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CARDIOLOGY YEAR 3 > Arrythmias > Flashcards

Arrythmias Flashcards

1
Q

What is the most common arrythmia

A

Atrial fibrillation

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2
Q

How can AF be classified

A

first detected episode
paroxysmal
persistent
permanent

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3
Q

What is meant by paroxysmal AF

A

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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4
Q

What is meant by persistent AF

A

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

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5
Q

What is meant by permanent AF

A

continuous AF
which cannot be cardioverted

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6
Q

What may someone with AF present with

A

patients may be asymptomatic

palpitations
dyspnoea
chest pain
irregularly irregular pulse
breathlessness

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7
Q

What investigations are required

A

first line ECG
FBC

Echocardiogram

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8
Q

What is AF characterised by

A

very rapid and uncoordinated atrial activity leading to irregularly irregular rhythm

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9
Q

What is the epidemiology of AF

A

commonest cardiac rhythm disorder

ageing is massive risk factor

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10
Q

What are causes of atrial fibrillation

A

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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11
Q

How do you manage AF if the patient is hemodynamically unstable

A

cardioversion

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12
Q

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

A

rate or rhythm control

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13
Q

How you manage rate control of a patient with AF

A

Beta blocker

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

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14
Q

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

A

beta blocker
Amiodarone
Flecainide - if no structural heart disease

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15
Q

What drug should not be offered to patients with AF

A

aspirin monotherapy

  • for stroke prevention
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16
Q

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

A

anticoagulated with heparin

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

17
Q

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

A

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

during this period offer rate control

18
Q

What should rate control therapy be offered as

A

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

19
Q

When is rhythm control for AF usually preferred

A

if patients have concomitant heart failure or in younger patients

20
Q

When may electrophysiological therapy be offered

A

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

21
Q

What is the CHA2DS2Vasc score

A

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)

22
Q

How do you interpret the CHA2D2Vasc score

A

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

score of >1 in men , consider anticoagulation

score of >2 , offer anticoagulation

23
Q

What is the HAS-BLED score for

A

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)

24
Q

How do you interpret the HAS-BLED score

A

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

25
Q

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

A

Apizaban , dabagatran, edoxaban or rivaroxaban

warfarin if DOAC is contraindicated or not tolerated

26
Q

What is supraventricular tachycardia

A

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

27
Q

What is the aetiology of supraventricular tachycardia

A

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

28
Q

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

A

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

29
Q

What are the 2 types of automatic tachycardias

A

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

30
Q

What is the acute management for SVT

A

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

31
Q

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

A

beta-blockers
RFA

32
Q

What is ventricular tachycardia

A

tachyarrhythmia that originates from the ventricles-

producing 3 or more successive broad QRS complexes at rate of greater than 100bpm

33
Q

What is the aetiology of ventricular tachycardias

A

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

34
Q

What is the management for ventricular tachycardia

A

if patient is hemodynamically unstable -
immediate resuscitation
emergency direct cardioversion

if patient is stable -
Amiodarone
lidocaine
procainamide

35
Q

What drug should not be used in ventricular tachycardia

A

verapamil

36
Q

What drug to treat ventricular tachycardia should be used with caution

A

Lidocaine - if patient has severe left ventricular impairment

37
Q

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

A

electrophysiological study

ICD- implantable cardioverter-defibrillator

38
Q

What is torsades de pointes and how should it be managed

A

form of polymorphic VT associated with prolonged QT interval

IV magnesium sulphate

CARDIOLOGY YEAR 3 (11 decks)

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