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Year 6 Cardiology > Arryhthmias: Atrial flutter > Flashcards

Arryhthmias: Atrial flutter Flashcards

1
Q

What is atrial flutter?

A

Atrial flutter is a form of supraventricular tachycardia characterised by a succession of rapid atrial depolarisation waves.

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2
Q

What are the ECG findings in atrial flutter?

A

‘Sawtooth’ appearance; the underlying atrial rate is often around 300/min, and the ventricular rate depends on the degree of AV block.

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3
Q

What happens to the ventricular rate with a 2:1 AV block in atrial flutter?

A

The ventricular rate will be 150/min.

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4
Q

When may flutter waves be visible?

A

Flutter waves may be visible following carotid sinus massage or adenosine.

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5
Q

How is the management of atrial flutter similar to atrial fibrillation?

A

Management is similar, although medication may be less effective.

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6
Q

How does atrial flutter respond to cardioversion?

A

Atrial flutter is more sensitive to cardioversion, allowing for lower energy levels to be used.

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7
Q

What is a curative treatment for most patients with atrial flutter?

A

Radiofrequency ablation of the tricuspid valve isthmus.

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8
Q

What is atrioventricular (AV) block?

A

AV block, or heart block, is impaired electrical conduction between the atria and ventricles.

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9
Q

What are the types of atrioventricular block?

A

There are three types: First-degree heart block, Second-degree heart block, and Third-degree heart block.

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10
Q

What characterizes first-degree heart block?

A

In first-degree heart block, the PR interval is greater than 0.2 seconds.

Asymptomatic first-degree heart block is relatively common and does not need treatment.

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11
Q

What are the types of second-degree heart block?

A

Second-degree heart block has two types: Type 1 (Mobitz I, Wenckebach) and Type 2 (Mobitz II).

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12
Q

What is type 1 second-degree heart block?

A

Type 1 (Mobitz I, Wenckebach) involves progressive prolongation of the PR interval until a dropped beat occurs.

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13
Q

What is type 2 second-degree heart block?

A

Type 2 (Mobitz II) has a constant PR interval, but the P wave is often not followed by a QRS complex.

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14
Q

What characterizes third-degree heart block?

A

In third-degree (complete) heart block, there is no association between the P waves and QRS complexes.

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15
Q

What are features suggesting VT rather than SVT with aberrant conduction?

A

AV dissociation, fusion or capture beats, positive QRS concordance in chest leads, marked left axis deviation, history of IHD, lack of response to adenosine or carotid sinus massage, QRS > 160 ms

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16
Q

What is AV dissociation?

A

A condition where the atria and ventricles beat independently.

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17
Q

What are fusion or capture beats?

A

Fusion beats occur when a normal heartbeat merges with a ventricular tachycardia beat, while capture beats occur when a normal impulse captures the ventricle during tachycardia.

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18
Q

What does positive QRS concordance in chest leads indicate?

A

It suggests that all QRS complexes in the chest leads are in the same direction.

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19
Q

What does marked left axis deviation indicate?

A

It suggests a significant change in the heart’s electrical axis, often associated with ventricular tachycardia.

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20
Q

What is the significance of a history of IHD?

A

It indicates a higher risk for ventricular tachycardia due to underlying heart disease.

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21
Q

What does lack of response to adenosine or carotid sinus massage suggest?

A

It suggests that the tachycardia is likely ventricular rather than supraventricular.

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22
Q

What is the significance of a QRS duration greater than 160 ms?

A

It is a criterion that supports the diagnosis of ventricular tachycardia.

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23
Q

What are the features of complete heart block?

A

Syncope, heart failure, regular bradycardia (30-50 bpm), wide pulse pressure, JVP: cannon waves in neck, variable intensity of S1.

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24
Q

What is first degree heart block?

A

PR interval > 0.2 seconds.

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25
Q

What is second degree heart block type 1?

A

Progressive prolongation of the PR interval until a dropped beat occurs.

Also known as Mobitz I or Wenckebach.

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26
Q

What is second degree heart block type 2?

A

PR interval is constant but the P wave is often not followed by a QRS complex.

Also known as Mobitz II.

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27
Q

What is third degree (complete) heart block?

A

There is no association between the P waves and QRS complexes.

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28
Q

What is bradycardia?

A

Bradycardia is a slower than normal heart rate.

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29
Q

What does the management of bradycardia depend on?

A

The management of bradycardia depends on identifying adverse signs and the potential risk of asystole.

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30
Q

What are adverse signs indicating haemodynamic compromise?

A

Adverse signs include shock (hypotension, pallor, sweating, cold clammy extremities, confusion), syncope, myocardial ischaemia, and heart failure.

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31
Q

What is the first line treatment for bradycardia?

A

Atropine (500mcg IV) is the first line treatment.

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32
Q

What interventions may be used if there is an unsatisfactory response to atropine?

A

Interventions may include atropine (up to 3mg), transcutaneous pacing, or isoprenaline/adrenaline infusion titrated to response.

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33
Q

When should specialist help be sought in bradycardia management?

A

Specialist help should be sought for consideration of transvenous pacing if there is no response to initial measures.

34
Q

What are the risk factors for asystole?

A

Risk factors for asystole include complete heart block with broad complex QRS, recent asystole, Mobitz type II AV block, and ventricular pause > 3 seconds.

35
Q

When is specialist help indicated even with a satisfactory response to atropine?

A

Specialist help is indicated to consider the need for transvenous pacing in certain risk factors for asystole.

36
Q

What is tachycardia?

A

Tachycardia refers to a rapid heart rate, typically defined as a resting heart rate of over 100 beats per minute.

37
Q

What did the 2015 Resuscitation Council (UK) guidelines change regarding tachycardia management?

A

The guidelines replaced separate algorithms for broad-complex tachycardia, narrow complex tachycardia, and atrial fibrillation with one unified treatment algorithm.

38
Q

How are patients classified in the management of peri-arrest tachycardias?

A

Patients are classified as stable or unstable based on the presence of adverse signs.

39
Q

What are the adverse signs indicating an unstable patient?

A

Adverse signs include shock (hypotension, pallor, sweating, cold clammy extremities, confusion), syncope, myocardial ischaemia, and heart failure.

40
Q

What should be done if any adverse signs are present?

A

Synchronised DC shocks should be given, with up to 3 shocks allowed before seeking expert help.

41
Q

What is the treatment for regular broad-complex tachycardia?

A

Assume ventricular tachycardia and administer a loading dose of amiodarone followed by a 24-hour infusion.

42
Q

What should be done for irregular broad-complex tachycardia?

A

Seek expert help; possibilities include atrial fibrillation with bundle branch block or torsade de pointes.

43
Q

What is the treatment for regular narrow-complex tachycardia?

A

Perform vagal manoeuvres followed by IV adenosine; if unsuccessful, consider atrial flutter and control the rate.

44
Q

What is the approach for irregular narrow-complex tachycardia?

A

It is likely atrial fibrillation; if onset is < 48 hours, consider electrical or chemical cardioversion.

45
Q

What is usually the first-line treatment for rate control in irregular narrow-complex tachycardia?

A

Beta-blockers are usually the first-line treatment unless contraindicated.

46
Q

What is the definition of supraventricular tachycardia (SVT)?

A

SVT refers to any tachycardia that is not ventricular in origin, typically used in the context of paroxysmal SVT.

47
Q

What characterizes episodes of paroxysmal SVT?

A

Episodes are characterized by the sudden onset of a narrow complex tachycardia, typically an atrioventricular nodal re-entry tachycardia (AVNRT).

48
Q

What are other causes of supraventricular tachycardia?

A

Other causes include atrioventricular re-entry tachycardias (AVRT) and junctional tachycardias.

49
Q

What are the acute management options for SVT?

A

Acute management options include vagal manoeuvres, intravenous adenosine, and electrical cardioversion.

50
Q

What is the Valsalva manoeuvre?

A

The Valsalva manoeuvre involves trying to blow into an empty plastic syringe.

51
Q

What is the dosing protocol for intravenous adenosine in SVT management?

A

Administer a rapid IV bolus of 6mg; if unsuccessful, give 12 mg; if still unsuccessful, give a further 18 mg.

52
Q

What is contraindicated in asthmatics during SVT management?

A

Intravenous adenosine is contraindicated in asthmatics; verapamil is a preferable option.

53
Q

What are the prevention strategies for SVT episodes?

A

Prevention strategies include beta-blockers and radio-frequency ablation.

54
Q

What is Torsades de pointes?

A

A form of polymorphic ventricular tachycardia associated with a long QT interval. It may deteriorate into ventricular fibrillation and lead to sudden death.

55
Q

What are some congenital causes of long QT interval?

A

Jervell-Lange-Nielsen syndrome and Romano-Ward syndrome.

56
Q

Which antiarrhythmics can cause a long QT interval?

A

Amiodarone, sotalol, and class 1a antiarrhythmic drugs.

57
Q

What medications can lead to a long QT interval?

A

Tricyclic antidepressants, antipsychotics, chloroquine, terfenadine, and erythromycin.

58
Q

What electrolyte imbalances can cause a long QT interval?

A

Hypocalcaemia, hypokalaemia, and hypomagnesaemia.

59
Q

What are other causes of long QT interval?

A

Myocarditis, hypothermia, and subarachnoid haemorrhage.

60
Q

What is the management for Torsades de pointes?

A

IV magnesium sulphate.

61
Q

What is ventricular tachycardia (VT)?

A

Ventricular tachycardia (VT) is broad-complex tachycardia originating from a ventricular ectopic focus. It has the potential to precipitate ventricular fibrillation and hence requires urgent treatment.

62
Q

What are the two main types of ventricular tachycardia (VT)?

A

The two main types of VT are monomorphic VT and polymorphic VT.

63
Q

What commonly causes monomorphic VT?

A

Monomorphic VT is most commonly caused by myocardial infarction.

64
Q

What is a subtype of polymorphic VT?

A

A subtype of polymorphic VT is torsades de pointes, which is precipitated by prolongation of the QT interval.

65
Q

What are the causes of a prolonged QT interval?

A

Causes of a prolonged QT interval include congenital factors, drugs, and other conditions.

66
Q

What are some congenital causes of prolonged QT interval?

A

Congenital causes include Jervell-Lange-Nielsen syndrome (includes deafness) and Romano-Ward syndrome (no deafness).

67
Q

What drugs can cause prolonged QT interval?

A

Drugs that can cause prolonged QT interval include amiodarone, sotalol, class 1a antiarrhythmic drugs, tricyclic antidepressants, fluoxetine, chloroquine, terfenadine, and erythromycin.

68
Q

What are some other causes of prolonged QT interval?

A

Other causes include electrolyte imbalances (hypocalcaemia, hypokalaemia, hypomagnesaemia), acute myocardial infarction, myocarditis, hypothermia, and subarachnoid haemorrhage.

69
Q

What is the management for VT with adverse signs?

A

If the patient has adverse signs (systolic BP < 90 mmHg, chest pain, heart failure), then immediate cardioversion is indicated.

70
Q

What is the management for VT without adverse signs?

A

In the absence of adverse signs, antiarrhythmics may be used. If these fail, then electrical cardioversion may be needed with synchronised DC shocks.

71
Q

What are the drug therapies for VT?

A

Drug therapies include amiodarone (ideally through a central line), lidocaine (use with caution in severe left ventricular impairment), and procainamide.

72
Q

What should NOT be used in VT?

A

Verapamil should NOT be used in VT.

73
Q

What to do if drug therapy fails in VT?

A

If drug therapy fails, options include electrophysiological study (EPS) and implantable cardioverter-defibrillator (ICD), particularly indicated in patients with significantly impaired LV function.

74
Q

What does the European Resuscitation Council advise regarding broad complex tachycardia in a peri-arrest situation?

A

It is assumed to be ventricular in origin.

75
Q

What signs indicate that immediate cardioversion is needed?

A

Adverse signs include systolic BP < 90 mmHg, chest pain, heart failure, and syncope.

76
Q

What should be used if adverse signs are absent?

A

Antiarrhythmics may be used.

77
Q

What is the next step if antiarrhythmics fail?

A

Electrical cardioversion may be needed with synchronised DC shocks.

78
Q

What is the preferred method for administering amiodarone?

A

Ideally administered through a central line.

79
Q

What caution should be taken with lidocaine?

A

Use with caution in severe left ventricular impairment.

80
Q

Which drug should NOT be used in ventricular tachycardia (VT)?

A

Verapamil should NOT be used in VT.

81
Q

What are the options if drug therapy fails?

A

Options include electrophysiological study (EPS) and implantable cardioverter-defibrillator (ICD).

82
Q

In which patients is an implantable cardioverter-defibrillator (ICD) particularly indicated?

A

Patients with significantly impaired left ventricular function.

Year 6 Cardiology (36 decks)

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