Arrythmias

Question 1

Treatment for atrial ectopic beats?

Answer 1

Asymptomatic
Palpitations
Generally no treatment
B-adrenergic blockers may help
Avoid stimulants (caffeine, cigarettes)

Question 2

Treatment for sinus bradycardia

Answer 2

Treatment
Atropine (if acute, e.g. aMI)
Pacing if

Haemodynamic compromise: hypotension, CHF, angina, collapse

Question 3

What is a tachycardia?

Answer 3

HR > 100 beats

Question 4

Treatment for sinus tachycardia?

Answer 4

Treat underlying cause

B-adrenergic blockers

Question 5

Treatment for supraventricular tachycardia? (stable, narrow QRS complexes)

Answer 5

Vagal manoeuvres –> IV adenosine –> IV verapamil (CCB)

→ vagal maneuvers → adenosine (if regular) → beta-blocker/calcium channel blocker → get an expert

Question 6

Treatment for supraventricular tachycardia (stable, wide/regular/monomoorphic)

Answer 6

Stable (wide/regular/monomorphic) → adenosine → consider antiarrhythmic infusion → get an expert

Question 7

Chronic management for supra-ventricular tachycardias?

Answer 7

Avoid stimulants
Radiofrequency ablation
Antiarrhythmic drugs (class II or IV)
-verapamil
-diltiazem
-class III, IA and IC

Question 8

Which vein are the catheters placed in when carrying out ablation?

Answer 8

Femoral vein

Question 9

What can be used to guide the ablation catheter to the correct positions for ablation and then also to check the success or failure of the treatment, that is, termination of the arrhythmia at the end of the procedure ?

Answer 9

Intracardiac ECG

Question 10

What is lenegres disease?

Answer 10

Idiopathic fibrosis of the cardiac conducting system resulting in heart block

Question 11

Most common cause of restrictive cardiomyopathy?

Answer 11

Amyloidosis

Question 12

1st degree AV block?

Answer 12

Not really “block”
Just P-R interval longer than normal (> 0.2 sec)
Treatment: none
Long term follow up recommended, as more advanced block may develop over time

Question 13

Treatment indicated for Mobitz II 2nd degree heart block?

Answer 13

Permanent pacemaker indicated

Pathological, may progress to complete heart block (3rd degree HB)
Usually 2:1, or 3:1, but may be variable
Permanent pacemaker indicated

Question 14

Mobitz Type 1 2nd degree AV block

Answer 14

Mobitz I:
progressive lengthening of the PR interval, eventually resulting in a dropped beat.
Usually vagal in origin

Question 15

Treatment for 3rd degree AV block?

Answer 15

Ventricular pacing

Question 16

When would you use a ventricular pacemaker?

Answer 16

AF with slow ventricular rate

Question 17

VT acute treatment

Answer 17

DC cardioversion if unstable
If stable: consider pharmacologic cardioversion with AAD
If unsure if VT or something else, consider adenosine to make a diagnosis
Correct triggers

Question 18

Medications that can prolong the QT interview?

Answer 18

Sotalol
Quinidine
Terfenadine
Erythromycin

Question 19

Long term treatment for VT?

Answer 19

Correct ischaemia if possible (revascularisation)
Anti-arrhythmic drugs to date have been shown to be ineffective and are associated with worse outcome
Implantable cardiovertor defbrillators (ICD) if life threatening
Optimise CHF therapies

Question 20

When is adenosine contraindicated?

Answer 20

In asthma!!!

Question 21

Altered automaticity

Answer 21

Ischaemia

Catecholamines

Question 22

Triggered activity

Answer 22

Digoxin

Question 23

Re-entry

Answer 23

e.g. accessory pathway tachycardia (WPW)

Previous myocardial infarction