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cardiovascular > arrythmias > Flashcards

arrythmias Flashcards

1
Q

what is an arrythmia

A

abnormal heart rythm

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2
Q

why do arrithmyas happen

A

interuption to normal electrical signals that coordinate contraction of heart muscle

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3
Q

how can the 4 cardiac arrest rhythms be classified

A

shockable - defib may be effective

non-shockable

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4
Q

cardiac arrest rhythms: shockable rhythms

A

ventricular tachycardia

ventricular fibrillation

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5
Q

cardiac arrest rhythms: non-shockable

A

pulseless electrical activity (all electrical activity except VF/VT, incl sinus rhythm without pulse)
asystole

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6
Q

tachycardia treatment summary: unstable patient

A
  • consider up to 3 synchronised shocks

- consider consider amiodarone infusion

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7
Q

tachycardia treatment summary: stable patient with narrow QRS complex

A

AF - beta blocker or CCB
atrial flutter - beta blocker
SVT: vagal manouvers, adenosine

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8
Q

tachycardia treatment summary: stable patient w broad QRS

A

VT or unclear - amiodarone infusion

SVT w bundle branch block - treat as per normal SVT

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9
Q

atrial flutter

A

caused by a re-enterant rhythm in either atrium
electrical signal re-circulates in a self-perpetuating loop due to extra pathway
signal goes round and round without interuption

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10
Q

atrial flutter: atrial and ventricular bpm

A

atrial contraction 300bpm

signal makes way to ventricles every 2nd lap due to long AV node refractory period - 150bpm ventricular contraction

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11
Q

atrial flutter: ECG

A

‘sawtooth appearance’

p wave after p wave

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12
Q

atrial flutter: assoc conditions

A

htn
IHD
cardiomyopathy
thyrotoxicosis

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13
Q

atrial flutter: Mx

A

rate/rhythm control - beta blockers or cardioverison
treat underlying condition
radiofrequency ablation of re-enterant system
anticoagulation based on CHADVASC

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14
Q

supraventricular tachycardia

A

electrical signal re-entering atria from ventricles

  • electrical signal finds way back from v to atria
  • once signal back in atria it travels back through AV node –> v contraction
  • self-perpetuating elec loop
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15
Q

SVT ECG

A

fast narrow QRS complex tachycardia

looks like QRS complex immediately followed by T wave

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16
Q

paroxysmal SVT

A

SVT reoccurs and remits in same patient over time

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17
Q

types of SVT: atrioventricular nodal re-enterant tachycardia

A

when the re-entry point is back through AV node

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18
Q

types of SVT: atrioventricular re-entarent tachycardia

A

when re-entry point is an accessory pathway (wolf-parkinson-white syndrome)

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19
Q

types of SVT: atrial tachycardia

A

electircal signal originates in atria somewhere other than SA node

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20
Q

acute management of stable pt w SVT

A

stepwise approach with cont. ECG monitoring

  1. valsalva maneouvre
  2. carotid sinus massage - massage carotid on one side w fingers
  3. adenosine
  4. alt to adenosine –> verapamil
  5. dirrect current cardioversion
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21
Q

adenosine

A

works by slowing cardiac conduction 1ry through AV nose

interupts AV node/accessory pathway during SVT and ‘resets’ back to sinus rhythm

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22
Q

how is adenosine given

A

as rapid bolus inot a large proximal cannula to ensure it reaches heart with enough impact to interupt pathway

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23
Q

what happens after initial adenosine administration

A

often cause breif period of asystole or bradycardia however it is metabolised quickly and sinus rhythm should return

24
Q

when to avoid adenosine

A 
asthma 
COPD 
heart failure 
heart block 
severe hypotension
25
long term management of pt w paroxysmal SVT
medication - beta blockers, CCB, amiodarone | radiofrequency ablation
26
wolf-parkinson white syndrome
extra elcectrical pathway connecting atria and ventricles
27
wolf-parkinson white syndrome: what is extra pathway often called
bundle of kent
28
wolf-parkinson white syndrome: definitive treatment
radiofrequency ablation of accessory pathway
29
wolf-parkinson white syndrome: ECG changes
short PR interval wide QRS delta wave - slurred upstroke on QRS
30
radiofrequency ablaion can be curative for certain arrythmias caused by abnormal electrical pathways, incl...
AF atrial fluter SVT WPW syndrome
31
Torsades de pointes
type of polymorphic ventricular tachycardia stimulate recurrent contractions withut normal repolarisation occurs in pt w prolonged QT interval
32
Torsades de pointes: ECG
- QRS twist around baseline - QRS get progressively shortet - prolonged QT internal
33
prolonged QT interval
ECG finding of prolonged repolarisation after contraction
34
afterdepolarisations
wait longer time to repolarise causes random spontaneous depolarisation in some myocytes abnormal depilatisations pripr to repol
35
clinical course of Torsades de pointes
either terminate spontaneously | progress to VT
36
causes of prolonged QT
long QT syndrome medicatins: antipsychotics, citalopram, amiodarone, macrolide antibs electrolyte disturbance - hypokalaemia, hypocalcaemia
37
Torsades de pointes: acute Mx
``` correct cause - electrolyte disturbance or meds magnesium infusion (even if have normal Mg) defibrillation if VT occurs ```
38
Torsades de pointes: longterm Mx
- avoid meds that prolong QT - correct electrolyte disturbances - beta blockers - pacemaker or implantable defib
39
ventricular ectopics
premature ventricular beats caused by random electrical discharges from outside atria
40
ventricular ectopics: presentation
random, brief palpitations
41
ventricular ectopics: ECG
individual random, abdnormal, broad QRS complexes
42
ventricular ectopics: bigeminy
when V ectopics happen to frewuently that they happen after every sinus beat ECG normal sinus beat followed by ectopic
43
ventricular ectopics: Mx
- check bloods for anaemia, electrolyte disturbance, thyroid disease - reassure and no Rx if healthy - seek advice if background heart disease or concerning features e.g. chest pain, murmur
44
AV node blocks
heart block
45
1st degree heart block
delayed atrioventricualr conduction through AV node despite this, every atrial impulse leads to ventric contraction --> every p wave results in QRS
46
1st degree heart block ECG
PR interval > 0.2s | 1 big square
47
second degree heart block
some of atrial impulses do not make it through AV nodes to ventricles --> instances where P wave doesnt lead to QRS several types - mobitz T1 - mobitz T2 - 2:1 block
48
second degree heart block: Mobitz type 1
atrial impulses become gradually weaker until it does not pass through AV node after failure, atrial impulses become strong again and cycle repeats
49
second degree heart block: Mobitz type one ECG
increasing PR interval until P wave no longer conduct --> absent QRS
50
second degree heart block: Mobitz type 2
there is intermitted failure of AV conduction --> missing QRS PR interval normal risk of asystole
51
second degree heart block: 2:1 block
there are 2 p waves for each QRS every 2nd P wave is not strong enough to stimulate QRS
52
3rd degree heart block
complete heart block no observable relationship between P waves and QRS signif risk of asystole
53
Rx of bradycardias/AV node blocks: stable
observe
54
Rx of bradycardias/AV node blocks: unstable or risk of asystole
1. atropine 500mcg IV no improvement> 2. atropine 500mcg IV 3. other inotropes 4. transcutaneous cardiac pacing
55
Rx of bradycardias/AV node blocks: high risk of asystole or prev asystole
- temp transvenous cardiac pacing | - permanent implantable pacemaker
56
atropine
antimuscarinic medication works by inhibiting parasympathetic NS --> pupil dilation, urinary retention, dry eyes, constipation

cardiovascular (51 decks)

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