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
name 2 class 4 drugs
> diltiazem | > verapamil
26
what are class 1a drugs used for?
> atrial fibrillation > premature atrial contractions > premature ventricular contractions > ventricular tachycardia
27
what are class 1b drugs used for?
> ventricular dysrhthymias
28
what are class 1c drugs used for?
> severe ventricular dysrhythmias | > atrial fibrillation
29
what are class 2 drugs used for?
> supra ventricular and ventricular dysrhythmias | > atrial fibrillation
30
what are class three drugs used for?
> difficult dysrhythmias > life threatening ventricular tachycardia > life threatening atrial fibrillation > sustained ventricular tachycardia
31
what are class four drugs used for?
> paroxysmal supraventricular tachycardia | > rate control of atrial fibrillation
32
what should you not give a patient who is on class four drugs?
beta blockers as they will go into cardiogenic shock and die
33
name two anti-dysrhythmic drugs which are not placed in to one particular category
> digoxin | > adenosine
34
what are the actions of digoxin?
> inhibition of the sodium potassium ATPase pump > positive inotrope (improving contraction strength) > allows more calcium to be available to contraction
35
what is digoxin used for?
> heart failure | > atrial dysrhythmias
36
what are the signs of digoxin toxicity?
``` > vomiting > xanthopsia (yellow glow) > reverse t waves > bradycardia > tachycrdia ```
37
what is the treatment for digoxin toxicity?
> stop digoxin | > if levels are high give digibind which binds to digoxin forming a complex that is excreted in the urine
38
what is amiodarone used to treat?
> ventricular tachycardia | > supraventricular tachycardia
39
what are the potential side effects of amiodarone?
> thyroid (hypo and hyper) > pulmonary fibrosis > corneal deposits > LFT abnormalities
40
what are the effects pf adenosine?
> slowing of conduction through the AV node | > converts paroxysmal supraventricular tachycardia to sinus rhythm
41
how is adenosine administered?
as a fast IV push
42
what can all anti-arrhythmias cause?
arrhythmias
43
what are the indications for anti-coagulation?
``` > atrial fibrillation > valvular heart disease > venous thrombo-embolism > after surgery > immobalisation ```
44
describe arterial thrombosis
adherence of platelets to arterial walls, this is white in colour and is associated with MI, stroke and ischaemia
45
describe venous thrombosis
this develops in areas of stagnated blood flow and is red in colour. it is associated with congestive heart failure, cancer and surgery.
46
what does warfarin inhibit?
the production of active clotting factors
47
what does the direct affect of warfarin depend on?
> concentration of warfarin in the liver > rate of accumulation of warfarin > long t1/2 of clotting factors means slow onset of action
48
what are the adverse effects of warfarin?
> bleeding | > teratogenic
49
explain the CHADS2 score for warfarin
``` C: congestive heart failure H: hypertension A: age more than 75 D: diabetes S: stroke ```