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Junior Medicine- Cardiology > Arrythmias > Flashcards

Arrythmias Flashcards

1
Q

What is an arrhythmia?

A

An abnormality in the rate and/or rhythm of the heart

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2
Q

Name the groups of arrhythmia?

A
  • Cardiac arrest rhythms
  • Narrow complex tachy rhythms (AF, A flutter, SVT)
  • Broad complex tachy rhythms (VT, SVT with bundle branch block)
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3
Q

Name the cardiac arrest rhythms and whether or not they’re shockable.

A

Shockable

  • VT
  • VF

Not Shockable

  • PEA
  • Asystole
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4
Q

How is a tachycardic rhythm treated if the Pt is unstable?

A
  • Up to 3 synchronised shocks

- Consider amiodarone infusion

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5
Q

How is a stable patient treated with tachycardic rhythm?

A
  • AF- Beta-blocker (or diltiazem CCB)
  • Flutter- Beta-blocker
  • SVT- Vagal manoeuvre e.g. valsalva and adenosine
  • VT- amiodarone infusion
  • SVT bundle branch block- vagal manoeuvre and adenosine
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6
Q

What causes atrial flutter?

A

Re-entrant rhythm

- self-perpetuating loop due to an extra pathway

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7
Q

What is the atrial and ventricular rate in a flutter?

A

Atrial = 300BPM

Ventricular = 150BPM

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8
Q

What does an ECG show in flutter?

A
  • Saw tooth appearance (P wave followed by P wave)
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9
Q

Which conditions are associated with flutter?

A
  • HTN
  • Ischaemic heart disease
  • Cardiomyopathy
  • Thyrotoxicosis
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10
Q

How is flutter treated?

A
  • Rate control (beta-blocker) or cardioversion
  • Radiofrequency ablation of the re-entrant rhythm
  • Anticoag (CHA2DS2VASc)
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11
Q

What is an SVT?

A
  • Electrical signal re-enters the atria from the ventricle
  • Travels back through the AV node into the ventricle again, causing a second contraction from the same impulse
  • Self-perpetuating loop (AVN-Vent-AVN-Vent…)
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12
Q

What does an ECG show in SVT?

A
  • QRS, T wave, QRS, T wave…
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13
Q

What are the three types of SVT?

A
  • Atrioventricular nodal re-entrant tachy (impulse goes back through the AVN)
  • Atrioventricular re-entry tachy (accessory pathway e.g. Wolff-Parkinson-White)
  • Atrial tachy (ectopics)
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14
Q

How are SVTs acutely managed in a stable patient?

A
  • Continuous ECG
  • Valsalva manoeuvre
  • Carotid sinus massage
  • Adenosine or Verapamil
  • DC cardioversion if all else fails
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15
Q

How does adenosine work?

A

Slows conduction at the AVN, resetting sinus rhythm, causes brief asystole/bradycardia before it is quickly metabolised

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16
Q

When is adenosine CI?

A
  • Asthma
  • COPD
  • HF
  • Severe hypotension
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17
Q

What dosing of adenosine is used IV?

A

6mg, then 12mg, then 12mg if no improvement

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18
Q

What is the long-term treatment of SVT?

A

Medication
- Beta-blocker/CCB/amiodarone

Radiofrequency ablation

19
Q

What is the cause of Wolff-Parkinson-White?

A

Accessory pathway- the Bundle of Kent

20
Q

How is WPW treated definitively?

A

Radiofrequency ablation of the Bundle of Kent

21
Q

What ECG changes are seen in WPW?

A
  • Short PR (<0.12s)
  • Delta wave (rising up into QRS)
  • Wide QRS (0.12s+)
22
Q

What is Radiofrequency Ablation?

A

1- Catheter in the femoral vein, fed on a wire through to the heart under XR guidance
2- In the heart, it is placed against different parts to test for electrical signals
3- Once an accessory is found, the ablation (heat) is applied to burn the area, and the scar tissue cannot conduct

23
Q

What is Torsades de Pointes?

A

Polymorphic VT- ‘twisting of the tips’

  • QRSs get smaller and smaller, then big and smaller and smaller…
  • Seen in long QT
24
Q

What causes Torsades de Pointes?

A

Long QT- prolonged repolarisation

- High risk of early afterdepolarisation

25
Q

What can Torsades de Pointes lead to?

A
  • Either spontaneously return to sinus

- Or cause VT, cardiac arrest and sudden death

26
Q

What can cause a long QT?

A
  • Long QT syndrome (inherited)
  • Medication- citalopram, flecainide, sotalol, amiodarone, macrolide ABx e.g. clarythromycin
  • Electrolytes- hypokalaemia, hypomagnesaemia, hypocalcaemia
27
Q

How is Torsades de Pointes treated?

A
  • Treat cause e.g. electrolytes/medication
  • Magnesium infusion even if normal Mg
  • Defibrillate if VT
28
Q

How is prolonged QT managed long-term?

A
  • Avoid medications that prolong QT
  • Correct electrolytes
  • Beta-blockers (but not sotalol)
  • Pacemaker or implantable defib
29
Q

What are ventricular ectopics?

A
  • Premature ventricular beats
  • Present as random, brief palpatations
  • Common at all ages, even if healthy, but more so in pre-existing heart conditions
30
Q

What is bigeminy?

A

Ventricular ectopics so frequently that they occur after every sinus beat
ECG: P, QRS, QRS, P, QRS, QRS, P…

31
Q

How are ventricular ectopics managed?

A
  • Check for anaemia, electrolytes, thyroid function
  • Reassure if patient is healthy
  • Refer if FHx of sudden death, background of heart disease etc.
32
Q

What are the types of AVN heart block?

A
  • First degree
  • Second degree (Mobitz Type 1/Wenckebach’s and Mobitz Type 2)
  • 2:1
  • Third degree
33
Q

What is first degree heart block?

A
  • Every impulse gets through AVN but is delayed, no QRS dropped

ECG: over 0.2s PR

34
Q

What is M Type 1/ Wenckebach’s?

A
  • Impulses gradually weaken before one isn’t conducted through the AVN

ECG: Progressively long PR, QRS drops, then restarts

35
Q

What is M Type 2?

A
  • Intermittent failure of the AVN to conduct

ECG: prolonged PR, consistent, then a random QRS drops

36
Q

What is Third degree block?

A
  • Complete AVN block

- Ventricular escape rhythm

37
Q

What is 2:1 block?

A
  • Every other impulse doesn’t get through

ECG: P, QRS, P, P, QRS (every other QRS dropped)

38
Q

Which heart block has an asystole risk?

A
  • Third Degree (highest)

- Mobitz Type 2 (moderate)

39
Q

How are Types 1, Wenckebach’s and 2:1 treated if stable?

A

Observation

40
Q

How are unstable patients or asystole risk (M Type 2, Third degree) treated?

A

Atropine 500mcg IV

No improvement- repeat up to 6 doses/3mg
Then, use another inotrope e.g. noradrenaline

41
Q

How might an asystole risk be treated long-term?

A

Pacemaker

42
Q

How long do pacemaker batteries last?

A

5 years

43
Q

What can’t you do with a pacemaker?

A
  • MRIs may be CI (newer ones are compatible)

- Diathermy and TENS in surgery

44
Q

How can you tell what type of pacemaker is in place on an ECG?

*Important for exams

A

Single chamber (RA or RV only)- Vertical black line before the P wave or QRS

Dual chamber (RA and RV have leads)- Vertical black lines before both P and QRS

Junior Medicine- Cardiology (15 decks)

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