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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
Q

What may co-exist with AF?

A

Periods of fast ventricular rate, which may require a pacemaker to allow for pharmacologic control

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26
Q

How does atrial fibrillation effect diastole?

A

lost atrial kick and decreased filling times

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27
Q

What can atrial fibrillation result in?

A

Congestive heart failure, especially when there is diastolic dysfunction

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28
Q

What do ventricular rates of <60bpm suggest in atrial fibrillation

A

AV conduction disease

29
Q

What should be done in the presence of atrial fibrillation and AV conduction disease?

A

Caution taken with anti-arrhythmic and rate controlling drugs

May require permanent pacing

30
Q

What are the objectives of managing atrial fibrillation?

A 
Rhythm control (maintain SR) OR
Rate control (Accept AF but control ventricular rate)

Anti-coagulation if high risk for thromboemolism

31
Q

Which drugs are used for rate control in atrial fibrillation?

A

If restoration to SR is not possible, slow down AVN conduction;

  • digoxin
  • b blockers
  • verapamil, diltiazem
32
Q

How can you restore sinus rhythm in atrial fibrillation?

A
  • pharmacological cardioversion with anti arrhythmic drugs (amiodarone)
  • direct current cardioversion
33
Q

How do you maintain SR in a patient who had atrial fibrillation?

A
  • anti-arrhythmic drugs (flecainide, sotalol, amiodarone)
  • catheter ablation of the atrial focus/pulmonary veins
  • surgery (maze procedure)
34
Q

What is the aim of electrical cardioversion?

A

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
Q

What determines the electophysiolocal effects of AADS?

A 
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
Q

Name some Class I antiarrhythmics?

A

Lignocaine, quinidine, flecainide, propafenone

37
Q

Name a Class II antiarrhythmic?

A

Propanolol

38
Q

Name some Class III antiarrhythmics?

A

Amiodarone, sotalol, dronedarone

39
Q

Name a class IV anti-arrhythmic?

A

Verapamil

40
Q

What is torsades des pointes?

A

Rapid and distinct VT with a twisting configuration of QRS morphology

41
Q

What is the HR in torsades des pointes?

A

200-250bpm

42
Q

What is the rhythm of torsades des pointes?

A

Irregular

43
Q

How can torsades des pointes be recognised?

A

Long QT interval
Wide QRS
Continuously changes QRS morphology

44
Q

What is torsades des pointes associated with?

A

Prolonged repolarization

45
Q

What causes torsades des pointes?

A

Acquired or congenital

46
Q

Which type of mitral valve disease has the highest stoke risk?

A

Mitral Stenosis

47
Q

What gender and age is at increased risk of thromboembolism?

A

Female >75

48
Q

What heart decisions predispose to thromboembolism?

A

Hypertension
Heart failure
Previous thromboembolism/stroke
CAD

49
Q

What non cardiovascular conditions predispose to thromboembolism?

A

Diabetes

Thyrotoxicosis

50
Q

What is the indication for anticoagulation in valvular atrial fibrillation?

A

If the cause is mitral stenosis or regurgitation

51
Q

What are the indications for anti-coagulation in non valvular atrial fibrillation?

A 
Age >75
Hypertension
Heart Failure
Previous stroke/thromboembolism
CAD/DM
Diabetes
52
Q

What is the acronym for remembering anti-coagulation indication in atrial fibrillation?

A

CHADSVAS

53
Q

What is the use of radiofrequency ablation in atrial fibrillation?

A

Maintain SR
- by ablating AF focus

For rate control
-ablation of the AVN to stop fast conduction to ventricles

54
Q

What is atrial flutter?

A

Rapid and regular form of reentrant atrial tachycardia

55
Q

What is the usual character of atrial flutter?

A

Normally paroxysmal

56
Q

What is atrial flutter sustained by?

A

Macro-reentrant circuit located in the right atrial myocardium

57
Q

How long do episodes of atrial flutter last?

A

Seconds to years

58
Q

What does chronic atrial flutter progress to?

A

Atrial fibrillation

59
Q

What is chronic atrial flutter suggestive of?

A

Underlying heart disease

60
Q

What is the atrial and ventricular rates in atrial flutter?

A

Atria: 300bpm (220-430)

Ventricle: 150bpm

61
Q

What is the pathological wave form?

A

Saw tooth f wave

62
Q

What is the QRS complex like in atrial flutter?

A

Normal

63
Q

What is the conduction like in atrial flutter

A

Normal but often in a 2:1 ration

64
Q

What is the rhythm like in atrial flutter?

A

Regular but may be variable

65
Q

How is initiation of atrial flutter achieved?

A

rapid atrial pacing and or the introduction of multiple premature beats near the low septum

66
Q

How is termination of atrial flutter achieved?

A

rapid atrial pacing, cardioversion, medication (Ia, Ic, III anti arrhythmic drugs)

67
Q

What are the two goals in the treatment of atrial flutter?

A

Terminate the flutter and prevent recurrence

Control the ventricular response

68
Q

What are the treatment options of atrial flutter?

A

-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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