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Cardiovascular > Cardiac Arrhythmia > Flashcards

Cardiac Arrhythmia Flashcards

1
Q

describe supraventricular arrhythmia

A

supraventricular tachycardia;
atrial fibrillation (heart quivering)
atrial flutter (very fast)
ectopic atrial tachycardia (SA rhythm overdriven)

bradycardia;
sinus bradycardia
sinus pauses

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2
Q

describe ventricular arrhythmia

A

ventricular ectopics or premature ventricular complexes
ventricular tachycardia
ventricular fibrillation

asystole (heart does not depolarise)

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3
Q

describe AV node arrythmias

A 
AVN re-entry tachycardia
AV reciprocating or AV reentrant tachycardia
AV block;
1st degree - slower
2nd degree - intermittent
3rd degree - complete block
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4
Q

describe anatomical causes of arrhythmia

A

left ventricular hypertrophy (pressure problems)
accessory pathways
congenital heart disease

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5
Q

describe autonomic nervous system causes of arrhythmia

A

sympathetic stimulation - stress, exercise, hyperthyroidism, automaticity
increased vagal tone causing bradycardia

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6
Q

describe metabolic causes of arrhythmia

A

hypoxia - chronic pulmonary disease, pulmonary embolus
ischaemic myocardium - acute MI, angina
electrolyte imbalance - K, Ca, Mg

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7
Q

describe inflammation causes of arrhythmia

A

viral myocarditis

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8
Q

describe drug causes of arrhythmia

A

direct electrophysiologic effects or via autonomic nervous system

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9
Q

describe genetic causes of arrhythmia

A

mutations of genes encoding cardiac ion channels e.g. the congenital long QT syndrome

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10
Q

describe electrophysiological mechanisms

A 
ectopic beats - beats or rhythms that originate in places other than the SA node;
altered automaticity (e.g. ischaemia, catecholamines)
triggered activity (e.g. digoxin, long QT syndrome)

re-entry - requires more than one conduction pathway, with different speed of conduction (depolarisation) and recovery of excitability (refractoriness);
accessory pathway tachycardia, previous MI, congenital heart disease

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11
Q

describe the mechanism of tachycardia

A

ectopic focus may cause single beats or a sustained run of beats, that if faster than sinus rhythm, take over the intrinsic rhythm
re-entry - triggered by an ectopic beat, resulting in a self perpetuating circuit
may or may not be life threatening depending on how they affect cardiac output

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12
Q

describe changes in the action potential in arrhythmia

A 
increases phase 4 slope causing increase in heart rate, ectopics;
hyperthermia
hypoxia
hypercapnia
cardiac dilation 
hypokalaemia, prolongs repolarisations

decreases phase 4 slope causing slowed conduction (bradycardia, heart block);
hypothermia
hyperkalaemia

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13
Q

symptoms of arrhythmia

A 
palpitations 
shortness of breath
dizziness
syncope
presyncope
sudden cardiac death
angina, heart failure
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14
Q

tests for investigating arrhythmia

A

ECG - assess rhythm, previous MI (Q-waves), pre-excitation

CXR

echocardiogram - structural disease (enlarged atria, LV dilatation, previous MI scar, aneurysm)

exercise ECG - ischaemia

24 hour ECG - paroxysmal arrhythmia, link symptoms to underlying heart rhythm

event recorder

electrophysiology - triggers the clinical arrhythmia via radio-frequency ablation and studies mechanisms

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15
Q

describe normal sinus arrhythmia

A

variation in heart rate, due to reflex changes in vagal tone during respiratory cycle
inspiration reduces vagal tone and increases heart rate

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16
Q

describe sinus bradycardia

A 
bradycardia;
<60 beats/min
physiological e.g. athlete
drugs - beta-blocker
ischaemia - common in inferior STEMI
17
Q

treatment of sinus bradycardia

A

atropine (if acute e.g. MI)

pacing if haemodynamic compromise - hypotension, CHF, angina, collapse

18
Q

describe sinus tachycardia

A

tachycardia;
HR>100 beats/min
physiological e.g. anxiety, fever, hypotension, anaemia
inappropriate (drugs)

19
Q

treatment for sinus tachycardia

A

treat underlying cause

b-adrenergic blockers

20
Q

describe atrial ectopic beats

A

symptoms;
asymptomatic
palpitations

no treatment - adrenergic blockers may help
avoid stimulants (e.g. caffeine, cigarettes)
21
Q

describe causes of normal supraventricular tachycardia

A

AV nodal re-entrant tachycardia
AV reciprocating tachycardia/AV reentrant tachycardia (via accessory pathway)
ectopic atrial tachycardia

22
Q

management of supraventricular tachycardia

A

acute;
increase vagal tone - valsalva, carotid management
slow conduction in AVN - IV adenosine, IV verapamil

chronic;
avoid stimulants
electrophysiologic study and radio-frequency ablation (selective cautery of cardiac tissue to prevent tachycardia, targeting either an automatic focus or part of re-entry circuit)
beta blockers
anti-arrhythmic drugs
23
Q

describe causes of AVN conduction disease - heart block

A 
ageing process
acute MI
myocarditis
infiltrative disease - amyloid
drugs - B-adrenergic,  CCB
calcific aortic valve disease
post-aortic valve surgery
genetic - lenegre's disease, myotonic dystrophy
24
Q

describe 1st degree AV block

A

slow conduction
PR interval longer >0.2 seconds
no treatment - long term follow up recommended as more advanced block may develop
rule out other pathology

25
Q

describe 2nd degree AV block

A 
intermittent block at AVN 
2 types;
Mobitz;
progressive lengthening of PR interval, eventually resulting in a dropped beat
usually vagal in origin 
mobitz II;
pathological, may process to complete heart block 
usually 2:1 or 3:1 but may be variable
permanent pacemaker indicated 
treatment - ventricular pacing
26
Q

describe 3rd degree AV block

A

no action potentials form SA node/atria get through AV node

treatment - ventricular pacing

27
Q

types of pacemaker

A

single chamber - paces the right atria or right ventricle only
dual chamber - paces the Ra and the RV (maintaining AV synchrony, used for AVN disease)

28
Q

describe causes of ventricular ectopics

A

structural causes - left ventricular hypertrophy, heart failure, myocarditis
metabolic - ischaemic heart disease, electrolytes
marker for inherited conditions

29
Q

causes of ventricular tachycardia

A

significant heart disease;
coronary heart disease
previous MI

rare;
cardiomyopathy
inherited

30
Q

describe ventricular fibrillation

A

chaotic ventricular electrical activity which causes heart to lose ability to function as pump
treatment - defibrillation, cardiopulmonary resuscitation

31
Q

describe treatment of ventricular tachycardia

A

unstable - direct current cardioversion
stable - pharmacologic cardioversion with AAD, prepare for DCCV

if unsure of diagnosis, consider adenosine

implant cardiovertor defibrillators

32
Q

causes of ventricular tachycardia

A

electrolytes
ischaemia
hypoxia
pro-arrhythmic medications

33
Q

describe implant cardiovertor defibrillators

A

termination of ventricular tachycardia/fibrillation;
anti-tachycardia pacing
cardioversion
defibrillation

atrium and ventricle;
pacing for bradycardia

34
Q

describe ventricular tachycardia and fibrillation pearls

A

wide QRS tachycardia with history of CAD/HF = VT until proven otherwise.
Most ventricular arrhythmias occur in the setting of structural heart disease (CHF, CAD).
Anti-arrhythmic drugs are ineffective on survival, but are often used together with ICDs to reduce symptoms.
Optimal management of the underlying condition e.g. CHF, CAD are important
primary arrhythmic conditions
VT/VF in structurally normal hearts may be genetic, with implications for family members
Drug induced

Cardiovascular (39 decks)

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