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2 - Cardiovascular Medicine > Arrythmia > Flashcards

Arrythmia Flashcards

1
Q

What is an arrhythmia

A

Abnormal rhythm of the heart
Accelerated, slow or irregular heart rates caused by abnormalities in the electrical impulses of the myocardium

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2
Q

Pathway of electrical discharge in the heart

A

SA NODE - > AV NODE -> bundle of his -> purkinje fibers

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3
Q

Pacemaker of the Heart

A

SA NODE

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4
Q

Autonomic regulation of the pacemaker

A

Vagal activity d decreases heeart rate
sympathetic activity increases heart rate

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5
Q

Three main mechanisms of tachycardia

A

Increased automaticity
reentry
triggered activity

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6
Q

What is increased automaticity in tachycardia

A

Repeated Spontaneous depolarization of an ectopic focus in response to catecholamines

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7
Q

What is the reentry mechanism in tachycardia

A

Tachycardia initiated by ectopic beats and sustained by reentry circuit

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8
Q

Commonest cause of tachyarrhythmias

A

Reentry circuit

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9
Q

What is triggered activity in mechanism of tachycardia

A

Secondary depolarized arising from an uncompletely repolarised cell membrane

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10
Q

Mechanisms of bradycardia

A

Reduced automaticity from sinoatrial node

Conduction blocks - failure of nerve impulse to propagate along an axon

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11
Q

Classification of arrhythmias

A

Normotopic arrhythmias - irregular heartbeat with SAnode as pacemaker

Ectopic arrhythmia- irregular heartbeat, sinoatrial node not pacemaker

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12
Q

Type of normotopic arrythmias

A

Sinus bradycardia
Sinus tachycardia
Sinus Arrhythmia

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13
Q

What is sinus bradycardia

A

Reduction in discharge of impulses from SA node resulting in decreased heart rate. The heart rate becomes less than 60bpm.

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14
Q

Physiological causes of sinus bradycardia

A

Sleep
Athletic heart

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15
Q

Pathological causes of sinus bradycardia

A

Hypothyroidism
Raised Intracranial pressure
Raised Intracranial pressure

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16
Q

What is sinus tachycardia

A

Increase in discharge of impulses resulting in increase in heart rate rate becomes greater than 100bpm.

17
Q

Physiological causes of sinus tachycardia

A

1Exercise
Emotions
Pregnancy

18
Q

Pathological causes of sinus tachycardia

A

Anaemia
Hyperthyroidism
Fever, Phaeochromocytoma, Drugs like beta-agonists.

19
Q

What is sinus arrythmias aka respiratory sinus arrythmia

A

normal rhythmical increase and decrease in heart rate in relation to respiration , with heart rate increasing during inspiration and decreasing during respiration

20
Q

SubTypes of ectopic arrythmias

A

Homotopic arrythmias ( impulses arise from any part of the conductive system)

Heterotopic arrythmia ( impulses arise from the musculature of the heart other than the conductive system)

21
Q

Examples of ectopic arrythmias

A

Atrial fibrillation
Atrial flutter
Ventricular fibrillation

22
Q

What is atrial fibrillation

A

Rapid and irregular atrial contractions occurring mostly due to circus movements of impulses within atrial musculature at a rate of about
300-400bpm.

23
Q

People at risk of atrial fibrillation.

A

aged people
People with heart diseases.

24
Q

What is atrial flutter

A

rapid regular atrial contractions caused by ectopic foci originating from the musculature of atria. The atria contracts more often than the ventricles. Atrial rate is about 250-3506pm.

25
Q

What is ventricular fibrillation

A

rapid and irregular twitching of ventricles. Rate reaches about 400-500bpm which can lead to death since ventricles cannot pump blood.

26
Q

Causes of arrythmias

A

Electrolyte imbalance
Coronary artery disease
Cardiomyopathy
Hypo/hyperthyroidism
Drugs
Idiopathic
Alcohol
Congenital heart disease
Valvular heart disease
Phaeochromocytoma

27
Q

Clinical features of arrythmias

A

Asymptomatic
Palpitations
Dizziness
Shortness of breath
Easy fatiguability
Chest pain

28
Q

Complications of arrythmias

A

Stroke
Sudden death
Heart failure

29
Q

Arrythmias investigations

A

Ecg ( if intermittent arrythmias , should use ambulatory or patient activated ecg )
Echocardiogram
Stress test
Trans eosophageal echocardiogram
Chest x ray
Bue

30
Q

Antiarrythmic drugs

A

Class I: Sodium channel blockers like flecanide, lidocaine, disopyramide

Class II: Beta-blockers such as propranolol, esmolol, sotalol

Class III: Prolongation of action potential. eg. Amiodarone, Dronedarone

Class IV: Calcium channel blockers like Verapamil, Diltiazem

Class IV: Calcium channel blockers like Verapamil, Diltiazem

Miscellaneous: Adenosine, magnesium and potassium salts, digitalis, atropine

31
Q

Devices used in arrythmias

A

Permanent pacemaker
Implantable cardioverter defribillator

32
Q

Surgery done in arrythmias

A

Cardiac ablation
Coronary artery bypass

33
Q

What is sick sinus syndrome

A

fibrosis, degeneration, or ischemia of SA node which presents with palpitation dizziness, syncope with intermittent tachycardia/bradycardia, or pauses with no atrial or ventricular activity

2 - Cardiovascular Medicine (16 decks)

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