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Arrythmias Flashcards

1
Q

What is the first line management for unstable tachycardias?

A

Synchronised DC shocks

Peri arrest, hypotension regardless of broad complex, narrow complex or atrial fibrillation

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2
Q

What’s the treatment for stable patient with a broad complex tachycardia with a regular rhythm?

A

Loading dose amiodarone followed by 24 hour infusion. (Lidocaine and procainamide are also options)

Regular BCT - Assume ventricular tachycardia unless previously confirmed SVT with bundle branch block.

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3
Q

What’s the management of a stable, broad complex tachycardia with an irregular rhythm?

A

1) AF with BBB - treat as narrow complex tachycardia

2) polymorphic VT (e.g. Torsade de pointe) - IV magnesium

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4
Q

What’s the management of a stable, narrow complex tachycardia with an irregular rhythm?

A

Probably AF

1) onset <48 hours electrical or chemical cardioversion
2) >48 anticoagulation and rate control eg B-blocker or digoxin

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5
Q

In which patients should you be wary of when prescribing either B-blockers, flecanide or digoxin?

A

BB - asthmatics
Flecanide - structural heart problems
Digoxin - renal problems

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6
Q

What’s the management of a stable, narrow complex tachycardia with a regular rhythm?

A

Vagal manoeuvres followed by IV adenosine

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7
Q

In the management of narrow complex tachycardia with regular rhythms, what dose of adenosine do you give?

A

Initially 6mg, followed by 12mg, followed by another 12mg

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8
Q

Whats a long QT interval and what can it lead to?

A

> 430(males) and >450(females)

Causes delayed depolarisation of the ventricals and can lead to VT, sudden collapse or death.

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9
Q

Causes of a long QT interval?

A

Congenital - Jerrell-Lange-Nielsen syndrome(inc. deafness). Romano-ward syndrome. (No deafness)

Drugs - amiodarone, sotalol, class 1a antiarrthymic drugs, TCA, SSRIS, haloperidone, erythromycin, methadone,

Other - electrolytes, ⬇️K+,⬇️ca2+ ⬇️mg2+, acute MI, myocarditis, hypothermia, Subarachnoid haemorrhage

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10
Q

Signs indicating unstable/ peri-arrest arrthymias

A

Shock (hypotension <90), pallor, sweating, cold, clammy,confusoin)
Syncope
Myocardial ischaemia
Heart failure

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11
Q

What’s used for pharmacological cardioversion of AF?

A

Flecanide or amiodarone

Not flecanide in structural or ischemic heart disease.

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12
Q

What are the main 2 types of VT?

A

Monomorphic- caused by MI

Polymorphic - Long QT precipitates torsades de pointes

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13
Q

What are the main electrolytes causing VT?

A

Hypokalamia

Hypomagnesiumia

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14
Q

Which AF patients would you NOT cardiovert (rhythm control)?

A

Those with AF over 48 hours, as clot will likely to have formed and this can cause a stroke.

Need anticoagulant first.

Generally older people over 65 have rate control. Eg BB or CCB

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15
Q

What does CHA2DS2VAS stand for?

A 
Congestive heart failure
Hypertension 
Age >75 (2)
Age 65-74 (1)
Diabetes
Stroke or TIA (2)
Vascular disease (IHD, PAD) 
Sex (female)
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16
Q

What is bifascicular block on ECG??

A

Combination of RBBB with left anterior or posterior hemiblock. (Left access deviation)

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17
Q

What is trifascicular block on ECG??

A

RBBB, LAD and 1st degree heart block

18
Q

What’s a stokes-Adams attack?

A

Complete heart block (wide QRS) with dizziness and blackouts

Rx permanent pacemaker

19
Q

Causes of right BBB

A

Infarct (inf MI)
Normal variant
Congential (vSD, fallots, ASD)
Hypertrophy (RVH. -PE,Cor pulmonale)

20
Q

Causes of LBBB

A

Infarct inf MI
Coronary heart disease
Fibrosis
LVH - AS, HTN

21
Q

What is the intial shock energy (J) in biphasic defibrillation for broad complex tachycardia?

22
Q

What is the intial shock energy (J) in biphasic defibrillation for narrow complex tachycardia?

23
Q

What is the intial shock energy (J) in biphasic defibrillation for atrial fibrillation?

24
Q

What is the intial shock energy (J) in biphasic defibrillation for ventricular arrthymias?

25
Q

Which patients With AF would you favour rhythm control over rate control?

A

Coexistent heart failure
First onset of AF
Obvious reversible causes

26
Q

Management of paroxysmal AF?

A

Pill in the pocket - oral flecanide or propafenone or sotalol

And anticoagulate

27
Q

Treatment options for persistent AF with heart failure?

A

Carvedilol and or digoxin

These improve LV function
Do not use non- dihydropyridine CCB (negatively inotropic effects)

28
Q

How to differentiate between VT and SVT with BBB?

A

VT is more likely if:

  • hx of IHD
  • qrs >140
  • AV dissociation
  • RS >100
  • capture complexs (intermittent normal QRS)
  • concordance of QRS direction in v1-v6 (all positive or all negative)
  • monophasic (triphasic in SVT)
  • q wave in lead V6 (deep S wave in V6)
  • LAD
29
Q

Causes of VT?

A

IM QVICK

Infarction 
Myocarditis
QT interval long 
Valve abnormally - mitral prolapse, AS
Iatrogenic - digoxin, anti arrthymics, 
Cardiomyopathy (dilated)
K⬇️, mg ⬇️, o2 ⬇️, acidosis
30
Q

What’s the most common post MI arrthymia?

A

Ventricular extrasystoles (ectopics)

If frequent - consider amiodarone

31
Q

Pacemarker codes?

A

3 letters at least

1) chamber paced (A,V, D-dual)
2) chamber sensed (A, V, D, O- none)
3) pacemarker response (triggered, inhibited, dual, reverse
4) programmable or multiprogrammable
5) p- pace, s-shocks, d- pace and shocks, o-none

32
Q

Which are the most common pacemarkers used?

33
Q

What’s cardiac resynchronisation therapy?

A

For people with heart failure
- paces biventricular +/- atrial lead
May be combined with a defibrillator

34
Q

Which features with bradycardia indicate the need for treatment?

A

Shock - hypotension, pallor, sweating, cold, clammy.
Syncope
MI
Heart failure

Rx- atropine IV

35
Q

What features indicate the need for transvenous pacing with bradycardia?

A

Potential for asytole

  • complete heart block with broad QRS
  • recent asytole
  • Mobitz 2
  • ventricular pause >3 seconds

If delay in transvenous: use atropine, transcutaneous pacing, adrenaline infusion

36
Q

Investigation for arrthymias??

A

12 lead ECG
TFT
u&E (k+)
FBC

Normal?
Do holter monitoring

Holter normal?
External loop recorder
Implantable loop recorder

37
Q

Management for long QT?

A

Avoid drugs/precipitants
Beta blockers
If QT > 500 or cardiac arrests then ICD

38
Q

Post stroke and AF what is the antiplatlet/anticoagulation guidelines?

A

300mg aspirin for 2 weeks, then life long anti-coagulation (warfarin or DOAC)

39
Q

Treatment for WPW?

A

Radioablatin

Meds: sotalol, amiodarone, flecanide

40
Q

Top three intrinsic causes of AF

A

HTN, CAD, VDH

41
Q

Top 3 extrinsic causes of AF

A 
Thyrotoxicosis
Acute infection (eg rheumatic heart disease)
Drug and alcohol intoxication

Cardiology (16 decks)

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