypertrophy
Accessory pathways
Congenital HD

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What are the Utonomic causes of arrhythmias?

Sympathetic stimulation
(Nervousness, exercise, CHF, hyperthyroidism)

Increased vagal tone (bradycardia, heart block)

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What is a supraventricular arrthymia?

Origin is above ventricle

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Metabolic causes of arrhthymias

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

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Other causes of arrhythmias

Not anatomical, autonomic, metabolic

Inflammation
Drugs
Genetic

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What are the physiological mechanism of arrhythmias?

Altered automaticity
Triggered activity
Re-entry

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Symptoms of arrthymias

Palpitations 
Dyspnoea 
Dizziness 
Syncope 
Worsening of existing condition

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Investigations for arrhythmias

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

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How do you treat atrial ectopic beats?

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

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Treatment for sinus bradycardia

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

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Treatment for sinus tachycardia

Treat underlying cause

Beta blockers

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Acute management of SVT

Vagal manoeuvres, carotid massage
IV adenosine
IV verapamil

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Chronic management of SVT

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

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What is ablation?

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

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What is 1st degree AV block?

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

Husband is late but comes home every night

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Treatment of first degree AV block

None

Long term follow up re commended incase it progresses

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

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

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

Atropine

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

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

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

Atropine | Sometimes requires pacing

What is 3rd degree heart block?

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

Treatment for 3rd degree heart block

Temporary or permanent pacing

What do premature ventricular ectopics indicate?

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

Treatment for premature ventricular ectopics

Beta blockers

Causes of VT

Coronary artery disease Previous MI Cardiomyopathy Inherited arrthymia syndromes

Characteristics of VT on an ECG

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

Acute treatment of VT

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

Long term treatment for VT

``` Correct ischaemia (revascularisation) Anti-arrthymic drugs Implantable cardiovertor defibrillators (ICD) ```

What is VF?

Chaotic ventricular electrical activity | Heart can't pump

Treatment of VF

Defibrillation | CPR

What is AF?

Chaotic disorganised atrial activity | Irregular heartbeat

What are the 3 forms of AF?

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

Diseases associated with AF

``` Hypertension CHF Sick sinus syndrome Coronary heart disease Thyroid disease Valvular heart disease Cardiac surgery ```

Symptoms of AF

``` Palpitations Dizziness Syncope Chest pain Dyspnoea Sweatiness Fatigue ```

Where is the ectopic focus in AF?

Around the pulmonary veins

Treatment of AF

Anti-arrhythmic drugs | Electrical cardioversion

Examples of anti arrhthymic drugs used in AF

Digoxin Betablockers Verapamil, diltiazem

What does AF look like on an ECG?

Absent P waves

What are the classes of anti-arrhthymic drugs?

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)

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

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

What can lead to TdP?

Hypokalemia Drug induced prolongation of action potential Renal impairment

What indicates the need for anticoagulation in valvular AF?

Mitral valve disease (MS & MR)

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

``` Age > 75 Hypertension Heart failure Previous thromboembolism CAD/ DM Diabetes ```

What is atrial flutter?

Rapid and regular form of atrial tachycardia

What is the treatment for atrial flutter?

RF ablation Pharmacological therapy Cardioversion Warfarin (prevent thromboembolism)

What rhythms are shockable?

VF | VT

What arrthymias are not shockable?

Asystole (adrenaline 1mg) | PEA (adrenaline 1mg)