Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Medicine > Arrythmias > Flashcards

Arrythmias Flashcards

1
Q

Atrial flutter

A

supraventricular tachycardia
Self perpetuating Regular reentrant circuit going around ( usually) the right atrium everytime impulse goes around the atrium it may or may not conduct down AV node to conduct heart beat
Sawtooth on ECG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Atrial Fibrillation

A

Chaotic activity in atria from multiple foci, overrides SAN to causes irregular rapid ventricular rate
Usually arises from pulmonary veins in left atrium
no p wave, irregularly irreg , narrow complex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Classification of atrial fibrillation

A

Lone AF- might happen in infection, sepsis
Paroxysmal pAF - Intermittent episodes
Persistent - >1 week without terminating or can be terminated, but requires medical intervention
Permanent
Medical intervention does not re-establish sinus rhythm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Atrial fibrillation stroke risk

A

Loss of coordinated atrial activity means blood in atria relatively static
lood clots from left atria can pass into left ventricle and end up occluding cranial arteries resulting in catastrophic ischaemic stroke or can also embolise to arms or legs.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Management of AF

A
  1. Medication:
    Rate control: beta blocker, calcium channel blocker, digoxin
    Rhythm control: Flecanide
    Amiodarone
    (Electrical Cardioversion in those with life-threatening haemodynamic instability acutely; or planned as outpatient who are in persistent af)
    Reduce clotting
  2. Implantable pacemaker may be used to constantly pace the atrium
  3. Radiofrequency catheter ablation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Paroxysmal SVT

A

often used to refer to AVNRT and ARNT ( sudden onset/offset, rate 140-200bpm)
more likely to have a degree of global ST depression on ECG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

AV nodal re-entrant tachycardia - AVNRT

A

2 pathways in AV node,fast pathway and a slow one,Atrial ectopic may occur
Excitation is coming from the loop so there are no p waves

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

AV re-entrant tachycardia AVRT (WPW)

A

usually presents at a younger age than AVNRT
Circuit can consist of both atria and ventricle
WPW Wolff parkinson white syndrome an example , accessory pathway is called bundle of kent
no p waves,ECG can have a slurred upstroke of QRS ( delta)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Tx paroxysmal SVT

A

vagal maneuvers to activate vagus nerve causing AV nodal conduction slowing and may therefore terminate re-entrant arrhythmias using the AV node as part of the circuit.
ablation
AVNRT: destroy the slow alpha pathway
AVRT: destroy the accessory pathway
Don’t use med to slow AVN in WPW bc of risk of VT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Supraventricular Tachycardia

A

narrow complex tachycardia
heart rate> 100 bpm
QRS width of less than 120 ms on ECG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

SVT with adverse features

A 
HISS
Heart failure
Ischaemia
Shock (BP<90)
Syncope
Patients with adverse features should be given synchronised DC shock.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Regular rhythm SVT management

A

vagal manoeuvres such as carotid sinus massage or the Valsalva manoeuvre should be attempted first.
If this fails, IV Adenosine 6mg,It should then be given rapidly over 1-3 seconds, followed by a 20 ml IV Normal Saline bolus.
If this fails, a second dose of Adenosine 12mg can be administered, followed by another 18mg.
If this fails then a beta-blocker or verapamil can be tried before DC cardioversion is attempted.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Contra-indications to the use of Adenosine

A

heart transplant patients
those who have central line access
or patients on medications that can potentiate the effects of Adenosine such as Dipyridamole or Carbamazepine
Asthma is a contra-indication to the use of Adenosine so Verapamil should be used instead.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Ventricular Tachycardia

A

Broad complex regular tachycardia until proven otherwise is ventricular tachycardia
heart rate >100 bpm and a QRS width of more than 120 ms
Can be very dangerous and lead to sudden cardiac death
It can progress to ventricular fibrillation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Causes of Ventricular Tachycardia

A

Electrolyte abnormalities such as hypokalaemia and hypomagnesaemia
Structural heart disease including Myocardial infarction and HOCM
Drugs that cause QT prolongation e.g. clarithromycin, erythromycin
Inherited channelopathies e.g. Romano-Ward syndrome, Brugada syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Mx ventricular tachycardia

A

If unconscious: CPR/Shock
Cardioversion
Ablation can be used to destroy tissue causing tachycardia
Long term tx can include beta blocker, amiodarone, ICD
main medical treatment option for stable patients with a regular broad complex tachycardia is IV Amiodarone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Regular broad complex tachycardia management

A

IV Amiodarone

18
Q

Long QT syndrome

A

Some of the ventricle cells take abnormally long to repolarize
Torsades de pointes is a specific form of polymorphic ventricular tachycardia in patients with a long QT interval,can degenerate into VF

19
Q

Causes of a long QT interval

A

Toxins: drugs including anti-arrhythmics, anti-psychotics and tricyclic antidepressants. Clarithromycin
Inherited: congenital long QT syndromes
Ischaemia
Myocarditis
Mitral valve prolapse
Electrolyte abnormalities, such as hypokalaemia and hypocalcaemia. Acute pancreatitis can cause hypocalcaemia.
Subarachnoid Haemorrhage

20
Q

Polymorphic VT (torsades de pointes) management

A

intravenous magnesium sulphate
2g over 10 minutes.
if unstable, then immediate DC cardio version

21
Q

Ventricular fibrillation

A

broad and irregular rhythm tachyarrythmia
Ventricular spasm, looks like a bag of worms ,muscle fibres contract independently
Does Not happen for long till the heart stops all together

22
Q

Mx ventricular fibrillation

A

CPR and Defibrillation
long term: ICD may be implanted, medications

23
Q

Brugada syndrome

A

genetic condition caused by sodium channelopathies,AD
common cause of sudden cardiac death
On ECG often has ST elevations (ventricular strain) and RBBB
Can have ICD implanted to prevent sudden cardiac death

24
Q

bradyarrhythmias

A

<60bpm

25
Q

Causes of bradycardia

A

hypothermia
increased intracerebral pressure, autonomic dysfunction (increased vagal tone)
metabolic disturbances (e.g. hypocalcaemia, hyperkalaemia)
hypothyroid
carotid sinus stimulation
iatrogenic- NHP-CCBs, beta-blockers, digoxin, cholinesterase inhibitors
MI
sepsis

26
Q

Causes of AV conduction block

A

usually due to some damage/fibrosis to the conduction system
Lev’s disease
progressive heart block
Ageing process
Hereditary forms
IHD
Cardiomyopathies
Myocarditis

27
Q

First degree AV block

A

conduction in AVN is slowed
Prolonged PR interval (>200ms) on ECG
benign condition, does not often progress into higher degree of blocks, no treatment required

28
Q

2nd degree heart block
Mobitz type 1 ( Wenckebach)

A

PR interval progressively prolonged with each beat until a dropped beat occurs (the p wave isn’t followed by a QRS), then pattern repeats
sometimes requires pacemaker

29
Q

2nd degree heart block
Mobitz type 2

A

eg every 2nd beat conducted through the AVN for a 2:1 block
Constant pr interval
progresses to full heart block
will always require pacemaker

30
Q

Third degree heart block

A

complete heart block, no signal transmitted through the AVN,
Complete dissociation between P waves and QRS complexes on ECG
patients always require urgent pacemaker

31
Q

Management of bradycardia

A

intravenous atropine 500mcg iv up to max 3mg
other drugs include: epinephrine (adrenaline), dopamine, glucagon in beta blocker/ calcium channel blocker overdose
Patients who are not responsive to medical therapy require prompt temporary pacing.

32
Q

CHA2DS2-VASc Mnemonic

A 
C – Congestive heart failure
H – Hypertension                                      
A2 – Age >75 (Scores 2)
D – Diabetes
S2 – Stroke or TIA previously (Scores 2)
V – Vascular disease                                 
A – Age 65-74
S – Sex category (female)
Score>2, offer anticoagulant
33
Q

HAS-BLED

A 
H – Hypertension
A – Abnormal renal and liver function
S – Stroke
B – Bleeding
L – Labile INRs (whilst on warfarin)
E – Elderly
D – Drugs or alcohol
34
Q

ORBIT

A

Low haemoglobin or haematocrit
Age (75 or above)
Previous bleeding (gastrointestinal or intracranial)
Renal function (GFR less than 60)
Antiplatelet medications

35
Q

Anticoagulant choice

A

DOAC- 1st choice
Warfarin - Not 1st line choice for anticoagulation for new AF patients.
LMWH - Used as bridging therapy.Also Used in patients with severe renal failure ( creatinine <15) who are unable to take DOAC or warfarin

36
Q

Left bundle branch block LBBB

A

always indicates underlying cardiac disease
WILLIAM
V1 deep negative S wave
V6 is positive and often notched from the left ventricle depolarising late

37
Q

Right bundle branch block

A

may be a normal variant
V1 positive because right side is closest to V1 and the direction of travel is L to R
Wide slurred S wave in the lateral leads gives W shape
MARROW

38
Q

Atrial flutter Mx

A

Similar to that of atrial fibrillation (rate control, anticoagulation) although medication may be less effective
atrial flutter is more sensitive to cardioversion however so lower energy levels may be used
radiofrequency ablation of the tricuspid valve isthmus is curative for most patients

39
Q

2nd degree heart block
Mobitz type 2

A

will always require pacemaker

40
Q

Complcations of SVT can include:

A

Syncope
Deep vein thrombosis
Embolism
Cardiac tamponade
Congestive cardiac failure
Myocardial infarction
Death

41
Q

Investigating palpitations

A

12-lead ECG
thyroid function tests
urea and electrolytes
FBC

Medicine (72 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions