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Cardiovascular Diseases > Arrythmias > Flashcards

Arrythmias Flashcards

1
Q

What are the 5 main clinical causes of arrythmias?

A

I DAMAG(E)

  • Inflammation (viral myocarditis
  • Drugs (direct or indirect)
  • Abnormal anatomy (LVH, acc. pathways)
  • Metabolic (hypoxia, ischaemia, electrolyte)
  • Autonomic nervous system
  • Genetic (ion channel genes)
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2
Q

What are ectopic beats?

A

Beats or rhythms that originate in places outwith the SA node

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3
Q

What is Wolf Parkinson White syndrome?

A
  • Accessory pathway tachycardia
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4
Q

What is triggered activity?

A
  • In the terminal phase of the AP (phase 3) a small depolarisation may occur and if of sufficient magnitude can lead to a sustained train of depolarisations (TA)
  • This mechanism underlies digoxin toxicity, TdP in the long QT syndrome and hypokalaemia
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5
Q

What what two factors can cause rentry?

A
  • —Structural abnormalities: accessory pathways, scar from myocardial infarction, congenital heart disease
  • —Functional: Conditions that depress conduction velocity or shorten refractory period promote functional block, e.g. ischaemia, drugs
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6
Q

What are the main symptoms of an arrhythmia?

A
  • Palpitations
  • Dyspnoea
  • Dizziness
  • Presyncope/Syncope
  • Sudden cardaic death
  • Angina
  • Heart failure
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7
Q
A
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8
Q

Why would you use a 12 lead ECG when dealing with arrythmias?

A
  • To assess rhythm
  • Signs of previous MIs (Q waves) or pre-excitation (Wolf Parkinson White syndrome)
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9
Q

What does pre excitation look like on an ECG?

A
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10
Q

Why would you do an exercise ECG for a suspected arrhythmia?

A
  • To assess for ischaemia
  • Test for exercise induced arrhythmia
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11
Q

When would you use a 24hr Holter ECG when testing for arrhythmia?

A
  • To assess for paroxysmal arrhythmia
  • To like symptoms to underlying heart rhythm
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12
Q

Why would you use an echo with suspected arrhythmia?

A

To assess for structural diseases e.g.

  • enlarged atria in AF
  • LV dilatation
  • previous MI scar, aneurysm
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13
Q

What is an electrophysiological study?

A
  • Trigger the clinical arrhythmia and study its mechanism/pathway
  • Opportunity to treat arrhythmia by delivering radiofrequency ablation to extra pathway
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14
Q

What is Normal Sinus Arrhythmia?

A
  • Variation in heart rate, due to reflex changes in vagal tone during the respiratory cycle
  • Inspiration reduces vagal tone and increases HR
  • Physiological (normally seen in young, healthy people)
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15
Q

What is sinus bradycardia and what can cause it?

A
  • <60 bpm
  • physiological (i.e. athlete)
  • drugs (ß blocker)
  • ischaemia: common in inferior STEMIs
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16
Q

What is the treatment of sinus bradycardia?

A
  • atropine (if acute, e.g. acute MI)
  • pacing if haemodynamic compromise
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17
Q

What is and what causes sinus tachycardia?

A
  • >100 bpm
  • physiological (anxiety, fever, hypotension, anaemia)
  • inappropriate (drugs etc.)
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18
Q

How do you treat sinus tachycardia?

A
  • Treat underlying cause
  • ß blockers
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19
Q

What are the symptoms and treatment of atrial ectopic beats?

A
  • Asymptomatic
  • Palpitations
  • Generally no treatment
  • ß blockers may help
  • Avoid stimulants e.g. coffee/cigarettes
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20
Q

What are AVNRT, AVRT and EAT

A
  • AVNRT = AV nodal reentrant tachycardia
  • AVRT = AV reentrant tachcardia (via an accessory pathway)
  • EAT = ectopic atrial tachycardia
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21
Q
A
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22
Q

What is orthodomic AVRT? What does it look like on a 12 lead ECG?

A

Antegrade (moving forward) conduction through AV node due to accessory pathway

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23
Q

What is antidromic AVRT? What does it look like on a 12 lead ECG?

A

Retrograde (moving backwards) conduction through AV node

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24
Q

What is the management of acute supraventricular tachycardia?

A
  • Increase vagal tone (valsalva, carotid massage)
  • Slow AVN conduction - IV adenosine or verapamil
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25
Q

What is the management of chronic supraventricular tachycardia?

A
  • —Avoid stimulants
  • Electrophysiologic study and Radiofrequency ablation (first line in young, symptomatic patients
  • Beta blockers
  • Antiarrhythmic drugs
26
Q

What is RFCA?

A
  • Radiofrequency catheter ablation
  • Selective cautery of cardiac tissue to prevent tachycardia, targeting either an automatic focus or part of a re-entry circuit
27
Q

What does the Electrophysiologic Study and RFCA procedure involve?

A
  • ECG catheters to heart via femoral veins
  • Intracardiac ECG recorded during sinus rhythm, tachycardia and during pacing manouvres to locate tachycardia mechanism
  • catheter placed over focus/pathway and tip heated to 55-65oC
28
Q

What is heart block?

A

AVN conduction disease

29
Q

What are some causes of heart block?

A
  • Ageing
  • Acute MI
  • Myocarditis
  • Infiltrative disease (amyloid)
  • Drugs (ß blockers, CCBs)
  • Calcific aortic valce disease
  • Post-aortic valve surgery
  • Genetic: Lenegre’s disease, myotonic dystrophy
30
Q

What defines 1st degree heart block, what is the treatment and what is the follow up?

A
  • PR interval longer than normal (>0.2s)
  • Treatment: none
  • Long term follow up reccomended as advanced block may develop over time
31
Q

What is Mobitz 1 second degree heart block? What does it look like on an ECG?

A

Mobitz I

  • progressive lengthening of the PR interval, eventually resulting in a dropped beat
  • usually vagal in origin
32
Q

What is 3rd degree heart block? What is the treatment of it and what does it look like on a 12 lead ECG?

A
  • Where no APs from the SA node/atria get through the AV node
  • Ventricular pacing = treatment
33
Q

What is Mobitz 2 second degree heart block? What is its treatment and what does it look like on an ECG?

A
  • —Pathological, may progress to complete heart block (3rd degree HB)
  • Usually 2:1, or 3:1, but may be variable
  • Permanent pacemaker indicated
34
Q

What are the types of pacemakers?

A
  • Single chamber (paces the RA or RV only)
  • Dual chamber (paces both RA and RV) - maintains AV syncrony (preseves atrial kick), used for AVN disease
35
Q

What are some causes of ventricular ectopics?

A
  • Structural causes: LVH, heart failure, myocarditis
  • Metabolic: Ischaemic heart disease, electrolytes
  • May be a marker for inherited cardaic conditions
36
Q

When do you need to further investigate ventricular ectopics and what can be done to treat it?

A
  • Further investigation if worse on exercise
  • ß blockers
  • Ablation of focus
37
Q

What is the danger of ventricular tachycardia and what are the causes

A
  • Can cause sudden death
  • Most patients have CAD/a precious MI
  • More rare: cardiomyopathy or inherited syndromes such as Long QT or Brugada
38
Q

What are the defining ECG characteristics of VT?

A
  • Rapid, wide, distorted QRS
  • Large, inverted T waves
  • Usually no P waves
39
Q

What is ventricular fibrilation overall?

A
  • Chaotic ventricular electrical activity which causes the heart to lose the ability to function as a pump
40
Q

What is the long term treatment

A
  • Correct ischaemia e.g. revascularisation
  • Optimise congestive heart failure therapies
  • ICD
  • VT catheter ablation
41
Q

What should you treat a wide QRS tachycardia with a history of CAD/HF as?

A

VT until proven otherwise

42
Q

What use are AADs in VTs

A

Reduce symptoms - ineffective on survival

43
Q

What is Atrial Fibrilation?

A
  • —Chaotic and disorganized atrial activity
  • Causes a irregular heartbeat
  • Most common sustained arrythmia
  • Incidence increases with age
44
Q

What are the three types of atrial fibrilation?

A
  • Paroxysmal - lasting <48 hrs, often recurrent
  • Persistent - Episode >48 hrs that can be cardioverted to NSR, unlikely to spontaneously revert to NSR
  • Permanent - no way to restore NSR
45
Q

What are the methods of termination of atrial fibrilation?

A
  • Pharmacologic cardioversion with AADs (30% effective)
  • Electrical cardioversion (90% effective)
  • Spontaneous reversion to sinus rhythm
46
Q

What is lone A Fib?

A
  • —A Fib with absence of any heart disease and no evidence of ventricular dysfunction
  • Could be gnetic
  • Significant stroke rate if >75 yo
47
Q

What are the symptoms of A Fib?

A
  • ——Palpitations
  • Pre-syncope (dizziness), Syncope
  • Chest pain
  • Dyspnoea
  • Sweatiness
  • Fatigue
48
Q

What is the atrial rate, rhythm, ventricular rate and signs of A Fib on an ECG?

A
  • Atrial: >300bpm
  • Rhythm: Irregularly irregular
  • Ventricular rate: variable
  • Signs: no P waves, presence of F
49
Q

What complication can be caused by A Fib?

A
  • Reduced diastole, reduced CO
  • Can lead to congestive heart failure, especially if diastolic dysfunction
50
Q

What is a dangerous ventricular rate in A Fib?

A
  • <60 bpm points to AV conduction disease
  • Caution w AADs
  • May require permanent pacing
51
Q

What are the main aims of atrial fibrilation management?

A
  • Rhythm control - attempt to maintain SR

OR

  • Rate control - accept AF but control V rate
  • Anticoagulation for both if approaches high risk for thromboembolism
52
Q

What four drugs can be used to slow down AVN conduction and treat rate control of A Fib?

A
  • —Digoxin
  • Betablockers
  • Verapamil, diltiazem
  • Alone or in combination
53
Q

What can be dine to restore and maintain NSR in A Fib?

A

Restore

  • Pharmacological (AAM e.g. amiodarone)

Maintain

  • AAMs
  • Catheter ablation of atrial focus / pulmonary veins
  • Surgery (Maze procedure)
54
Q

What is TdP?

A

Torsades de Pointes

  • —Heart rate: 200 - 250 bpm
  • Rhythm: Irregular
  • Recognition:
    • Long QT interval
    • Wide QRS
    • Continuously changing QRS morphology
55
Q

What score can be used to identify likelhood of a stroke?

A

CHA2DS2-VASC

56
Q

If you have A Fib and mitral valve disease what should be done?

A

Anticoagulation

57
Q

What is A Flutter, where does it originate and what can it lead to?

A
  • Rapid and regular form of A tachycardia
  • Usually paroxysmal
  • Sustained by macro-reentrant circuit in RA
  • Can lead to A Fib or result in thrombo embolism
58
Q

What is the defining characteristic of a A Flutter ECG?

A

Sawtooth baseline

59
Q

What are the A Flutter treatment options?

A
  • RF ablation (80-90% long term success
  • AAM - slow ventricular rate, restore and maintain NSR
  • Cardioversion
  • Warfarin to prevent thromboembolism
60
Q

What are shockable and unshockable rhythms?

A
  • Shockable
    • VF
    • Pulseless VT
  • Non-shockable
    • PEA
    • Asystole

Cardiovascular Diseases (9 decks)

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