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Cardio > Arrythmias > Flashcards

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
Q

when is the QT interval prolonged in women?

A

more than 460 milliseconds

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24
Q

what is depolarisation?

A

the electrical process that leads to heart contraction

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25
Q

what is repolarisation?

A

a recovery period before the muscle cells are ready to depolarise again (contraction)

26
Q

what does a prolonged QT interval represent?

A

prolonged repolarisation of the myocytes (heart muscles) after a contraction

27
Q

what can waiting for a long time for a repolarisation result in?

A

spontaneous depolarisation in some muscle cells before repolarisation
known as afterdepolarisations

28
Q

what do afterdepolarisations do
and what can this lead to?

A

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
Q

what does torsades des pointes look like on an ECG?

A

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
Q

what does torsades des pointes become?

A

it will either spontaneously terminate and revert to normal sinus rhythm
or progress to ventricular tachycardia which can lead to cardia arrest

31
Q

what are the causes of prolonged QT syndrome?

A

long QT syndrome (inherited condition)
medications - antipsychotics, citalopram, flecanide, stall, amiodraone, macrolide antibiotics
electrolytes imbalances - hypokalaemia, hypomagnesaemia, hypocalcaemia

32
Q

what is the management of prolonged QT syndrome?

A

stopping and avoiding medications that cause it
correcting electrolyte imbalances
beta blockers - not sotalol
pcaemaerks or implantable cardiac defibrillators

33
Q

what is the acute management of torsades des pointes?

A

correcting underlying cause - electrolyte imbalances, medication
magnesium infusion - even if serum magnesium normal
defibrillation if ventricular tachycardia occurs

34
Q

what is ventricular ectopics?

A

premature ventricular beats

35
Q

what are ventricular ectopics caused by?

A

random electrical discharges outside the atria

36
Q

what do patients with ventricular ectopics often complain of?

A

random extra or missed heat beats

37
Q

who is ventricular ectopics more common in?

A

relatively common at all ages and in healthy patients
more common w pre-exiting heart conditions - ischaemic heart disease or heart failure

38
Q

how does ventricular ectopics appear on an ECG?

A

isolated, random, abnormal, broad QRS complexes on an otherwise normal ECG

39
Q

what is bigeminy?

A

when every other beat is a ventricular ectopic

40
Q

how does bigeminy appear on an ECG?

A

normal beat, immediately followed by an ectopic beat, normal beta, ectopic beat etc

41
Q

what does management of ventricular ectopics involve?

A

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
Q

what causes first degree heart block?

A

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
Q

how does first-degree heart block present on an ECG?

A

PR interval greater than 0.2s (5 small or 1 big square)

44
Q

what causes second-degree heart block?

A

when some atrial impulses do no make through the AV node to the ventricles
some P waves not followed by QRS complexes

45
Q

what are the types of second-degree heart block?

A

mobitz type 1 - Wenckebach phenomenon
mobitz type 2

45
Q

what is second-degree heart block mobitz type 1?

A

where the conduction through the AV node takes progressively longer until it finally fails after which it resets

46
Q

how does second-degree heart block mobitz type 1 present on an ECG?

A

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
Q

what is second degree heart block mobitz type 2?

A

where there is intermittent failure of conduction through the AV node

47
Q

what is this degree heart block?

A

complete heart block
there is no observable relationship between the P waves and QRS complexes

48
Q

what is there a risk of with second degree heart block mobitx type 2?

A

asystole

48
Q

how does second degree heart block mobitx type 2 look on an ECG?

A

absence of QRS complexes following P waves
usually a set ratio of P waves to QRS complexes
PR interval remains normal

49
Q

when can it be difficult to tell if t is mobitz type 1 or 2 second degree heat block?

A

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
Q

what is there a significant risk of with this degree heart block?

A

asystole

51
Q

what is bradycardia?

A

slow heart rate
typically less than 60bpm
can be under 60 in normal fit healthy patients without causing any symptoms

52
Q

what are some causes of bradycardia?

A

medications - beta blockers
heart block
sick sinus syndrome

53
Q

what is sick sinus syndrome?

A

it encompasses many conditions that cause dysfunction in the SA node

53
Q

what is sick sinus syndrome often caused by?

A

idiopathic degenerative fibrosis of the SA node

54
Q

what can sick sinus syndrome result in?

A

sinus bradycarida
sinus arrythmias
prolonged pauses

55
Q

what carries a risk of asystole?

A

mobitz type 2
third degree/complete heart block
previous asystole
ventricular pauses longer than 3s

56
Q

what is the management of unstable patients and those at risk of systole?

A

IV atropine - first line
inotropes - isoprenaline or adrenaline
temporary cardiac pacing
permanent implantable pacemaker - when available

57
Q

what are options of temporary cardiac pacing?

A

transcutaneous pacing - using pads on patients chest
transvenous pacing - using a catheter fed through the venous system to the heart directly

58
Q

what type od medication is atropine?

A

antimuscarinic

59
Q

how does atropine work?

A

by inhibiting the parasympathetic nervous system
leads to side effects of pupil dilation, dry mouth, urinary retention, constipation

Cardio (4 decks)

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