Arrythmias: Pathophysiology, Presentation + Investigation Flashcards
How can an arrhythmia present?
- Asymptomatic
- Palpitations
- Dyspnoea
- Chest pain
- Fatigue
- Embolism
How are arrhythmias investigated?
- Document arrhythmia on 12 lead ECG, 24 hr recording/ event recorder
- Blood tests including thyroid function
- ECHO
What are the therapeutic approaches?
- Rate control vs rhythm control
- Consider anticoagulation
How is supraventricular tachycardia described?
AV node re-entrant tachycardia
How does SVT present?
- Palpitations
- Dyspnoea
- Dizziness
What is the prognosis for SVT?
-Good
What is the treatment for SVT?
- Drugs
- RFA
What can SVT be due to?
Accessory pathway- WPW if overt
What is the treatment for atrial flutter?
- Control ventricular rate and thromboembolic risk
- Usually cardiovert
- Prevent with AA drugs or RFA of cavotricuspid isthmus
What protocol should be followed for ventricular fibrillation?
Cardiac arrest protocol
What does ventricular tachycardia present with?
- Palpitations
- Chest pain
- Dyspnoea
- Dizziness
- Syncope
What is VT usually due to?
Structural heart disease
What investigations should be carried out for VT?
- Bloods
- ECHO
- Angio
- etc
How is VT treated?
- Cardiac arrest protocol
- DC cardioversion
- Drugs
How is VT prevented?
- Treatment of underlying cause
- AA drugs and/or ICD
What causes long QT syndrome?
Congenital or acquired
What can LQT syndrome cause?
TdP
What is the treatment for LQT syndrome?
- Drugs
- Pacing
- ICD
What are the indications for ICD therapy as secondary prevention?
- Cardiac arrest due to VF/VT not due to transient or reversible cause (early phase of acute MI)
- Sustained VT causing syncope or significant compromise
- Sustained VT with poor LV function
What are the indications for temporary pacing?
- Intermittent or sustained symptomatic bradycardia particularly syncope
- Prophylactic when patient at high risk for development of severe bradycardia
What are the indications for permanent pacing?
- Symptomatic or profound 2nd/3rd degree AV block particularly when cause is unlikely to disappear
- Probably Mobitz type II 2nd/3rd degree AV block even if asymptomatic
- AV block associated with neuromuscular diseases
- After AV node ablation
- Alternating RBBB/LBBB
- Syncope when bifascicular/trifascicular and no other explanation
- Sinus node disease associated with symptoms
- Carotid sinus hypersensitivity/malignant vasovagal syncope
