Arrythmias Flashcards by mary olayiwola

What is the most common arrythmia

Atrial fibrillation

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How can AF be classified

first detected episode
paroxysmal
persistent
permanent

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What is meant by paroxysmal AF

when a patient has 2 or more episodes of AF
and if they terminate spontaneously
episodes last less than 7 days - usually <24hrs

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What is meant by persistent AF

if 2 or more episodes of AF
not self-terminating
episodes last greater than 7 days

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What is meant by permanent AF

continuous AF
which cannot be cardioverted

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What may someone with AF present with

patients may be asymptomatic

palpitations
dyspnoea
chest pain
irregularly irregular pulse
breathlessness

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What investigations are required

first line ECG
FBC

Echocardiogram

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What is AF characterised by

very rapid and uncoordinated atrial activity leading to irregularly irregular rhythm

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What is the epidemiology of AF

commonest cardiac rhythm disorder

ageing is massive risk factor

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What are causes of atrial fibrillation

ATRIALE-PIBI

alcohol and caffeine
thyrotoxicosis
rheumatic fever and mitral valve disease

ischaemic heart disease
atrial myxoma
lungs
electrolyte disturbances
pharmacological
iatrogenic
blood pressure
infections

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How do you manage AF if the patient is hemodynamically unstable

cardioversion

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If patient with AF is hemodynamically stable the how do you manage them

rate or rhythm control

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How you manage rate control of a patient with AF

Beta blocker

if doesnt work combination of any 2 :
beta blocker
digoxin
diltiazem (CCB)

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How do you manage rhythm control in a a patient with AF

beta blocker
Amiodarone
Flecainide - if no structural heart disease

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What drug should not be offered to patients with AF

aspirin monotherapy

for stroke prevention

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What should patients with AF for less than 48 hours be treated with

anticoagulated with heparin

can be cardioverted electrically or pharmacologically
- using flecainide if no SHD or amiodarone if present

How should patients with AF for more than 48 hours be treated

delay cardioversion until they have been maintained on therapeutic anticoagulation for minimum of 3 weeks

during this period offer rate control

What should rate control therapy be offered as

as first line strategy
UNLESS
-reversible cause
-new onset AF
-heart failure is present
-rhythm control is more appropriate

When is rhythm control for AF usually preferred

if patients have concomitant heart failure or in younger patients

When may electrophysiological therapy be offered

radiofrequency ablation may be offered in intractable cases of AF that do not respond to medical therapy

What is the CHA2DS2Vasc score

used to assess risk of stroke

C- history of congestive heart failure (1)
H- hypertension (1)
A-age 65-74(1), >75 (2)
D-diabetes
S-stroke, venous thromboembolism (2)
S- female ( 1)
Vasc- vascular disease(1)

How do you interpret the CHA2D2Vasc score

score of 0 in men or 1 in women , recommend no anticoagulation

score of >1 in men , consider anticoagulation

score of >2 , offer anticoagulation

What is the HAS-BLED score for

used to assess risk of bleeding if on therapy

H- hypertension SBP>160 (1)
A- abnormal liver/renal function (1 point each )
S- stroke history (1)
B-bleeding history /predisposition (1)
L- labile INR (1)
E-elderly >65
D -drugs ( NSAIDs, antiplatelets) OR alcohol (1)

How do you interpret the HAS-BLED score

score =>3 does not preclude anticoagulation but caution is warranted , with regular review

What DOAC should be considered after CHA2DS2Vasc score has been calculated if needed

Apizaban , dabagatran, edoxaban or rivaroxaban warfarin if DOAC is contraindicated or not tolerated

What is supraventricular tachycardia

refers to paroxysmal episodes of tachycardia that are not ventricular in origin

What is the aetiology of supraventricular tachycardia

caused by re-entry mechanisms , or impulse initiation disorders producing automatic tachycardias

What is the difference between AVNRT AND AVRT and what type of tachycardias are they

Re-entrant tachycardias AVNRT - is caused by a non-anatomical pathway involving dual pathways with fast and slow conduction velocities AVRT- caused by an anatomically defined re-entrant circuit involving one or more accessory pathways

What are the 2 types of automatic tachycardias

Junctional tachycardia- secondary to abnormal impulses from junctional region Atrial tachycardia- tachycardia that is initiated and maintained irrespective of SA node, AV junction, accessory pathway or ventricular tissue

What is the acute management for SVT

first assess haemodynamic stability - if unstable arrange urgent direct cardioversion Vagal maneuvers- Valsalva - blow into empty plastic syringe carotid sinus massage IV ADENOSINE rapid IV bolus of 6mg - if unsuccessful go up to 12 , then 18

What drugs are given to a patient with SVT to prevent further episodes

beta-blockers RFA

What is ventricular tachycardia

tachyarrhythmia that originates from the ventricles- producing 3 or more successive broad QRS complexes at rate of greater than 100bpm

What is the aetiology of ventricular tachycardias

Ischemic heart disease structural heart disease electrolyte abnormalities medications - digoxin toxicity

What is the management for ventricular tachycardia

if patient is hemodynamically unstable - immediate resuscitation emergency direct cardioversion if patient is stable - Amiodarone lidocaine procainamide

What drug should not be used in ventricular tachycardia

verapamil

What drug to treat ventricular tachycardia should be used with caution

Lidocaine - if patient has severe left ventricular impairment

If drug therapy fails how should a patient with ventricular tachycardia be managed

electrophysiological study ICD- implantable cardioverter-defibrillator

What is torsades de pointes and how should it be managed

form of polymorphic VT associated with prolonged QT interval IV magnesium sulphate