Arrythmia Flashcards
Treatment for bradycardia
firstly identify whether there is a reversible cause of bradycardia. If cardiogenic then manage pharmacologically
1. Atropine
2. Isoprenaline
If pharmacological treatment fails for bradycardia, what should you do?
transvenous pacing
How many ms is big box on ECG?
0.2 ms
Differentials for causes of bradycardia
cardiac in origin- AV block
non cardiac in origin- hypothyroidism, hyperkalaemia, vasovagal, hypothermia
drug-induced- beta blockers, digoxin, amiodarone
physiological- athletes, sleeping etc
Symptoms of bradycardia?
fatigue
lightheadedness
pre-syncope/scyncope
cognitive slowing
exercise intolerance
or asymptomatic
exacerbation of preexisting conditions
Are you worried about first degree heart block?
can be benign, idiopathic, nothing to worry about most of the time
Management for narrow QRS supraventricular tachycardia?
vasovagal manoeuvre
adenosine
What would you check immediately after seeing VT on ECG?
Do they have a pulse??? pulseless VT- CPR
Doses of adenosine?
6mg initially and then 12mg
In which condition would you avoid adenosine?
asthma due to bronchoconstriction
If adenosine fails, which other pharmacological treatment could you consider?
verapamil
amiodarone
Name two adverse features of tachyarrhythmias?
shock
syncope
ischaemia
heart failure
If patient has adverse features of tachyarrhythmia, what would be your management?
sedate and then electrical cardioversion
followed by amiodarone
Would you cardiovert septic patient with AF?
no treat reversible cause
List two adverse symptoms and signs of SVT episode
heart failure
chest pain
Clinical evidence of low cardiac output- confusion/low GCS, systolic BP <90
What are signs of low CO in SVT patient
pallor, sweating, cold, clammy extremities (increased sympathetic activity), impaired consciousness or syncope (reduced cerebral blood flow), and hypotension (e.g. systolic blood pressure <90mmHg).
Name two pharmacological agents for initial management of SVT. State their MOA
adenosine- transient heart block in the atrioventricular (AV) node
verapamil- block voltage-dependent calcium channel, decreasing impulse conduction through the AV node
If chemical cardioversion is unsuccessful in SVT patient, list three steps to take next
- Call cardiology reg/senior doctor
- Sedate
- DC cardioversion
Name two ECG changes in hyperkalaemia
hypertented T waves
widened QRS
Prolonged PR
Bundle branch block
Name two abnormal gas findings on venous gas of patient with hyperkalaemia and who has CKD
low bicarb
acidotic (raised H+)
Low PCO2`
