Arrythmia

Question 1

AV block poem

Answer 1

R is far from P- first degree

Longer longerr longerrr drop- wenkebac

Some Ps dont get through- Mobitz 2

P and Q dont agree- third degree

Question 2

QRS morphology in AV2

Answer 2

Mobitz 1= normal

Mobitz 2 = usually abnormal

Question 3

Cause of mobitz 1

Answer 3

DIGOXIN

Question 4

Cause of Mobitz 2

Answer 4

AVN ischemia

Question 5

HR in 3°AV block

Answer 5

30-60

WIDE QRS COMPLEXES

AV dissociation

QRS and T in opposite direction

Question 6

Total arrythmia types (14)

Answer 6

Sinus Bradycardia
Sinus arrest
1AVB
Mobitz1
Mobitz2
3AVB

Sinus tachycardia 
Unifocal atrial tachycardia
Multifocal atrial tachycardia 
Atrial flutter
Afib
PSVT
Vtach
Vfib

Question 7

Max conduction rate of AVN

Answer 7

250

Question 8

Atrial ectopic cause and rate

Answer 8

Hypoxia in COPD

100-250

Question 9

Atrial flutter presentation and speed

Answer 9

Palpitations

250-350

Question 10

Afib cause

Answer 10

Stretching of atrial fibres

LAE
CMP
ASD

Question 11

DOC stable Afib and further mx

Answer 11

Beta blockers

(If not allowed then CCB/Digoxin)

MOA: block avn further so as to stop arrythmia from reaching ventricles

F/b convert afib into sinus rhythm

By either 1) Ibutilide 2)DC shock

Maintenance of sinus rhythm DOC= AMIODARONE

Question 12

AFib + WPW syndrome C/I and doc

Answer 12

C/I CCB/BB — accentuated bundle of k

DOc- PROCAINAMIDE IBUTILIDE AMIODARONE

Question 13

Afib most risky factor

Answer 13

Thrombo-embolism

Therefore always do TEE BEFORE CARDIOVERSION

Question 14

PSVT ecg characteristic

Answer 14

P waves superimposed by QRS
(So usually no P)

If P wave present: in reverse direction (CIRCUS WAVE) d/t retrograde stimulation through bundle

HR regular and fast

Question 15

Frog sign is positive in

Answer 15

PSVT

Question 16

PSVT Mx

Answer 16

Carotid massage—6mg adenosine—12mg adenosise—DC shock

Doc maintainence: VERAPAMIL

Doc prophylaxis : class 2 and 4 antiarr

Question 17

V tach ecg characteristics

Answer 17

> 3 consecutive ectopics

HR: 100-250

Wide QRS

Qrs and T in opposite direction

Question 18

Rx all Ventricular Tachycardia

Except Vtach<30s = AMIODARONE

Answer 18

IMMEDIATE DC shock 350J

DOC: AMIODARONE»LIGNOCAINE

Question 19

TDP RX

Answer 19

MgSO4

Question 20

Causes of 1AVB

Answer 20

Drugs (mc)
K+ / Mg++
Rheumatic Fever

Question 21

Causes of 3AVB

Answer 21

Degenerative HD (mc)
Post sx
Congenital SLE

Question 22

Pathology of tachyarrythmia

Answer 22

Defect in impulse production
(Enhanced automaticity of pacemaker cells-IHD/deg/electrolyte)

Defect in impulse propagation

a) Re-entry
b) After depolarisation

Question 23

Differentiate Atrial and Ventricular tach

Answer 23

QRS normal. QRS wide
Carotid massage. -
- Variab H. Sounds

Question 24

Doc AFib + HF

Answer 24

DIGOXIN

Only antiarrythmic with inotropic action

Question 25

Common in elderly in ICU?

Answer 25

MAT
(Sepsis—-cytokines—pacemaker ++)

MAT NEVER CAUSES HYPOTENSION

Question 26

M.c tachyarrythmia in ICU Pt.

Answer 26

Afib

Question 27

Causes of AFib

Answer 27

Young: -Valvular HD
Holiday heart syndrome
DCMP

Old: Degenerative HD
Thyrotoxicosis

Question 28

Capture beats and Fusion beats

Answer 28

Both give evidence of VTACH

CB- Normal beat in VTach (p followed by qrs) - that is impulse from atria has finally reached the ventricle, which was constantly getting depolarised by ectopics

FB- complexes formed due to fusion of atrial impulses and ventricular ectopics

Question 29

Sustained VT timing

Answer 29

30 seconds

Question 30

Reperfusion Arrythmia treatment

Answer 30

Atropine & lignocaine

(Aka AIVR- accelerated idioventricular rhythm)

D/t sudden reperfusion of blocked coronary

Question 31

AF thrombus risk
(CHA2DS2 Vasc)
If > 2 increased risk

Answer 31

CHF
HTn
Age>75 (2points)  64-75= 1 point
DM
Stroke H/o (2 points)    Sex: F
Vascular D/o