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Cardiovascular system > Arrythmias > Flashcards

Arrythmias Flashcards

1
Q

what investigations would you carry out for an arrhythmia?

A

> 12 lead ECG, 24 hours
blood tests (thyroid function)
echocardiogram

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2
Q

what are the signs and symptoms for supraventricular tachycardia?

A

> palpitations
dyspnoea
dizziness

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3
Q

explain why supraventricular tachycardia occurs with reference to an accessary pathway?

A

the accessory pathway conducts into the ventricles quicker than the AV node resulting in premature excitation.

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4
Q

what may be done to fix intermittent palpitations caused by supraventricular tachycardia?

A

Valsalva manoeuvre

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5
Q

what is the presentation of ventricular tachycardia?

A

> palpitations
dyspnoea
dizziness
syncope

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6
Q

what investigations are carried out for ventricular tachycardia?

A

> bloods
ECHO
angiogram

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7
Q

what are the indications for intermediate cardiovascular defibrillator therapy?

A

> cardiac arrest due to ventricular failure/tachycardia
sustained ventricular tachycardia causing syncope/significant compromise
sustained ventricular tachycardia with poor left ventricle function

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8
Q

what are the intermediate indications for temporary pacing?

A

> intermediate/sustained symptomatic bradycardia, particularly syncope
prophylactic when a patient is at high risk of development of sever bradycardia (2nd/3rd degree AV block, post anterior MI, or when asymptomatic)

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9
Q

what are the indications for permanent pacing?

A

> symptomatic/profound 2nd/3rd degree AV block
probably mobitz type 2 2nd/3rd degree AV block even if asymptomatic
AV block associated with neuromuscular diseases
after or in preparation for AV node ablation
alternating RBBB/LBBB
syncope when bifascicular/trifascicular block with no other explanation
sinus node disease associated with symptoms
carotid sinus hypersensitivity/malignant vasovagal syncope

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10
Q

name three types of arrhythmia

A

> sinus arrhythmia
supraventricular arrhythmia
ventricular arrhythmia

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11
Q

what is an arrhythmia?

A

any deviation from the normal rhythm of the heart

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12
Q

describe how an ecg would look in ventricular fibrillation

A

rhythm: extremely irregular

p wave: absent

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13
Q

is the inside of a cardiac cell more negative or positive compared to the outside?

A

negative

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14
Q

what are the electrophysiological properties of class 1A drugs?

A

they are fast sodium-channel blockades that delay the repolarisation and increases the action potential duration.

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15
Q

what are the electrophysiological properties of class 1b drugs?

A

they are intermediate sodium-channel blockades that accelerate repolarisation and decrease the action potential duration.

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16
Q

what are the electrophysiological properties of class 1c drugs?

A

they are slow sodium channel blockades that have little effect on the duration of the action potential.

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17
Q

what are the electrophysiological properties of class 2 drugs?

A

beta-adrenergic receptor antagonists (beta-blockers), that reduce the sympathetic nervous system stimulation and depress stage four pf depolarisation.

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18
Q

what are the electrophysiological properties of class 3 drugs?

A

they prolong refractoriness and increase the action potential duration by blocking the potassium channels.

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19
Q

what are the electrophysiological properties of class 4 drugs?

A

they are calcium channel blockades

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20
Q

name 3 class 1a drugs

A

> quinidine
procainamide
dispyramide

21
Q

name 3 class 1b drugs

A

> lidocaine
mexiletine
tocainide

22
Q

name 2 class 1c drugs

A

> flecainide

> propafenone

23
Q

name 2 class 2 drugs

A

> atenolol

> bisoprolol

24
Q

name 3 class 3 drugs

A

> amiodarone
bretylum
sotalol

25
Q

name 2 class 4 drugs

A

> diltiazem

> verapamil

26
Q

what are class 1a drugs used for?

A

> atrial fibrillation
premature atrial contractions
premature ventricular contractions
ventricular tachycardia

27
Q

what are class 1b drugs used for?

A

> ventricular dysrhthymias

28
Q

what are class 1c drugs used for?

A

> severe ventricular dysrhythmias

> atrial fibrillation

29
Q

what are class 2 drugs used for?

A

> supra ventricular and ventricular dysrhythmias

> atrial fibrillation

30
Q

what are class three drugs used for?

A

> difficult dysrhythmias
life threatening ventricular tachycardia
life threatening atrial fibrillation
sustained ventricular tachycardia

31
Q

what are class four drugs used for?

A

> paroxysmal supraventricular tachycardia

> rate control of atrial fibrillation

32
Q

what should you not give a patient who is on class four drugs?

A

beta blockers as they will go into cardiogenic shock and die

33
Q

name two anti-dysrhythmic drugs which are not placed in to one particular category

A

> digoxin

> adenosine

34
Q

what are the actions of digoxin?

A

> inhibition of the sodium potassium ATPase pump
positive inotrope (improving contraction strength)
allows more calcium to be available to contraction

35
Q

what is digoxin used for?

A

> heart failure

> atrial dysrhythmias

36
Q

what are the signs of digoxin toxicity?

A 
> vomiting
> xanthopsia (yellow glow)
> reverse t waves
> bradycardia
> tachycrdia
37
Q

what is the treatment for digoxin toxicity?

A

> stop digoxin

> if levels are high give digibind which binds to digoxin forming a complex that is excreted in the urine

38
Q

what is amiodarone used to treat?

A

> ventricular tachycardia

> supraventricular tachycardia

39
Q

what are the potential side effects of amiodarone?

A

> thyroid (hypo and hyper)
pulmonary fibrosis
corneal deposits
LFT abnormalities

40
Q

what are the effects pf adenosine?

A

> slowing of conduction through the AV node

> converts paroxysmal supraventricular tachycardia to sinus rhythm

41
Q

how is adenosine administered?

A

as a fast IV push

42
Q

what can all anti-arrhythmias cause?

A

arrhythmias

43
Q

what are the indications for anti-coagulation?

A 
> atrial fibrillation
> valvular heart disease
> venous thrombo-embolism
> after surgery
> immobalisation
44
Q

describe arterial thrombosis

A

adherence of platelets to arterial walls, this is white in colour and is associated with MI, stroke and ischaemia

45
Q

describe venous thrombosis

A

this develops in areas of stagnated blood flow and is red in colour. it is associated with congestive heart failure, cancer and surgery.

46
Q

what does warfarin inhibit?

A

the production of active clotting factors

47
Q

what does the direct affect of warfarin depend on?

A

> concentration of warfarin in the liver
rate of accumulation of warfarin
long t1/2 of clotting factors means slow onset of action

48
Q

what are the adverse effects of warfarin?

A

> bleeding

> teratogenic

49
Q

explain the CHADS2 score for warfarin

A 
C: congestive heart failure
H: hypertension
A: age more than 75
D: diabetes
S: stroke

Cardiovascular system (34 decks)

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