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Cardiology > Arrythmias > Flashcards

Arrythmias Flashcards

1
Q

What are the potential causes of sinus tachycardia?

A

Physiological
Pathological - hyperthyroidism, cocaine, amphetamines
Compensatory - MI, PE, sepsis, heart failure

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2
Q

What are the four adverse features to assess for in the management of arrhythmia?

A

Shock
Heart failure
Syncope
Myocardial ischaemia

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3
Q

How is a tachycardia managed when there is the presence of 1 or more adverse feature?

A

DC cardio version up to three times

Then, if there is no resolution 300mg IV amiodarone over 20m minutes followed by 900mg IV amiodarone over 24 hours

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4
Q

Describe the ECG appearance of paroxysmal SVT?

A

Tachycardia 150-200 bpm
Narrow QRS
Absent or retrograde P waves

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5
Q

Describe the initial management of narrow complex tachycardia without adverse features?

A

1st line - vagal manoeuvers
2nd line - IV adenosine 6mg, then 12mg, then 12mg
3rd line - specialist referral and further rate control

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6
Q

What underlying factors may result in paroxysmal SVT?

A

Psychological stress
Caffeine
Nicotine
Wolff Parkinson White syndrome

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7
Q

Describe the ECG appearance of Wolff Parkinson White syndrome?

A

Elongated QRS
Shortened PR interval
Presence of delta wave

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8
Q

What accessory pathway is present in Wolff Parkinson White syndrome?

A

Bundle of Kent

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9
Q

Describe the management of Wolff Parkinson White syndrome?

A

Pharmacotherapy - amiodarone or procainomide
If unstable - DC cardio version
Definitive management - catheter ablation

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10
Q

What is the definitive management for long-standing atrial flutter or AF?

A

Catheter ablation

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11
Q

What are the risk factors for atrial flutter?

A 
Increasing age
Valvular disease
Atrial septal defect
Cardiac / thoracic procedure
Anti-arrythmics
Hyperthyroidism
COPD
Asthma
Pneumonia
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12
Q

What is the definition of paroxysmal, persistent, long-standing and permanent AF?

A

Paroxysmal - more than 1 episode lasting more than 30 seconds which resolves (spontaneously or with intervention_ within seven days

Persistent - AF episode which persists >7 days

Long-standing - AF episode which persists >1 year

Permanent - AF which is refractory to treatment

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13
Q

Describe the management of acute AF?

A

If unstable or present <48hours - DC cardio version or rhythm control and anticoagulation

If stable and >48 hours - rare control (beta blockers, non-dihydropyridamole calcium channel blockers, 2nd line - digoxin)

If rate control fails - rhythm control with amiodarone

If CHASVAS score >1 in men or >2 in women the long-term anticoagulation with DOAC

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14
Q

Arrythmias are often asymptomatic, however what are the potential symptoms of arrhythmia?

A 
Palpitations
Chest pain
Dizziness
Syncope
Altered mental status
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15
Q

What is the management of torsades de pointes?

A

IV magnesium sulphate

2nd line - isoprenaline

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16
Q

What is the management of VT?

A

DC cardio version if unstable / adverse features present

Otherwise, IV amiodarone 300mg over 20 mins then 900mg IV amiodarone over 24 hours

17
Q

What are the potential causes of VT?

A 
Drugs - macrolides, antipsychotics
Ischaemic heart disease - inferior MI
Congenital heart disease
Hypertrophic or idiopathic dilated cardiomyopathy 
Chagas disease
18
Q

If a patient survives VF, what intervention should be considered?

A

Placement of implantable cardiodefibrillator device

19
Q

What are the causes of sinus bradycardia?

A 
Physiological - in athletes
Hypothyroidism
Hypothermia
Valvular disease
Drugs - calcium channel blockers, beta blockers, 
Iatrogenic
Ischaemic heart disease (inferior MI)
Hypokalaemia
TB
Thyphoid fever
Rheumatic fever
Viral myocarditis
20
Q

What are the causes of heart block?

A 
Ischaemic heart disease / ACS
Cardiomyopathy
Valvular disease
Drugs - beta blockers, calcium channel blockers, digitalis
Electrolyte disturbances / acidosis
Myocarditis
Cardiac TB
Infective endocarditis
Lyme disease
Erbs dystrophy
Myotonic dystrophy
21
Q

Describe the management of bradycardia?

A

If adverse features (shock, MI, HF, syncope) or type 2 Mobitz or complete heart block:
Give atropine 500 micrograms IV up to six times
Then external transcutaneous pacing if not resolved

If none of the above criteria:
Observe and treat underlying cause

22
Q

What are the potential causes of right bundle branch block?

A 
Can be physiological
Right ventricular hypertrophy
Atrial septal defect
Ischaemic heart disease
Brugada syndrome
PE
Rheumatic heart disease
Myocarditis
Cardiomyopathy
Hypertension
23
Q

What are the potential causes of left bundle branch block?

A 
Acute MI
Aortic stenosis
Dilated cardiomyopathy
Extensive coronary artery disease
Hypertension -> aortic regurgitation
Lyme disease

Cardiology (12 decks)

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