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Cardiovascular System - High > Arrythmias > Flashcards

Arrythmias Flashcards

1
Q

Arrhythmia is defined as an

A

abnormal heart rhythm

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2
Q

Arrhythmias can happen in which chamber of the heart?

A

Atria and ventricles

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3
Q

Which type of arrhythmia is defined by irregular heartbeat rhythm?

A

Fibrillation

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4
Q

Which type of arrhythmia is defined by fast heart rate of > 100bpm

A

Tachycardia

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5
Q

Which type of arrhythmia is defined by slow heart rate of <60bmp

A

Bradycardia

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6
Q

Which type of arrhythmia is defined by the atria contracting rapidly but with a regular rhythm?

A

Flutter

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7
Q

Which is more dangerous, ventricular fibrillation or atrial fibrillation?

A

VF

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8
Q

Which is VF more dangerous than AF?

A

The ventricles are quivering instead of beating. It is a medical EMERGENCY! (As the heart cannot effectively pump blood to the body or to itself)

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9
Q

What are the two factors that can be controlled to manage Atrial Fibrillation?

A

Rate control

Rhythm control - attempt to restore and maintain sinus rhythm

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10
Q

Do NICE guidelines suggest to treat rhythm or rate as first line treatment?

A

Rate

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11
Q

What drugs are given to treat rate?

A

Beta Blocker (not sotalol) or rate-limiting Calcium Channel Blocker (verapamil or diltiazem; unlicensed)

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12
Q

What treatment is given to treat rhythm if AF is present for >48 hours?

A

Electrical cardioversion (make sure the pt has been fully anti-coagulated for at least 3 weeks, if not possible, parenteral anticoagulation)

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13
Q

What treatment is given to treat rhythm is AF is present for <48 hours?

A

Amiodarone or flecainide

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14
Q

What treatment MUST always be added after rate and rhythm control and for what duration?

A

Anticoagulation for at least 4 weeks

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15
Q

If anticoagulant treatment is contra-indicated or not tolerated, what option is considered?

A

Left appendage occlusion

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16
Q

What condition must be ruled out before initiating cardioversion?

A

left atrial thrombus

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17
Q

Which of the two generally responds less well to drug treatment; Atrial fibrillation or atrial flutter

A

Atrial flutter

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18
Q

Recurrent episodes of any arrhythmias can be treated by

A

Catheter ablation

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19
Q

Treatment for arrhythmias after myocardial infarction:

  • In patients with paroxysmal tachycardia
  • Bradycardia
A
  • best not to administer an anti-arrhythmic until you get an ECG record
  • atropine IV, if unresponsive then adrenaline IV
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20
Q

SEVERE BRADYCARDIA IS TREATED WITH

A

ATROPINE IV, if unresponsive EPINEPHRINE

21
Q

Paroxysmal supraventricular tachycardia treatment steps:

A
  • immersing face in ice cold water or any reflex vagal stimulation should be performed with ECG monitoring
  • if unresponsive, adenosine IV or verapamil IV
  • if unresponsive, current cardioversion
22
Q

SEVERE SUPRAVENTRICULAR TACHYCARDIA IS TREATED WITH

A

FACE IN ICE COLD WATER, if unresponsive ADENOSINE IV OR VERAPAMIL IV

23
Q

Torsades de pointes is a form of ________ __________

A

Ventricular tachycardia

24
Q

Ventricular tachycardia is treated with

A

Immediate defibrillation and then amiodarone IV if unresponsive

25
Q

Following restoration of sinus rhythm, we treat pt with either

A
  • BB or sotolal (in place of BB)

- BB and amiodarone

26
Q

Torsades de pointes is associated with a long ___ ________. It is usually induced by _____, but other factors including h_____, s_____ b______, and g____ p__- d_______ are also implicated. Episodes are usually ____-_____

A 
QT interval
drugs
hypokalaemia
severe bradycardia
genetic pre-disposition
self limiting
27
Q

TDP can be treated with ______ _______.

A

magnesium sulphate

28
Q

WHICH CLASS OF DRUGS CAN FURTHER WORSEN TDP? AND HOW SO?

A

ANTI-ARRHYTMICS

BY PROLONGING QT INTERVAL

29
Q

Examples of water soluble BBs

SAN water

A

Sotalol
Atenolol
Nebivolol

30
Q

Examples of cardioselective BBs

ABs

A

Atenolol

Bisoprolol

31
Q

Examples of fat-soluble BBs

PPLM fat palm

A

Propranolol
Pindolol
Labetolol
Metroprolol

32
Q 
Important adverse effects of amiodarone:
SKIN
HEART
LIVER
LUNGS 
THYROID
A
  • grey discolouration and photosensitivity (avoid direct sunlight and wear sunscreen)
  • bradycardia, AV block
  • hepatitis
  • pneumonitis
  • hyper or hypothyroid disorders due to structural similarities to thyroid hormone
33
Q

Avoid amiodarone in patients with:

A

active thyroid disease
severe hypotension
heart block

34
Q

Does amiodarone have a short or long half life?

A

Very long half life. May still be present weeks or even months after stopping treatment

35
Q

Interaction between Amiodarone and BBs

A

Increased risk of bradycardia, AV block and myocardial depression

36
Q

Interaction between Amiodarone and Lithium

A

Risk of ventricular arrhythmias

37
Q

Interaction between Amiodarone and Digoxin

A

Increased plasma levels of digoxin - possible digitoxicity

38
Q

Interaction between Amiodarone and Warfarin

A

Amiodarone inhibits Warfarin metabolism – enhanced anticoagulant effect

39
Q

Which electrolyte disturbances need to be corrected before starting sotalol to avoid life threatening ventricular arrhythmias?

A
  • hypokalaemia

- hypomagensaemia

40
Q

Digoxin is most useful for controlling ventricular response in persistent and permanent _____ ________ and _____ ______. It is now rarely used for ____ control of heart rate.

A

atrial fibrillation
atrial flutter
rapid

41
Q

Digoxin has a ______ half life and can take upto ___ days to be excreted by the body.
Time for onset of effect is __ minutes for the tablets and __ hours for IV route, therefore usually oral route of administration is preferred.

A

long
11
30
2

42
Q

Which route is not recommended for digoxin?

A

intramuscular

43
Q

Digoxin maintenance doses are usually give ____ daily but higher doses may be divided to avoid ____

A

once

nausea

44
Q

Which electrolyte imbalance predisposes the patient to digitalis toxicity, and how is it managed?

A

Hypokalaemia

Managed with potassium-sparing diuretic (eplerenone) or, if necessary, potassium supplements.

45
Q

What is used to treat life threatening overdosage of digoxin?

A

Digoxin-specific antibody fragments

46
Q

What is the drug action of digoxin? How does it work in HF and in AF

A
  • It is a positive ionotrope (increases force of contraction) and reduces conduction in AV node.
  • It is a negative chronotope (reduces ventricular rate)
47
Q

What are some of the important adverse effects of digoxin?

A
  • bradycardia
  • gastrointestinal disturbances
  • headache
  • visual disturbance (blurred or yellow vision)
  • rash
  • dizziness
48
Q

What is the desired therapeutic range of digoxin and what is the toxic range?

A
  • 1 to 2 mcg/Litre

- 1.5 to 3mcg/Litre indicates toxicity

Cardiovascular System - High (4 decks)

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