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Cardiovascular 2018 > Cardiac Arrhythmia 2 > Flashcards

Cardiac Arrhythmia 2 Flashcards

1
Q

What is the atrial activity described as in atrial fibrillation?

A

Chaotic and disorganised

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2
Q

What is the heartbeat like in atrial fibrillation?

A

Irregularly irregular

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3
Q

What are the three variations of atrial fibrillation?

A

Paroxysmal
Persistent
Permanent (chronic)

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4
Q

How does atrial fibrillation present?

A

Can be asymptomatic or symptomatic

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5
Q

What is sustained atrial fibrillation facilitated by?

A

Increased parasympathetic tone, atrial refractory periods are decreased, shortening the wave length, making it easier fir AF to sustain itself

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6
Q

What is chronic atrial fibrillation associated with?

A

Heart disease

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7
Q

What is paroxysmal atrial fibrillation associated with?

A

Normal hearts

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8
Q

What increases the incidence of atrial fibrillation?

A

Age

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9
Q

Where are the ectopic foci in atrial fibrillation?

A

In muscle sleeves in the ostia of the pulmonary veins

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10
Q

What are the methods of atrial fibrillation termination?

A
  • Pharmacologic cardioversion with anti-arrhythmic drugs (30% effective)
  • Electrical cardioversion (90% effective)
  • Spontaneous revision to sinus rhythm
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11
Q

What drugs can be used to terminate atrial fibrillation?

A

Flecainide
Sotalol
Amiodarone

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12
Q

Define paroxysmal atrial fibrillation?

A

Paroxysmal and lasting less than 48 hrs

Often recurrent

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13
Q

Define persistent atrial fibrillation?

A

An episode of AF lasting longer than 48hrs, which can still be cardioverted to NSR

Unlikely to spontaneously revert to NSR

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14
Q

Define permanent Atrial fibrillation?

A

Inability of pharmacologic methods to restore NSR

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15
Q

Name some of the cardiac conditions associated with atrial fibrillation?

A 
Hypertension
CHF
Sick sinus rhythm
Coronary heart disease
cardiac valve disease
congenital heart disease
pericarditis
Tumours
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16
Q

Name some non-cardiac conditions associated with atrial fibrillation?

A 
Obesity
Thyroid disease
Familial 
Alcohol abuse
Cardiac surgery
COPD, pneumonia
Septicaemia
Vagal cause- high endurance athletes
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17
Q

Define lone (idiopathic) atrial fibrillation

A

Absence of any heart disease and no evidence of venticular dysfunction

A diagnosis of exlusion

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18
Q

What could be the cause of lone atrial fibrillation?

A

Genetic?

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19
Q

What is associated with lone atrial fibrillation?

A

Significant stroke risk of >75 years of age

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20
Q

What are the symptoms of atrial fibrillation?

A
  • Palpitations
  • pre-syncope
  • syncope
  • chest pain
  • dyspnoea
  • sweatiness
  • fatigue
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21
Q

What would you see on an ECG of atrial fibrillation?

A 
Atrial rate: >300bpm
Rhythm: Irregularly irregular
Ventricular rate: variable
Absence of P waves
Presence of f waves
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22
Q

What is the ventricular rate dependant upon in atrial fibrillation?

A

AV node conduction properties
Sympathetic and parasympathetic tone
Presence of drugs which act on the AV node

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23
Q

What is AV nodal conduction facilitated by?

A

Sympathetic tone and inhibited by parasympathetic tone

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24
Q

What drugs are useful in controlling ventricular rate in atrial fibrillation?

A

beta blockers and calcium channel blockers which are effective at slowing conduction and prolonging refractoriness in the AV node

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25
What may co-exist with AF?
Periods of fast ventricular rate, which may require a pacemaker to allow for pharmacologic control
26
How does atrial fibrillation effect diastole?
lost atrial kick and decreased filling times
27
What can atrial fibrillation result in?
Congestive heart failure, especially when there is diastolic dysfunction
28
What do ventricular rates of <60bpm suggest in atrial fibrillation
AV conduction disease
29
What should be done in the presence of atrial fibrillation and AV conduction disease?
Caution taken with anti-arrhythmic and rate controlling drugs May require permanent pacing
30
What are the objectives of managing atrial fibrillation?
``` Rhythm control (maintain SR) OR Rate control (Accept AF but control ventricular rate) ``` Anti-coagulation if high risk for thromboemolism
31
Which drugs are used for rate control in atrial fibrillation?
If restoration to SR is not possible, slow down AVN conduction; - digoxin - b blockers - verapamil, diltiazem
32
How can you restore sinus rhythm in atrial fibrillation?
- pharmacological cardioversion with anti arrhythmic drugs (amiodarone) - direct current cardioversion
33
How do you maintain SR in a patient who had atrial fibrillation?
- anti-arrhythmic drugs (flecainide, sotalol, amiodarone) - catheter ablation of the atrial focus/pulmonary veins - surgery (maze procedure)
34
What is the aim of electrical cardioversion?
Immediate restoration of sinus rhythm by terminating the arrhythmia via the delivery of a dose of electrical current to the heart at a specific moment in the cardiac cycle
35
What determines the electophysiolocal effects of AADS?
``` Depending on which ion channel they block Class I- Na+ channels (rhythm) Class II- B receptors (rate) Class III- K+ channels (rhytmn) Class IV- Ca2+ channels (rate) ```
36
Name some Class I antiarrhythmics?
Lignocaine, quinidine, flecainide, propafenone
37
Name a Class II antiarrhythmic?
Propanolol
38
Name some Class III antiarrhythmics?
Amiodarone, sotalol, dronedarone
39
Name a class IV anti-arrhythmic?
Verapamil
40
What is torsades des pointes?
Rapid and distinct VT with a twisting configuration of QRS morphology
41
What is the HR in torsades des pointes?
200-250bpm
42
What is the rhythm of torsades des pointes?
Irregular
43
How can torsades des pointes be recognised?
Long QT interval Wide QRS Continuously changes QRS morphology
44
What is torsades des pointes associated with?
Prolonged repolarization
45
What causes torsades des pointes?
Acquired or congenital
46
Which type of mitral valve disease has the highest stoke risk?
Mitral Stenosis
47
What gender and age is at increased risk of thromboembolism?
Female >75
48
What heart decisions predispose to thromboembolism?
Hypertension Heart failure Previous thromboembolism/stroke CAD
49
What non cardiovascular conditions predispose to thromboembolism?
Diabetes | Thyrotoxicosis
50
What is the indication for anticoagulation in valvular atrial fibrillation?
If the cause is mitral stenosis or regurgitation
51
What are the indications for anti-coagulation in non valvular atrial fibrillation?
``` Age >75 Hypertension Heart Failure Previous stroke/thromboembolism CAD/DM Diabetes ```
52
What is the acronym for remembering anti-coagulation indication in atrial fibrillation?
CHADSVAS
53
What is the use of radiofrequency ablation in atrial fibrillation?
Maintain SR - by ablating AF focus For rate control -ablation of the AVN to stop fast conduction to ventricles
54
What is atrial flutter?
Rapid and regular form of reentrant atrial tachycardia
55
What is the usual character of atrial flutter?
Normally paroxysmal
56
What is atrial flutter sustained by?
Macro-reentrant circuit located in the right atrial myocardium
57
How long do episodes of atrial flutter last?
Seconds to years
58
What does chronic atrial flutter progress to?
Atrial fibrillation
59
What is chronic atrial flutter suggestive of?
Underlying heart disease
60
What is the atrial and ventricular rates in atrial flutter?
Atria: 300bpm (220-430) Ventricle: 150bpm
61
What is the pathological wave form?
Saw tooth f wave
62
What is the QRS complex like in atrial flutter?
Normal
63
What is the conduction like in atrial flutter
Normal but often in a 2:1 ration
64
What is the rhythm like in atrial flutter?
Regular but may be variable
65
How is initiation of atrial flutter achieved?
rapid atrial pacing and or the introduction of multiple premature beats near the low septum
66
How is termination of atrial flutter achieved?
rapid atrial pacing, cardioversion, medication (Ia, Ic, III anti arrhythmic drugs)
67
What are the two goals in the treatment of atrial flutter?
Terminate the flutter and prevent recurrence Control the ventricular response
68
What are the treatment options of atrial flutter?
-RF ablation -Pharmacologic therapy >slow the ventricular rate >resore sinus rhythm >maintain sinus rhythm once converted -Cardioversion -Warfarin for prevention of thromboembolism

Cardiovascular 2018 (39 decks)

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