Brady and Tachy

Question 1

Mx of bradycardia

Answer 1

Asymptomatic or HR >40 : No rx

Symptomatic or HR < 40 : atropine

Question 2

Sick sinus syndrome definition

Answer 2

Sinus node dysfunction

Question 3

Presentations of sick sinus syndrome

Answer 3

Bradycardia +/- arrest

Sinoatrial block

SVT alternating with bradycardia

Question 4

Mx of sick sinus syndrome

Answer 4

Pace if symptomatic

Question 5

Indications to shock pt with arrhythmia

Answer 5

BP < 90

Chest pain

Signs of heart failure

Reduced GCS

Question 6

Mx of AF / atrial flutter

Answer 6

Shock if indicated

Rate / Rhythm control

Anticoagulation

Question 7

When to us Rhythm control rather than Rate control for AF

Answer 7

Atrial structure normal

Question 8

Rate control medication

Answer 8

Beta blocker / verapamil or diltiazem
Digoxin
Amiodarone

Question 9

Rhythm control medication

Answer 9

Amiodarone
Flecanide

Question 10

How to determine to give anticoagulation for AF

Answer 10

CHADS2 VASc

HAS-BLED

Question 11

Use of CHADS2 VASc

Answer 11

Risk of clots

Question 12

Use of AA HAS-BLED

Answer 12

Risk of bleeding

Question 13

Components of CHADS2 VASc

Answer 13

CCF

HTN

Age > 75

DM

Stroke (2 points)

Vascular disease

Age > 65

Sex category (female)

Question 14

Interpretation of CHADS2 VASc

Answer 14

0 - no rx

1 - consider anti-platelet / anti-coagulation

2 - should be on anti-coagulation

Question 15

Components of AA HAS-BLED

Answer 15

Abnormal liver funcion

Abnormal renal funtion

HTN

Alcohol

Stroke

Bleeding

Labile INR

Elderly > 65

Drugs

Question 16

Interpretation of AA HAS-BLED

Answer 16

1 - Low risk

2 - medium risk (can use anti-coag if needed)

3 - high risk (look for alternatives to anti-coag)

Question 17

SVT ECG changes

Answer 17

Narrow complex

Regular tachy

No p waves

Question 18

Acute mx of SVT

Answer 18

Vagal manoeuvres

IV adenosine or verapamil

Shock

Question 19

CI to verapamil use in acute SVT

Answer 19

If pt already on beta blocker

Question 20

CI to adenosine

Answer 20

Asthma

Question 21

Maintenance Rx for SVT

Answer 21

Beta blocker or verapamil

Question 22

Examples of vagal manoeuvres

Answer 22

Breath holding

Valsalva manoeuvre

Carotid massage

Question 23

VT ECG changes

Answer 23

Broad complex

Regular tachy

Question 24

Types of VT

Answer 24

Pulseless VT

Pulsed VT

Question 25

Mx of pulseless VT

Answer 25

Shock

Question 26

Mx of pulsed VT

Answer 26

Amiodarone

Question 27

Prophylaxis of VT

Answer 27

Sotalol Amiodarone

Question 28

VF ECG changes

Answer 28

Broad complex Irregular tachy

Question 29

Mx VF

Answer 29

Shock

Question 30

Types of heart block

Answer 30

Type 1 Type 2 : Mobitz 1, Mobitz 2 Type 3

Question 31

Type 1 heart block ECG changes

Answer 31

Long PR

Question 32

Type 2 Mobitz 1 Heart block ECG changes

Answer 32

Gradually increasing PR until drop beat

Question 33

Type 2 Mobitz 2 Heart block ECG changes

Answer 33

Beats dropped every set number of beats

Question 34

Type 3 Heart block ECG changes

Answer 34

No relationship between P waves and QRS

Question 35

Mx of Type 1 heart block

Answer 35

No Rx

Question 36

Mx of Type 2 Mobitz 1 heart block

Answer 36

No Rx Atropine if symptomatic

Question 37

Mx of Type 2 Mobitz 2 heart block

Answer 37

Atropine Pacing

Question 38

Mx of Type 3 heart block

Answer 38

Permanent pacemaker

Question 39

Causes of AF

Answer 39

IHD Rheumatic heart disease Thyrotoxicosis HTN

Question 40

Sx of AF?

Answer 40

Asymptomatic but also - chest pain/ palpitations - SOB - Fainting

Question 41

Sign of AF?

Answer 41

- Irregularly irregular pulse - signs of LVF

Question 42

4 types of AF?

Answer 42

Acute Paroxysmal Persistant Permanent

Question 43

Acute AF definition

Answer 43

\< 48 hrs

Question 44

Paroxysmal AF definition

Answer 44

\< 7 days May recur

Question 45

Persistant AF definition

Answer 45

\> 7 days

Question 46

Permanent AF definition

Answer 46

\> 1 yr

Question 47

Acute AF mx?

Answer 47

Emergency cardioversion if indicated Control ventricular rate Start LMWH

Question 48

Paroxysmal AF mx?

Answer 48

- Anticoagulate (chadsvasc) - PRN: flecainide, propafenone

Question 49

Prevention of AF

Answer 49

B blocker or Sotalol or Amiodarone

Question 50

Antiarrhythmics for persistent AF

Answer 50

- Not needed if successfully treated precipitant - 1st line: beta blockers - 2nd line: amiodarone

Question 51

Aim of rate for persistent AF rate control

Answer 51

\< 90 bpm at rest

Question 52

Rate control for persistent AF?

Answer 52

1st: b-blocker or CCB (not both) 2nd: add digoxin 3rd: consider amiodarone

Question 53

Mx of permanent AF?

Answer 53

Rate control

Question 54

Mx of persistent AF?

Answer 54

Rate control + antiarrhythmics