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MBBS VI - SpC - Medicine > Cardiac - arrhythmia, AF > Flashcards

Cardiac - arrhythmia, AF Flashcards

1
Q

Arrhythmia

Classification by origin of depolarization

A
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2
Q

Arrhythmia

Classification by QRS complex

A
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3
Q

Interpret

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4
Q

Interpret

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5
Q

Interpret

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6
Q

Interpret

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7
Q

Interpret

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8
Q

Interpret

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9
Q

Narrow complex tachycardia

Diagnostic flowchart

A
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10
Q

Wide complex tachycardia

Diagnostic flowchart

A
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11
Q

LBBB vs RBBB

ECG features

A
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12
Q

Arrhythmia

First line management

A
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13
Q

Anti-arrhythmics

Classes
Example
MoA
Useage

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14
Q

Stable regular narrow complex tachycardia

Treatment

A
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15
Q

Stable wide complex tachycardia

Treatment

A
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16
Q

Vagal maneuver

MoA
S/E
C/I

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17
Q

ATP

MoA
S/E
C/I

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18
Q

Atrial flutter/ atrial fibrillation

Management

A
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19
Q

Outline risk stratification score for thromboembolic risk - CHA2DS2-VASc score

A
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20
Q

Sinus tachycardia

Management

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21
Q

Atrial tachycardia
AVRT
AVNRT

Management

A
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22
Q

Multifocal atrial tachycardia

Management

A
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23
Q

Wide complex tachycardia: VT, SVT with BBB, unknown type

Treatment

A
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24
Q

Bradycardia

Types

A
25
Q

Heart block

ECG findings of 1st, 2nd, 3rd degree heart block

A
26
Q

Heart block causes

A

1st and 2nd degree
 Acute MI
 Ischemic heart disease
 Acute rheumatic heart disease
 Myocarditis
 Hypo-K+
 Digoxin toxicity
 β-blockers treatment

3rd degree
 Acute MI
 Aortic stenosis
 Fibrosis around bundle of His
 LBBB + RBBB

27
Q

RBBB

ECG features
Causes

A
28
Q

LBBB

ECG features
Causes

A
29
Q

Left anterior hemi-block

ECG features

A
30
Q

Bifascicular block

ECG feature

A
31
Q

Sick sinus syndrome

ECG features

A
32
Q

Bradycardia

First line management

A
33
Q

Ventricular fibrillation/ Pulseless VT

Management

A
34
Q

Pulseless electrical activity

Causes
Management

A
35
Q

Outline primary CDAB and secondary ABCD surveys for VF, Pulseless VT, PEA, asystole

A
36
Q

Asystole

Management

A
37
Q

AF

Classification

A
38
Q

AF

Causes

A
39
Q

AF

D/dx

A
40
Q

AF

Pathogenesis

A
41
Q

AF

Clinical manifestations

A
42
Q

AF

Investigation

A
43
Q

AF

Treatment approaches

A
44
Q

AF

Rate control drug choices
Target HR control

A

Pharmacological rate control

Target heart rate control
- Symptomatic: Resting HR < 80 bpm
- Asymptomatic + LVEF > 40%: HR < 110 bpm
- Note that rate-control strategy is not indicated if the AF has a slow HR originally

ABCD medications
- β-blockers&raquo_space; non-dihydropyridine CCB, digoxin, and amiodarone

45
Q

AF

Rate control drugs
- MoA
- Examples
- Contraindications

A
46
Q

AF

Non-pharmacological rate control
Indication

A
47
Q

AF

Anti-arrhythmics - Class Ic
- Examples
- MoA
- C/I
- S/E

A
48
Q

AF

Anti-arrhythmics - Class III Amiodarone

  • MoA
  • C/I
  • S/E
A
49
Q

AF

Anti-arrhythmics - Class III Dronedarone

  • MoA
  • C/I
  • S/E
A

Removal of iodine molecule causes less thyroid and systemic side effects compared to amiodarone, but less effective
Iodine also causes fat binding and increases half life of amiodarone

50
Q

AF

Anti-arrhythmics - Class III Ibutilide, Dofetilide, Sotalol

  • MoA
  • C/I
  • S/E
A
51
Q

Choice of class III anti-arrhythmics in AF with:
- No heart disease
- Post-MI/ CAD
- Heart failure
- Hypertension with LVH

A
52
Q

AF

Non-pharmacological rhythm control options

A

Direct-current (DC) cardioversion (Electrical cardioversion)

Catheter ablation:
- Indicated in patients with symptomatic paroxysmal/ persistent/ long-standing persistent AF who are refractory or intolerant to ≥ 1 Class I or III anti-arrhythmic drugs
- radiofrequency ablation (RFA) and cryoballoon (cryothermal) ablation
- Most common pulmonary vein isolation technique is circumferential pulmonary vein isolation (PVI)
- Anticoagulation is indicated to prevent thromboembolism around the time of RFA
- Complications include cardiac tamponade (most common), stroke, TIA or pulmonary vein stenosis

Surgical maze procedures (Surgical ablation)
- Indicated in selected patients undergoing other cardiac surgery e.g. valvular replacement or CABG
- radiofrequency or cryothermal energy (Cox-Maze IV procedure)
- create a “maze” of functional myocardium within the atrium

53
Q

Direct-current (DC) cardioversion (Electrical cardioversion)

Indications
Anticoagulant timing
S/E

A

Indications
o Hemodynamically unstable patients
o Refractory to pharmacological cardioversion
o Rapid control of ventricular rate during AF is required (preferred over pharmacological cardioversion in patients with decompensated HF, ongoing myocardial ischemia, or hypotension)

54
Q

AF

Prevention of thromboembolism

  • Indication
  • Risk stratification
  • Drug choices
A

Choice of antithrombotic options
Options = Warfarin/ Dabigatran/ Rivaroxaban/ Apixaban

Aspirin + Clopidogrel (Dual anti-platelet therapy) – Less effective
- Indicated in patients who refuse or contraindicated to anticoagulants

Aspirin alone – Even less effective
- Indicated in patients who refuse or contraindicated to anticoagulants

55
Q

AF

Warfarin
- Target INR
- MoA
- Indication
- Contraindicaton

A
56
Q

AF

Direct anticoagulant
* Drug types
* Indication
* Contraindication
* MoA

A
57
Q

AF

Thromboembolism prevention
Compare NOAC vs Warfarin
- Efficacy
- Safety
- Advantage of NOAC
- Disadvantage of NOAC

A
58
Q

AF

Bridging therapy
- Indication
- Drug choice

A
59
Q

AF

Non-pharmacological prevention

A

MBBS VI - SpC - Medicine (80 decks)

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