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Cardiology > Arrythmias > Flashcards

Arrythmias Flashcards

1
Q

What is arrythmia?

A
  • Abnormal heart rhythms due to interrupted electircal signals that coordinate heart contraction
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2
Q

What causes arrythmia?

A
  • Cardiac
    • IHD
    • LA diltation due to MR
    • Cardiomyopathy
    • Pericarditis
    • Myocarditis
    • abberant conduction pathways
  • Non cardiac
    • caffeine, smoking, alcohol
    • medications
    • metabolic disturbances
    • phaechormocytoma
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3
Q

What medications can cause arrythmias?

A
  • B2 agonist
  • digoxin
  • L-DOPA
  • tricyclics
  • doxorubicin (chemotherapy)
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4
Q

What metabolic disorders can cause arrythmia?

A
  • K, Ca, Mg
  • hypoxia
  • hypercapnia
  • metabolic acidosis
  • thyroid disease
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5
Q

What is the presentation of arrythmia?

A
  • palpitations
  • chest pain
  • presyncope/syncope
  • hypotension
  • pulmonary oedema
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6
Q

What are the 4 cardiac arrest rhythms?

A
  • Shockable rhythm
    • ventricular tachycardia
    • ventricular fibrillation
  • Non schokable rhythm
    • pulseless electrical activity
    • asystole
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7
Q

What are the examples of NCT?

A
  • Sinus tachycardia
  • AF
  • Atrial Flutter
  • Supraventricular Tachycardia
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8
Q

What are the examples of SVT?

A
  • AVNRT - reentrant point back through AV node
  • AVRT - reentrant point is accessory pathway
  • Atrial tachycardia - electrical signal originates in atria other than SA node
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9
Q

What is the Px of Atrial Flutter?

A
  1. Normal: If SA node signal fail to reach AV node, automaticity foci in atrium will be triggered

In Atrial Flutter

  1. Irritable automaticity foci - reentrant rythm produced
  2. atria contracts at 300bpm
  3. ventricles contract 150bpm - long refractory period at AV node
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10
Q

What conditions is Atrial Flutter associated with?

A
  • Hypertension
  • Ischaemic heart disease
  • Cardiomyopathy
  • Thyrotoxicosis
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11
Q

How would you tx Atrial flutter?

A
  • Same as AF
  • Beta blocker / cardioversion
  • Radiofrequency ablation
  • Anticoagulation
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12
Q

What is the acute mx of patients c SVT?

A
  • Vasalva manoeuvre
  • Carotid sinus massage
  • Adenosine
  • Direct current cardioversion
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13
Q

How does adenosine work in SVT?

A
  1. Interrupts AV node/Accessory pathway during SVT
  2. Resets back to sinus rhythm
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14
Q

What dose of adenosine would you give for SVT?

Why must adenosine be given in a bolus dose?

A
  • 6mg then 12mg then 12mg
  • Ensures enough dose reaches the heart to interrupt the pathway
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15
Q

What will patients experience with adenosine?

A
  • brief period of asystole/bradycardia - feeling of dying
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16
Q

Which patients would you avoid adenosine in?

A
  • asthma
  • COPD
  • HF
  • HB
  • Severe hypotension
17
Q

What is the long term mx for SVT?

A
  • bb
  • CCB
  • amiodarone
  • radiofrequency ablation
18
Q

What ECG changes will you find in WPWS?

A
  • Short PR interval
  • narrow QRS in orthodromic
  • borad QRS in antidromic
  • d waves
19
Q

What medications are contraindicated in WPWS and why?

A
  • BB
  • CCB
  • Adenosine
  • These medications reduce conduction through AV node > promote conduction through accessory pathway
20
Q

What are the examples of BCT?

A
  • SVT c BBB/aberrancy
  • Antidromic WPWS
  • VT
  • AF c BBB/aberrancy
  • VF
  • Torsades
  • Polymorphic VT
  • Hyperkalaemia
21
Q

What is the Px of Torsades de Pointes?

A
  1. Prolonged QT = prolonged repolarisation of myocytes
  2. Delay repolarisation > spontaneous depolarisations known as afterdepolarisations
  3. These depolarisations spread throughout ventricles
  4. Recurrent ventricular contractions occur
22
Q

What is the prognosis of Torsades?

A
  • Normally self limiting
  • Can progress to VT > cardiac arrest
23
Q

What causes prolonged QT?

A
  • Long QT syndrome
  • Medications
    • antipsychotics
    • citalopram (SSRI)
    • flecanide
    • sotalol
    • amiodarone
    • macrolide
  • Metabolic
    • Hypokalaemia
    • Hypocalcaemia
    • Hypomagnesaemia
24
Q

How would you acutely Mx Torsades?

A
  • Correct cause
  • Mg infusion - if low Mg
  • Defibrillation
25
Q

What is the long term Mx of Torsade?

A
  • Avoid medications that prolong the QT interval
  • Correct electrolyte disturbances
  • Beta blockers (not sotalol)
  • Pacemaker or implantable defibrillator
26
Q

What are ventricular ectopics?

A
  • Premature ventricular beats caused by random electrical discharges from outside the atria
27
Q

What is the Mx for ventricular ectopics?

A
  • Check bloods for anaemia, electrolyte disturbance and thyroid abnormalities
  • Reassurance and no treatment in otherwise healthy people
  • Seek expert advice in patients with background heart conditions or other concerning features or findings (e.g. chest pain, syncope, murmur, family history of sudden death)
28
Q

What causes ventricular premature contractions?

A
  • Stimulants
    • alcohol, caffeine, nicotine
  • Electrolyte imbalance
  • Stress
  • Exercise
  • MI
  • HF
29
Q

Descirbe the basic ECG algorithm

A
  1. Rate
    • Brady: <40
    • Tachy: >120
  2. Rhythm
  3. Axis
  4. Intervals
    • PR (120-200ms)
      • short and delta waves > WPWS
    • QRS (120ms)
      • Tall > LVH
    • QTc (400-440ms)
  5. ST/T wave changes

Cardiology (15 decks)

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