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cardiology > Arrythmias > Flashcards

Arrythmias Flashcards

1
Q

What is first degree heart block?

A

Arrythmia with a fixed, prolonged PR interval

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2
Q

What is Mobitz type 1 second degree heart block?

A

PR intervals slowly increase, before a QRS complex is dropped

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3
Q

What is Mobitz type 2 second degree heart block?

A

PR intervals remain the same length but QRS complexes are dropped

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4
Q

What is third degree heart block?

A

P waves and QRS complexes are completely unrelated

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5
Q

What is the anatomical location of the conduction block in first degree heart block?

A

Between the SA node and the AV node (in the atrium)

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6
Q

Where does the anatomical block to conduction occur in Mobitz type 1 second degree heart block?

A

In the AV node

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7
Q

Where does the anatomical block to conduction occur in Mobitz type 2 second degree heart block?

A

Occurs after the AV node in the bundle of His or Purkinje fibres

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8
Q

Where does the anatomical block to conduction occur in third degree heart block?

A

Anywhere from the AV node down causing complete blockage

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9
Q

What two things could a shortened PR interval on an ECG mean?

A

The P wave is originating from somewhere closer to the AV node so the conduction takes less time (the SA node is not in a fixed place and some people’s atria are smaller than others)

An accessory pathway, causing faster conduction to the ventricle than the usual slow route across the atrial wall

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10
Q

When would a broad QRS complex occur?

A

Abnormalities in the depolarisation sequence, e.g.

  • a ventricular ectopic where the impulse spreads slowly across the myocardium from the focus in the ventricle
  • a bundle branch block, because the impulse gets to one ventricle rapidly down the intrinsic conduction system then has to spread slowly across the myocardium to the other ventricle
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11
Q

What changes on an ECG would an atrial ectopic beat result in?

A

An atrial ectopic would result in a narrow QRS complex because it would conduct down the normal conduction system of the heart

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12
Q

What do tall QRS complexes on an ECG imply?

A

Ventricular hypertrophy
Although could just be a tall person

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13
Q

What is a delta wave?

A

A sign that the ventricles are being activated earlier than normal from a point distant to the AV node e.g. through an accessory pathway

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14
Q

What is the cause of this abnormal ECG?

A

Hyperkalaemia - see tented T waves (AvR) and ST elevation (all due to hyperkalaemia)

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15
Q

What is the abnormality on this ECG?

A

Torsade de Pointes

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16
Q

What are the causes for torsade de pointes?

A
  • diarrheoa
  • low blood magnesium, and low blood potassium (commonly seen in malnourished and alcoholics)
  • QT prolonging medications such as clarithromycin, levofloxacin, or haloperidol
  • taken with fluoxetine
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17
Q

What is a focal tachycardia?

A

A tachycardia originating from one point in the heart e.g. the SA node

18
Q

What is an atrial tachycardia and in which patients is this usually seen?

A

A different focus in the atrium takes over from the sinoatrial node resulting in abnormal P waves preceding QRS complexes

Often seen in patients with chronic lung disease

19
Q

How is inappropriate (i.e. no underlying cause such as sepsis) sinus tachycardia treated?

A

Inappropriate sinus tachycardia can be slowed using beta blockers or ivabradine (selective sinus node blocker) but is usually best left alone

20
Q

How should appropriate (i.e. due to underlying cause such as sepsis or anaemia) sinus tachycardia treated?

A

Underlying cause treated

21
Q

How can atrial tachycardias be controlled?

A

Usually the rate can be controlled with calcium channel blockers or beta blockers

22
Q

What abnormality is this and what arrythmia is it characteristic of?

A

Saw tooth baseline

Atrial flutter

23
Q

What is atrial flutter?

A

Atrial flutter is caused by a re-entrant rhythm in either the right or left atrium

This re-entrant circuit around the atrium causes activation of the AV node every time electrical impulses pass through it

24
Q

Do supraventricular tachycardias give a narrow or broad ECG complex?

A

Narrow (<0.12)

25
Q

Do ventricular tachycardias give a narrow or broad QRS complex?

A

Broad (>1.2)

26
Q

Is this a supraventricular or ventricular tachycardia?

A

Ventricular - broad QRS

27
Q

What is the only SVT that causes wide QRS complexes?

A

Supraventricular tachycardia with a bundle branch block

28
Q

What is the abnormality here?

A

Right bundle branch block - RSR in lead V1 makes an M shape (M for MaRRow)

29
Q

What is the abnormality here?

A

Left bundle branch block - RSR’ wave in lead V6

30
Q

What is the most serious ventricular tachycardia?

A

Ventricular fibrillation

31
Q

What is the abnormality here?

A

Ventricular fibrillation

Irregular ECG looking like a childs scribble

32
Q

What is the abnormality here?

A

Ventricular tachycardia

Regular tachycardia with broad QRS complexes

33
Q

What is the name of the accessory pathway in Wolff-Parkinson White syndrome?

A

Bundle of Kent

34
Q

What is the pathology in Wolff-Parkinson-White syndrome?

A

The bundle of Kent (accessory pathway) allows electrical signals to the ventricles outside of the AV node

35
Q

How can supraventricular tachycardias be slowed down?

A

Adenosine

DC cardioversion

36
Q

What are the cardiac causes of atrial fibrillation?

A

Ischaemic causes

Valve disease (mitral)

Myxoma

Hypertension

37
Q

What are the non-cardiac causes of atrial fibrillation?

A

Alcohol

Thyrotoxicosis

Pneumonia

38
Q

What are the complications of atrial fibrillation?

A

Reduced cardiac output

Embolic stroke

Fast ventricular response

39
Q

Which ventricular arrythmias are shockable?

A

Ventricular fibrillation

Pulseless ventricular tachycardia

40
Q

Which arrythmias are not shockable?

A

Asystole

Pulseless electrical activity

Ventricular tachycardia with pulse

cardiology (15 decks)

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