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Arrythmias Flashcards

1
Q

what are the shockable cardiac arrest rhythms?

A

ventricular tachycardia
ventricular fibrillation

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2
Q

what are the non-shockable cardiac arrest rhythms?

A

asystole = no significant electrical activity
pulseless electrical activity = all electrical activity except VT/VF, including sinus rhythm without a pulse

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3
Q

what is narrow complex tachycardia?

A

fast heart rate w
QRS complex duration less than 0.12s (3 small squares on ECG)

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4
Q

what are the main differentials of a narrow complex tachycardia?

A

sinus tachycardia
supraventricular tachycardia
atrial fibrillation
atrial flutter

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5
Q

what does the treatment of sinus tachycardia focus on?

A

the underlying cause

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6
Q

what is supraventricular tachcardia treated with?

A

vagal manoeuvres
adenosine

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7
Q

what is atrial fibrillation treated with?

A

rate control
rhythm control

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8
Q

what is atrial flutter treated with?

A

rate control
rhythm control

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9
Q

what is broad complex tachycardia?

A

fast heart rate w
QRS complex duration more than 0.12s (3 small squares)

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10
Q

what are the differentials of broad complex tachycardia?

A

ventricular tachycardia or unclear cause
polymorphic ventricular tachycardia - torsades des pointes
atrial fibrillation with bundle branch block
supra ventricular tachycardia with bundle branch block

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11
Q

how is ventricular tachycardia or unclear cause of broad complex tachycardia treated?

A

IV amiodarone

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12
Q

how is polymorphic ventricular tachycardia (torsades des pointed) treated?

A

IV magnesium

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12
Q

how is atrial fibrillation with bundle branch block treated ?

A

same as AF
rate or rhythm control

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12
Q

how is supra ventricular tachycardia with bundle branch block treated?

A

same as SVT
vagal manoeuvres and adenosine

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13
Q

what are life threatening feautures of tachycardia and what are patients with these treated with?

A

syncope (loss of consciousness), heart muscle ischaemia (chest pain) shock or severe HF
treated with synchronised DC cardioverison under sedation or general anaesthesia
IV amiodraone added if DC shocks unsuccessful

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14
Q

what normally happens to an electrical signal passing through the atria?

A

passes through once
stimulates contraction
disappears through AV node

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15
Q

what is atrial flutter caused by?

A

a re-entrant rhythm in either atrium
an extra electrical pathway in the atria causes the electrical signal to re-circulate in a self-perpetuating loop
therefore the signal goes round and round the atria without interruption

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16
Q

what is the usual atrial rate in atrial flutter?

A

300 bpm

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17
Q

in atrial flutter does the electrical signal enter the ventricles on every loop?

A

no
because of the long refractory period of the AV node
leads to 2 atrial contractions for every ventricle contraction - ventricle 150bpm

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18
Q

how does atrial flutter appear on an ECG?

A

sawtooth appearance
repeated P waves at around 300bpm with narrow complex tachycardia

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19
Q

what is the treatment of atrial flutter?

A

similar to AFib
anticoagulation based on CHA2DS2-VASc score
radiofreuency ablation of re-entrant rhythm can be permanent solution

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20
Q

what is the QT interval?

A

from the start of the QRS complex to the end of the T wave

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21
Q

what does the corrected QT interval (QTc) estimate?

A

the QT interval if the heart rate were 60bpm

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22
Q

when is the QT interval prolonged in men?

A

more than 440 milliseconds

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23
when is the QT interval prolonged in women?
more than 460 milliseconds
24
what is depolarisation?
the electrical process that leads to heart contraction
25
what is repolarisation?
a recovery period before the muscle cells are ready to depolarise again (contraction)
26
what does a prolonged QT interval represent?
prolonged repolarisation of the myocytes (heart muscles) after a contraction
27
what can waiting for a long time for a repolarisation result in?
spontaneous depolarisation in some muscle cells before repolarisation known as afterdepolarisations
28
what do afterdepolarisations do and what can this lead to?
afterdepolarisations spread throughout the ventricles causing a contraction before proper repolarisation when this leads to recurrent contractions without normal depolarisations this is known as torsades des pointes - types of polymorphic VT
29
what does torsades des pointes look like on an ECG?
standard ventricular tachycardia but looks as though the QRS complex is twisting around the baseline height of QRS complex gets progressively smaller, then larger, then smaller, etc
30
what does torsades des pointes become?
it will either spontaneously terminate and revert to normal sinus rhythm or progress to ventricular tachycardia which can lead to cardia arrest
31
what are the causes of prolonged QT syndrome?
long QT syndrome (inherited condition) medications - antipsychotics, citalopram, flecanide, stall, amiodraone, macrolide antibiotics electrolytes imbalances - hypokalaemia, hypomagnesaemia, hypocalcaemia
32
what is the management of prolonged QT syndrome?
stopping and avoiding medications that cause it correcting electrolyte imbalances beta blockers - not sotalol pcaemaerks or implantable cardiac defibrillators
33
what is the acute management of torsades des pointes?
correcting underlying cause - electrolyte imbalances, medication magnesium infusion - even if serum magnesium normal defibrillation if ventricular tachycardia occurs
34
what is ventricular ectopics?
premature ventricular beats
35
what are ventricular ectopics caused by?
random electrical discharges outside the atria
36
what do patients with ventricular ectopics often complain of?
random extra or missed heat beats
37
who is ventricular ectopics more common in?
relatively common at all ages and in healthy patients more common w pre-exiting heart conditions - ischaemic heart disease or heart failure
38
how does ventricular ectopics appear on an ECG?
isolated, random, abnormal, broad QRS complexes on an otherwise normal ECG
39
what is bigeminy?
when every other beat is a ventricular ectopic
40
how does bigeminy appear on an ECG?
normal beat, immediately followed by an ectopic beat, normal beta, ectopic beat etc
41
what does management of ventricular ectopics involve?
reassurance and no treatment in otherwise healthy people with infrequent ectopics specialist advice for the with underlying heart disease, frequent or concerning symptoms (chest pain or syncope) or family history of heart disease or sudden death beta blockers sometimes used to manage symptoms
42
what causes first degree heart block?
delayed conduction through the AV node every atrial impulse still leads to a ventricular contraction therefore every P wave is followed by a QRS complex
43
how does first-degree heart block present on an ECG?
PR interval greater than 0.2s (5 small or 1 big square)
44
what causes second-degree heart block?
when some atrial impulses do no make through the AV node to the ventricles some P waves not followed by QRS complexes
45
what are the types of second-degree heart block?
mobitz type 1 - Wenckebach phenomenon mobitz type 2
45
what is second-degree heart block mobitz type 1?
where the conduction through the AV node takes progressively longer until it finally fails after which it resets
46
how does second-degree heart block mobitz type 1 present on an ECG?
an increasing PR interval until a P wave is not followed by a QRS complex PR interval then returns to normal and cycle repeats itself
47
what is second degree heart block mobitz type 2?
where there is intermittent failure of conduction through the AV node
47
what is this degree heart block?
complete heart block there is no observable relationship between the P waves and QRS complexes
48
what is there a risk of with second degree heart block mobitx type 2?
asystole
48
how does second degree heart block mobitx type 2 look on an ECG?
absence of QRS complexes following P waves usually a set ratio of P waves to QRS complexes PR interval remains normal
49
when can it be difficult to tell if t is mobitz type 1 or 2 second degree heat block?
when there is a 2:1 block 2 P waves for every QRS complex every other P wave does not stimulate a QRS complex
50
what is there a significant risk of with this degree heart block?
asystole
51
what is bradycardia?
slow heart rate typically less than 60bpm can be under 60 in normal fit healthy patients without causing any symptoms
52
what are some causes of bradycardia?
medications - beta blockers heart block sick sinus syndrome
53
what is sick sinus syndrome?
it encompasses many conditions that cause dysfunction in the SA node
53
what is sick sinus syndrome often caused by?
idiopathic degenerative fibrosis of the SA node
54
what can sick sinus syndrome result in?
sinus bradycarida sinus arrythmias prolonged pauses
55
what carries a risk of asystole?
mobitz type 2 third degree/complete heart block previous asystole ventricular pauses longer than 3s
56
what is the management of unstable patients and those at risk of systole?
IV atropine - first line inotropes - isoprenaline or adrenaline temporary cardiac pacing permanent implantable pacemaker - when available
57
what are options of temporary cardiac pacing?
transcutaneous pacing - using pads on patients chest transvenous pacing - using a catheter fed through the venous system to the heart directly
58
what type od medication is atropine?
antimuscarinic
59
how does atropine work?
by inhibiting the parasympathetic nervous system leads to side effects of pupil dilation, dry mouth, urinary retention, constipation

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