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YR6: CARDIAC > Arrythmias > Flashcards

Arrythmias Flashcards

1
Q

What are the shockable rhythms?

A

Ventricular fibrilation
Pulseless ventricular tachycardia

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2
Q

What are the non shockable rhythms?

A

Asystole
Pulseless electrical activity

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3
Q

If any adverse signs are present in a patient with tachyarrhythmia, what should be done?

A
  1. Up to 3 synchronised DC shocks (+ sedation if conscious) with continued CPR 30:2 in-between
  2. Amiodarone 300mg IV over 10-20 mins
  3. Repeat synchronised DC shock
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4
Q

List 4 adverse signs indicating a patient with an arrhythmia is unstable

A

Shock: hypotension, pallor, sweating, cold extremities, confusion, impaired consciousness
Syncope
Myocardial ischaemia
Heart failure

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5
Q

When assessing a tachyarrythmia, what should you consider?

A

Wide or Narrow complex?
Regular or Irregular
P waves present? Normal or abnormal?

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6
Q

List 5 causes of narrow complex tachycardia

A

Atrial fibrilation
Atrial flutter
Sinus tachycardia
AV nodal re-entry tachycardia
AV re-entry tachycardia

(SVTs: AF, atrial flutter, AVNRT, AVRT)

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7
Q

List 3 causes of broad complex tachycardia

A

Ventricular tachycardia
Supraventricular tachycardia with aberrancy e.g. BBB
Supraventricular tachycardia with pre-excitation e.g. WPW

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8
Q

What should be assumed about the origin of the tachyarrythmia unless proven otherwise?

A

Narrow: supraventricular tachycardias
Broad: ventricular tachycardias

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9
Q

How can you tell a beat is sinus in origin?

A

Normal p wave
Normal (narrow) QRS

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10
Q

How can you tell a beat is atrial in origin?

A

Abnormal p wave
Normal (narrow) QRS

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11
Q

How can you tell a beat is junctional (AVN) in origin?

A

p wave absent (buried)
or
Abnormal p wave just before/ after QRS
Narrow QRS

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12
Q

How can you tell a beat is ventricular in origin?

A

Wide QRS, abnormal T waves
No p wave

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13
Q

List 3 most common causes of a regular narrow complex tachycardia

A

Sinus tachycardia
Atrial flutter
Re-entrant SVT

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14
Q

List 4 symptoms of SVTs

A

Palpitations
Chest pain
Anxiety
SOB

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15
Q

Describe management of regular narrow complex tachycardia

A
  1. Vagal manœuvre: Valsalva
  2. Adenosine 6mg IV
  3. Adenosine 12mg IV
  4. Adenosine 18mg IV
  5. DC cardioversion (if above fail/ haemodynamically unstable)
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16
Q

What is the valsalva manœuvre?

A

Forced expiration against a closed glottis
Ask patient to try to blow plunger back on 20ml syringe

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17
Q

List 5 side effects of adenosine

A

Nausea
Dizziness
Breathlessness
Chest tightness
Flushing

18
Q

Name 2 drugs that interact with adenosine

A

Dipyridamole (antiplatelet agent): enhances effects of adenosine
Theophylline: blocks effects of adenosine

19
Q

Describe the MOA of adenosine

A

Causes transient heart block in the AV node
Agonist of A1 receptor in AVN, which inhibits adenylyl cyclase; reducing cAMP + causing hyperpolarization by increasing outward K+ flux
V short half-life: 8-10s

20
Q

How should adenosine be administered? Why?

A

Infused via a large-calibre cannula due to it’s short half-life

21
Q

In which patients is adenosine contraindicated? What drug is preferred?

A

Asthmatics (may cause bronchospasm)
Verapamil 5-10mg IV

22
Q

What is the long term management for patients with SVT due to AVNRT?

A

Educate on vagal manoeuvres
B-blockers
Catheter ablation

23
Q

Give 4 ECG features of atrial fibrillation

A

Irregularly irregular rhythm
No p waves
Unstable baseline
Narrow QRS complexes

24
Q

What is the probable cause of an irregular narrow complex tachycardia?

A

AF

25
Q

Describe acute management of atrial flutter

A

Similar to AF although medication may be less effective
Flutter is more sensitive to cardioversion so lower energy levels may be used

26
Q

Describe long term management for atrial flutter

A

Radiofrequency ablation of Tricuspid valve isthmus

27
Q

What are the types of ventricular tachycardia?

A

Monomorphic VT: all QRS complexes about the same size
Polymorphic VT (TdP): changing QRS amplitude

28
Q

Give 4 indicators of VT

A

AV dissociation
Fusion beats
Capture beats
Extreme axis deviation

29
Q

Describe management of Torsades de pointes

A

Magnesium sulfate 1-2g IV

30
Q

Describe treatment of broad complex tachycardias

In haemodynamically stable patients

A
  1. Amiodarone 300mg IV over 10-60 mins
  2. DC Cardioversion
31
Q

Give 2 alternatives to amiodarone in management of broad complex tachycardia

A

Lidocaine: use with caution in severe LV impairment
Procainamide

32
Q

What is the long term management for ventricular tachycardia?

A

Implantable cardioverter defibrillator
+/or B-blockers / Sotalol

33
Q

What is the class and MOA of Amiodarone?

A

Class III antiarrhythmic agent
Blocks K+ channels which inhibits repolarisation + hence prolongs the action potential.
Also has other actions such as blocking Na+ channels (a class I effect)

33
Q

What effect does Amiodarone have on the p450 enzyme system?

A

p450 inhibitor e.g.
Decreases metabolism of warfarin

34
Q

Give 2 limiting factors to the way in which amiodarone is administered

A

V long half-life (20-100 days). For this reason, loading doses are frequently used
Ideally given into central veins (causes thrombophlebitis)

35
Q

What ECG changes may be caused by amiodarone?

A

Lengthens QT (proarrhythmic effect)
Bradycardia

36
Q

What are the monitoring requirements for amiodarone?

A

Prior to Tx: TFT, LFT, U&E, CXR
Every 6 months: TFT, LFT

37
Q

What alternative drugs can be given second line in management of bradycardia?

A

Isoprenaline/ Adrenaline infusion

37
Q

List 8 adverse effects of amiodarone

A

Thyroid dysfunction: both hypo + hyper-thyroidism
Corneal deposits
Pulmonary fibrosis/ pneumonitis
Liver fibrosis/ hepatitis
Peripheral neuropathy, myopathy
Photosensitivity
‘Slate-grey’ appearance
Thrombophlebitis + injection site reactions

38
Q

What is the treatment for all patients with bradycardia?

A
  1. Atropine 500mcg IV
  2. Atropine 500mcg IV repeat to max 3mg
  3. Transcutaneous pacing
  4. Transvenous pacing
39
Q

Give 4 risk factors for deterioration of bradycardia to asystole

A

Complete heart block with broad complex QRS
Recent asystole
Mobits type II AV block
Ventricular pause >3s

YR6: CARDIAC (41 decks)

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