Arrythmias

Question 1

Arrhythmias are described in terms of

Answer 1

rate and site of origin

Question 2

Rate

Answer 2

Bradycardias

Tachycardias

Question 3

Site of origin

Answer 3

Supraventricular

Ventricular

Question 4

alterations in impulse formation involve

Answer 4

Changes in automaticity

Triggered activity

Question 5

abnormalities in impulse conduction arise from

Answer 5

Re-entry
Conduction block
Accessory tracts

Question 6

Partial conduction block

Answer 6

Slowed conduction

Tissue conducts all impulses, but more slowly than usual

Question 7

First degree block

Answer 7

longer PR interval

Question 8

Intermittent block

Answer 8

Tissue conducts some impulses but not others

Question 9

2 types of 2nd degree heart block

Answer 9

Mobitz Type 1

Mobitz Type 2

Question 10

Mobitz Type 1

Answer 10

PR interval gradually increases from cycle to cycle until AV node fails completely and a ventricular beat is missed

Question 11

Mobitz Type 2

Answer 11

PR interval is constant but every nth ventricular depolarisation is missing
Missing R waves

Question 12

Complete heart block

Answer 12

No impulses conducted through affected area

Question 13

Accessory pathway

Answer 13

Electrical pathway parallel to AV node

Question 14

Bundle of Kent

Answer 14

Impulse through bundle of Kent is quicker than through AV node
Ventricles receive impulses from both normal and accessory pathways

Question 15

Ventricular arrhythmias occur

Answer 15

Origin is ventricle

Question 16

Supraventricular arrhythmias occur

Answer 16

Origin is above ventricle

(SA node, atria, AV node,

Question 17

Ectopic beats

Answer 17

Beats originating in places other than SA node

Question 18

A normal action potential may trigger abnormal oscillations in membrane potential called

Answer 18

afterdepolarisations

Question 19

Repeated afterdepolaristaions can cause

Answer 19

an arrhythmia

Question 20

Early afterdepolarisation

Answer 20

Occur when heart rate is slow

Can lead to Torsades de Pointes

Question 21

Delayed afterdepolarisation

Answer 21

Occur when heart rate is fast

Triggered by drugs increasing Ca++ influx

Question 22

1st degree heart block story

Answer 22

Wife (P) waits at home

Husband (QRS) comes home late every night but at the same time

Question 23

2nd degree heart block Type 1 story

Answer 23

Wife (P) waits at home

Husband (QRS) comes home later and later every night until one day he doesn’t come home at all

Question 24

2nd degree heart block Type 2 story

Answer 24

Wife (P) waits at home

Husband (QRS) sometimes comes home, sometimes doesn’t

Question 25

Complete heart block story

Answer 25

Wife (P) no longer waits at home She and husband (QRS) are on separate schedules and have no relationship Requires 'counselling' from a permanent pacer

Question 26

Rhythm control classes

Answer 26

I and III

Question 27

Rate control classes

Answer 27

II and IV

Question 28

Class I

Answer 28

Reduce Na channel current

Question 29

Class II

Answer 29

B-adrenergic antagoinsts

Question 30

Class III

Answer 30

Action potential prolongation

Question 31

Class IV

Answer 31

Ca channel antagonists

Question 32

Supraventricular Tachycardias

Answer 32

Atrial Fibrillation Atrial Flutter Ectopic atrial tachycardia

Question 33

Supraventricular Bradycardia

Answer 33

Sinus bradycardia | Sinus pauses

Question 34

Ventricular arrhythmias

Answer 34

Ventricular ectopics Ventricular tachycardia Ventricular fibrillation Asystole

Question 35

AVN node arrhythmias

Answer 35

AVN re-entry tachycardia AV reciprocating tachycardia AV block

Question 36

Re-entry

Answer 36

Requires more than one conduction pathway with different speed of conduction

Question 37

Symptoms of Arrhythmias

Answer 37

``` Palpitations SOB Dizziness Syncope Presyncope Sudden cardiac death Angina ```

Question 38

Investigations of arrhythmias

Answer 38

ECG CXR Echo Stress ECG, 24 hour ECG

Question 39

Sinus Bradycardia

Answer 39

< 60 bpm Athlete Drugs (B blocker)

Question 40

Treatment for sinus bradycardia

Answer 40

Atropine | Pacing

Question 41

Sinus tachycardia

Answer 41

> 100 bpm Anxiety, fever, hypotension Illegal drugs

Question 42

Treatment of sinus tachycardia

Answer 42

Treat underlying cause | B blockers

Question 43

Atrial ectopic beats

Answer 43

Asymptomatic or palpitations No treatment Avoid stimulants

Question 44

SVT management

Answer 44

``` Acute = IV adenosine, IV veramapril Chronic = B blockers, anti-arrhythmics ```

Question 45

Causes of AVN conduction disease (heart block)

Answer 45

``` Age MI Myocarditis Drugs Genetic ```

Question 46

Treatment for 1st degree heart block

Answer 46

none

Question 47

Types of pacemaker

Answer 47

Single chamber or dual chamber (replaces RA and RV)

Question 48

Ventricular fibrillation

Answer 48

chaotic ventricular electrical activity causing heart to loose ability to function as a pump

Question 49

Treatment of V fib

Answer 49

Defibrillation | Cardiopulmonary resuscitation

Question 50

Atrial Fibrillation

Answer 50

Chaotic and disorganised atrial activity Irregular heartbeat Can be paroxysmal, persistant or chronic

Question 51

AF termination

Answer 51

Anti-arrhythmic drugs DCCV Spontaneous reversion to sinus rhythm

Question 52

Paroxysmal AF

Answer 52

Less that 48 hours

Question 53

Persistant

Answer 53

More than 48 hours | Reacts to drugs

Question 54

Chronic

Answer 54

Inability of pharmacological methods to restore

Question 55

A fib symptoms

Answer 55

``` Palpitations Presyncope Syncope Chest pain Dyspnea Sweatiness Fatigue ```

Question 56

ECG of AF

Answer 56

Irregularly irregular | Absence of P waves

Question 57

Management of AF

Answer 57

Rhythm control Rate control Anti-coagulation

Question 58

Rate control drugs

Answer 58

Digoxin B blockers Veramapril

Question 59

Rhythm control drugs

Answer 59

DCCV

Question 60

Atrial flutter

Answer 60

Rapid and regular form of atrial tachycardia Paroxysmal Seconds to years

Question 61

Atrial flutter ECG

Answer 61

Saw tooth

Question 62

Atrial flutter treatment

Answer 62

Pharmacological Cardioversion Warfarin