Arrythmia

Question 1

What is an arrythmia?

Answer 1

-abnormal heart beat which is either too slow(bradycardia) or too fast (tachycardia)

Question 2

Presentation of arrythmia

Answer 2

• asymptomatic
• palpitations
• dypsneoa
• chest pain
• fatigue
• embolism

Question 3

Investigation of arrythmia

Answer 3

• document it on ECG - 12 lead and record for 24 hours
• blood tests, especially thyroid function
• echocardiogram

Question 4

Medication given for arrythmia

Answer 4

Rate control / rythmn control

• beta blockers
• digoxin
• Class III
• Flecanide ( class Ic)
• Disopryramide ( class Ia)

Electrical approaches

• pace + ablation of AV node
• substrate modification

Anticoagulation ( pulmonary vein isolation, surgical procedures)
-warfarin or NOACs

Question 5

What is Supraventricular tachycardia

Answer 5

• rapid heart beat at/above AV node characterised by narrow QRS complexes
• AV nodal re-entrant tachycardia/AV re-entrant tachycardia ( due to accessory pathway)

Question 6

Treatment of supraventricular tachycardia

Answer 6

-none or RFA

Question 7

What is radiofrequency ablation? (RFA)

Answer 7

-proccedure whre part of conduction system of heart is ablated(removed) using the heatgenerated by frequency alternating current.

Question 8

Symptoms of supraventricular tachycardia

Answer 8

• palpitations
• dysponea
• dizziness

Question 9

What is Ventricular tachycardia

Answer 9

-abnormal rapid rythm that originates from ventricular myocardium/His-purkinje system

Question 10

What is torsades de Pointes

Answer 10

• irregular rapid rythm with characteristic twisting axis seen on ECG
• seen in long QT syndrome

Question 11

What is long QT syndrome

Answer 11

• condition that affects repolarisation after a heart beat
• congenital ( autosomal dominant gene mutation identifiable in most) or aquired (drugs)
• can cause TdP

Question 12

Treatment of Long QT syndrome

Answer 12

• drugs

- implantable cardioverter defibrillator (ICD)

Question 13

Indications for ICD therapy

Answer 13

Secondary preventation:

• cardiac arrest due to VF/VT not due to transient/reversivle cause
• eg early phase of acute MI
• Sustained VT causing syncope
• sustained VT with poor LV function

Question 14

Indications for pacing

Answer 14

Temporary

• intermittent/sustained symptomatic bradycardia
• prophylactic when patient is at high risk of developing severe bradycardia
• eg 2nd/3rd AV block, post anterior MI

Permaent

• 2nd/3rd AV block esp when cause is unlikely to disappear
• Mobitz type ll 2nd/3rd degree AV block even if asymptomatic
• AV block associated with neuromuscular diseases
• after AV node ablation
• alternating RBBB/LBBB
• syncope when bifascicular/trifascicular block and no other explanation
• sinus node disease associated with symptoms
• carotid sinus hypersensitivity/malignant vasovagal syncope
• poor LV function with LBBB (CRT-P or D therapy)

Question 15

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Answer 15

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