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Finals: Medicine > Bradyarrhythmia’s > Flashcards

Bradyarrhythmia’s Flashcards

1
Q

Define Bradyarrhythmia’s

A

Bradyarrhythmia refers to an abnormally slow heart rate (<60 bpm)

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2
Q

What is the cut off bpm for bradycardia

A

< 60 bpm

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3
Q

Bradyarrhythmia’s can be divided into two major categories.

Names these categories

A

Those affecting the Sino-atrial node (SAN)

Those affecting the atrioventricular node (AVN)

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4
Q

Name 4 examples of bradycardia that is a result of sino-atrial node involvement

A
  • Sinus bradycardia
  • Sinus pause/arrest
  • Sinus node dysfunction
  • Sinus node exit block
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5
Q

Name an example of bradycardia that is a result of atroventricular node involvement

A

Heart block (1st degree, 2nd degree (Mobitz type I and II) and 3rd degree or complete heart block)

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6
Q

Name the hallmark ECG features of sinus bradycardia

A

Sinus rhythm with a heart rate < 60 bpm

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7
Q

What is the aetiology associated with sinus bradycardia

A
  • May be normal in young, fit, and healthy individuals
  • May be suggestive of underlying SAN disease
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8
Q

This ECG strip shows what kind of bradycardia

A

Sinus bradycardia

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9
Q

Define the term “heart block”

A

Refers to the partial or complete interference of the normal conduction through the AV node, affecting the impulse transmission from the atrial to the ventricles

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10
Q

Heart block interference of the normal conduction through which node?

A

Aterioventricular node (AVN)

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11
Q

Heart block can be subdivided into 3 categories.

Name them?

A
  • First degree block
  • Second degree block
    • Mobitz type I (Wenckebach)
    • Mobitz type II
  • Third degree block
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12
Q

Describe what is going on in the heart to cause first degree heart block

A

Caused by a delay in conduction from the SA node to the ventricle

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13
Q

What are the hallmark ECG features of first degree heart block

A

Prolonged PR interval (> 200ms)

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14
Q

This ECG strip shows what kind of bradycardia

A

1st degree heart block

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15
Q

Describe what is going on in the heart to cause second degree heart block

A

Caused by the intermittent failure of the AV node to conduct between atria and ventricles

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16
Q

What are the hallmark ECG features of second degree heart block

A

“Dropped beat” i.e. not every P wave has a QRS complex following it

17
Q

This ECG strip shows what kind of bradycardia

A

2nd degree heart block

18
Q

If I said the second heart block is 2:1 block what am I commenting on in the ECG

A

Two P waves occur for every QRS complex

19
Q

Second degree heart block can be subdivided into two types.

Name these two types

A

Mobitz type I (Wenckebach)

Mobitz type II

20
Q

Wenckebach second degree heart block is also known as:

a) Mobitz type I
b) Mobitz type II

A

a) Mobitz type I

21
Q

What are the hallmark ECG features of Mobitz type I?

A

Characterised by the gradual prolongation of PR intervals before a block, so called ‘dropped beat’, occurs.

22
Q

What are the hallmark ECG features of Mobitz type II?

A

The block appears random – no pattern

There will constant PR intervals and then randomly a block occurs.

No prolong progressive PR interval.

23
Q

This ECG strip shows what kind of bradycardia

A

Mobitz type I, a second degree heart block

24
Q

This ECG strip shows what kind of bradycardia

A

Mobitz type II, a type of second degree heart block

25
Q

complete AV block refers to what kind of heart block:

a) 1st degree
b) 2nd degree
c) 3rd degree

A

c) 3rd degree

26
Q

Describe what is going on in the heart to cause 3rd degree heart block

A

Caused by a complete failure to conduct atrial impulses to the ventricles

27
Q

What are the hallmark ECG features of 3rd degree heart block

A
  • Complete dissociation between P waves and QRS complexes
  • QRS complex are broad (>120 ms) as the ventricles are being conducted by a slow ventricular rhythm
  • P waves are normal because the atria are conducting normally
28
Q

This ECG strip shows what kind of bradycardia

A

3rd degree heart block

29
Q

Name some of the clinical features of bradyarrhythmia

A
  • Fatigue, lethargy
  • Pre-syncope: dizziness
  • Syncope: transient loss of consciousness
  • Dyspnoea: may suggest pulmonary oedema
  • Chest pain: may suggest myocardial ischaemia
  • Shock: low BP (< 90 mmHg), pallor, sweating, cold
  • Impaired consciousness
30
Q

Name some of the clinical features suggestive of unstable bradycardia

A
  • Syncope
  • Myocardial ischaemia (chest pain)
  • Heart failure (breathlessness)
  • Shock (BP < 90 mmHg
31
Q

Presentation of bradycardia ranges from asymptomatic to shock.

What is the nature of the clinical features?

A

Features may be permanent or occur intermittently due to the paroxysmal nature of the arrhythmia

32
Q

Name the first line pharmacological therapy for the acute management of bradycardia’s?

A

IV bolus of Atropine 500mcg

33
Q

If patient has not improved after the admission of IV Atropine 500mcg, what should be given?

A

Atropine 500mcg IV repeated (up to 6 doses for a total to 3mg)

Other inotropes (such as noradrenalin)

Transcutaneous cardiac pacing (using a defibrillator)

34
Q

How many doses of atropine could be given to manage bradycardia’s?

A

Up to 6 doses can be given

Total: 3mg

35
Q

Atropine is what kind of drug

A

Antimuscarinic medication

36
Q

Describe the mechanism of action of atropine

A
  • Reversible antagonist of muscarinic acetylcholine receptors blocking the action of the vagus nerve on the SAN and AVN (i.e. inhibits the parasympathetic nervous system)
  • The effect is to increase the SAN electrical activity and increased conduction through the AVN
37
Q

Name some of the adverse effects of atropine

A

Pupil dilatation

Urinary retention

Dry eyes

Constipation

38
Q

What is the definitive management for bradycardia’s

A
  • Medications usually act as a bridge to more definitive pacing or while the underlying cause of bradycardia is treated
  • Pacing (temporary or permanent) delivers electrical stimuli to the heart via pacing leads
  • Permanent pacing via pacemaker

Finals: Medicine (91 decks)

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