Arrythmias

Question 1

Adult emergency arrhythmia management?

Answer 1

1. airway
   - open, main and protect
2. breathing
   - administer O2
   - ventilate if necessary
3. circulation
   - assess pulse, blood pressure and perfusion
   - attach ECG, pulse ox and vital signs monitor
4. drip
   - insert IV line with normal saline
5. ECG
   - run rhythm strip or a 12 lead ECG

Question 2

Bradycardia?

Answer 2

HR < 60 beats/min

Question 3

Clinical features of bradycardia?

Answer 3

Chest pains
SOB
↓ LOC
SBP <90 mmHG
HR<40

Question 4

Treatment of bradycardia?

Answer 4

atropine and pacing

Question 5

Diagnosing bradycardia?

Answer 5

Rule out
↑potassium
hypoxia
hypothermia
head injury
heart block

Question 6

Tachycardia?

Answer 6

HR > 100 beats/min
1. narrow complex
2. wide complex

Question 7

Narrow complex tachycardia?

Answer 7

HR >100 Supraventricular Tachycardia
(QRS <0.12 sec)

Question 8

Clinical features of narrow complex tachycardia?

Answer 8

Chest pains,
SOB,
↓LOC,
SBP< 90 mmHG ,
HR >200

Question 9

Treatment of narrow complex tachycardia?

Answer 9

If stable- vagal manoeuvres, adenosine & amiodarone
Unstable-synchronised electrical Cardioversion(SYNC on R wave)

Question 10

Wide complex tachycardia?

Answer 10

HR >100/min(QRS >0.12 sec)

Question 11

Clinical features of wide complex tachycardia include?

Answer 11

Chest pains, SOB,↓LOC,SBP<90,HR >150

Question 12

Treatement of wide complex tachycardia?

Answer 12

Stable-Amiodarone
Unstable –synchronised cardioversion(SYNC on R wave)

Question 13

What are vagal maneuvers?

Answer 13

Techs used to treat and diagnose SVTs by increasing vagal tone on the heart.

Question 14

Name the vagal maneuvers?

Answer 14

Carotid Sinus Massage(CSM) bifurcation of the internal and external carotids arteries→ IX→ medulla→ X
Valsalva maneuver→ Baroreceptors in the aortic arch → X
Right Vagus stimulate the SAN & Left Vagus stimulate the AVN

Question 15

Describe the modified valsava technique?

Answer 15

1. patient in recumbant position
2. patient blows in 10ml syringe for 15 seconds
3. place in spine position with leg raise for 45 seconds
   Note: 10ml syringe = 40mmHg

Question 16

Use of adenosine in treatment?

Answer 16

Adenosine(6:12:12) it exerts negative chronotropic and dromotropic therefore it is used for treatment and diagnosis of SVT.
Mechanism of action: slows down the electrical conduction thru AVN

Question 17

Use of amiodorone?

Answer 17

1. delays potassium efflux
2. decreased sodium influx
3. depresses calcium influx
4. prevent unnecessary/unwanted conduction/depolarisation of the cardiac cells - slowing down of the heart rate

Question 18

Narrow complex + irregular R-R interval - fibrillation waves?

Answer 18

atrial fibrillation
- Valvular heart disease, HPT, hyperthyroidism, cardiomyopathy(dilated, hypertrophic), alcohol abuse, post cardiac surgery, idiopathic

Question 19

Narrow complex + irregular R-R interval + regular p waves with variable AV block?

Answer 19

atrial flutter/tachycardia
- Valvular heart disease, HPT, hyperthyroidism, cardiomyopathy(dilated, hypertrophic), alcohol abuse, post cardiac surgery, idiopathic

Question 20

Narrow complex + irregular R-R interval + multiform p waves?

Answer 20

multifocal atrial tachycardia
- Lung diseases, hypoxia, acidosis, hypokalaemia, ischaemia

Question 21

Atrial fibrilation?

Answer 21

is the result of multiple wavelets of depolarisation moving around the atria chaotically, discharging at a frequency of 350-600 betas/min

Question 22

Atrial flutter with variable block?

Answer 22

flutter is due to a re-entry circuit in the right atrium with secondary activation of the left atrium
- saw-toothappearance in leads II, III, aVF, and usually discrete ‘P’ waves in lead V1. The atrial rate is usually about 300/min, but may be as slow as 150-200/min or as fast as 400-450/min.

Question 23

Multifocal atrial tachycardia?

Answer 23

• discrete P waves with at least 3 different morphologies
• absence of one dominant atrial pacemaker
• atrial rate > 100bpm
• the PP, PR and RR intervals all vary

Question 24

Narrow complex - regular R-R interval?

Answer 24

Common is Sinus Tachy.
Causes
1. Physiological:Exertion,anxiety,pain
2. Pathological: Fever, anaemia, hypovolaemia, hypoxia
3. Endocrine: Thyrotoxicosis
4. Pharmacological: Adrenaline as a result of phaeochromocytoma, salbutamol, alcohol, caffeine

Question 25

Pathophysiology of AV nodal reentrant tachycardia?

Question 26

Bradycardias & Atrio-ventricular conduction block?

Answer 26

Common is Sinus Bradycardia.
Causes
normal individuals during sleep & in those with high vagal tone e.g athletes and young healthy adults
Pathological
Acute myocardial infarction
Drugs: beta blockers, digoxin, amiodarone
Obstructive jaundice
Raised intracranial pressure
Sick sinus syndrome
Hypothermia
Hypothyroidism

Question 26

Bradycardia and first degree AV block?

Answer 26

Prolonged PR interval >.0200sec (5 small boxes)

Question 27

Second degree heart block-Mobitz Type I-Wenckebach?

Answer 27

Lengthening of the PR interval prior to the non
conducted P wave
Proximal to bundle of his

Question 28

Second degree heart block Mobitz Type II?

Answer 28

distal to bundle of HIS

Question 29

Third degree heart block?

Answer 29

Complete dissociation between P waves & QRS complex

Question 30

Check for what in cardiac arrythmias?

Answer 30

Acute myocardial infarction
Congestive cardiac failure
Side effects of drugs: digoxin, aminophylline,tricyclic antidepressants
Electrolyte imbalance: Hyperkalaemia
Acidosis/Alkalosis
Shock
Hyperthyroidism
Subarachnoid haemorrhage
Hypoxia