Arrythmia

Question 1

What occurs in atrial flutter

Answer 1

caused by a re- entrant rhythm in either atrium.
electrical signal is in a self perpetuating loop due to an extra electrical pathway in the atria

Question 2

what is the rate of atrial contraction in atrial flutter

Answer 2

300bpm

Question 3

what would you see on ecg for atrial flutter

Answer 3

saw tooth shapes , p wave after p wave

Question 4

associated conditions with atrial flutter

Answer 4

Hypertension
Ischaemic heart disease
Cardiomyopathy
Thyrotoxicosis

Question 5

treatment of atrial flutter

Answer 5

same as atrial fibrilation

Question 6

what is supraventricular tachycardia

Answer 6

when the electrical signal re enters the atria from the ventricles

Question 7

describe the self perpetuating loop of SVT

Answer 7

normally electrical signal can only go from the atria to the ventricles but in SVT the signal finds a way back to the atria .
once in the atria it travels back through the av node and causes another contraction

Question 8

name the three types of SVT

Answer 8

-atrioventricular nodal re entrant tachycardia
-atrioventricular re entrant tachycardia ( wolff parkinson - white - syndrome )
-atrial tachycardia

Question 9

what is Atrioventricular nodal re-entrant tachycardia”

Answer 9

when the re-entry point is back through the AV node.

Question 10

what is Atrioventricular re-entrant tachycardia”

Answer 10

when the re-entry point is an accessory pathway

Question 11

what is atrial tachycardia

Answer 11

is where the electrical signal originates in the atria somewhere other than the sinoatrial node.

Question 12

management of patients with SVT

Answer 12

-Monitor on ECG
-valsalva manoeuvure
- carotid sinus massage
-adenosine
- direct current cardioversion

Question 13

describe the wolff parkinson white syndrome

Answer 13

-caused by an extra electrical pathway causing the ventricles to contract early
- accessory pathway and av signal merge to contract both ventricles
- the extra pathway that is present is called the bundle of kent

Question 14

what ecg changes would you see in WPWS

Answer 14

• Short pr interval
• wide qrs complex
• ’ delta wave’ a slurred upstroke on the qrs complex

Question 15

explain the process of radiofrequency ablation

Answer 15

• first catheter ablation , general/ local anaesthetic catheter into femoral veins and feeding a wire through the venous system under xray until you enter the heart

once in the heart it is placed against different areas to test the electrical signals at that point

radioablation (heat) is used to burn the abnormal area of electrical activity

Question 16

RFA can be curative for what cases of arrhythmia

Answer 16

Atrial Fibrillation
Atrial Flutter
Supraventricular Tachycardias
Wolff-Parkinson-White Syndrom

Question 17

What is torsades de pointes

Answer 17

a type of polymorphic ventricular tachycardia

Question 18

what is depolarisation

Answer 18

change in membrane potential that leads to heart contraction

Question 19

what is repolarisation

Answer 19

a period of recovery before the myocytes are ready to depolarise again

Question 20

what are afterdepolarisations

Answer 20

abnormal spontaneous depolarisations prior to depolarisation

Question 21

causes of prolonged qt syndrome

Answer 21

• LONG QT SYNDROME - inherited
• ## medications - antipsychotics, sotalol, macrolide antibiotics

Question 22

acute management of torsades de pointes

Answer 22

• correct the cause
• magnesium infusion
• defibrilation if VT occurs

Question 23

long term management of prolonged QT syndrome

Answer 23

Avoid medications that prolong the QT interval
Correct electrolyte disturbances
Beta blockers (not sotalol)
Pacemaker or implantable defibrillator

Question 24

what are ventricular ectopics

Answer 24

premature ventricular beats caused by random electrical charges from outside the atria

Question 25

presentation of ventricular ectopics

Answer 25

random , brief palpitations

Question 26

how would ventricular ectopics be diagnosed on ECG

Answer 26

APPEAR AS individual random, abnormal broad QRS complexes on a background of a normal ECG

Question 27

what is bigeminy

Answer 27

This is where the ventricular ectopics are occurring so frequently that they happen after every sinus beat

Question 28

management for ventricular ectopic

Answer 28

-Check bloods for anaemia, electrolyte disturbance and thyroid abnormalities
-Reassurance and no treatment in otherwise healthy people
-Seek expert advice in patients with background heart conditions or other concerning features or findings

Question 29

what would you do in rhythm control