Arrythmias

Question 1

How does a normal sinus rhythm go?

Answer 1

• originates from sino atrial node ( starts passage of electrical impulse)
  Then the 2 atria will contract together then impulse moves to atrioventricular node which facilitates a crucial delay to prevent the atria and ventricles from contracting simultaneously. Passes through Bundle of Hiss which left branch of it goes earlier since the left ventricle is thicker so it would take longer to receive the impulse so that both ventricles contract at the same time

Question 2

How to know if someone has an arrhythmia?

Answer 2

ECG is the ay to tell if someone has an arrhythmia and an ECO while tell you the reason for said arrhythmia

Question 3

Types of arrhythmia +clinical picture

Answer 3

• can be tachyarrhytmias or bradyarrhthmias
• can be asymptomatic or can be symptomatic ;
  1. Most common, palpitations which is abnormal awareness of heart beat
  2. Syncope (fainting)
  3. Cardiac arrest

Question 4

Bradyarrhythmias clinical picture?

Answer 4

• classic syncope episode from bradyrrhthmis called Stokes Adam’s Attack/ Adam stokes disease
  Sudden onset collapse with loss of consciousness
  Pale complexion
  Recovery to normal after 1 -2 minutes
• cardiac output and heart rate very low so the blood going to the brain is low leading to syncope recovery due to SA node fixing it but it may happen agin and SA node may not be always able to fix it

Question 5

What is atrial fibrillation?

Answer 5

• it is when the SA node sends too many impulses at once , disorganised electrical signals, so the atria contract in a disorganised manner
  May lead to turbulence of blood so can cause a thrombus to the ventricle to aorta then stroke
• characterized by irregular often rapid heart beat
  Has strong associations with CVDs such as heart failure, VHD, hypertension and coronary artery disease
• metabolic associations with diabetes myelitis and thyrotoxicosis

Question 6

How to manage AF?

Answer 6

1- rate control by anti-arrhythmic drugs eg Digoxin
2- anticoagulation
If there are no risk factors yaani this is just random due to maybe over activation of sympathetic nervous system then no need to give anticoagulant

If there is one moderate risk factor like diabetes , heart failure or MI then give ; aspirin 81-325 mg/day or anticoagulant

If there are any high risk factors or more than one moderate risk factor like a stroke incidence before or valve replacement then give anticoagulant like Warfarin

Question 7

Management of arrhythmias

Answer 7

Pharmacological; anti arrhythmic drugs
Non pharmacological:
1. Implantable defibrillator: implantable cardioverter defibrillator , small battery powered device places in the chest to detect and stop irregular heart beats , delivers electric shocks to SA node when needed to reset heart rhythm ( electrical cardio version )
2. Permanent pacemaker: device used to control irregular heart rhythm, pace maker has flexible insulated wires that are placed in one or more chamber of heart , these wires deliver the electrical pulses to adjust the heart rate
3. Cardiac ablation: locate source of irritable cells , uses probe with radio frequency or cryotherapy (freezing) to kill irritable tissue

Question 8

Cardiac arrest relevance to dental practice?n

Answer 8

In case of cardiac or respiratory arrest , expected to know how to do CPR and have a defibrillator
Know local intermediate life support algorithm
Ensure basic equipment is available and in good condition