Cardiac arrhythmia management Flashcards

1
Q

What is pulseless electrical activity (PEA)

A
  1. no pulse found -> Cardiac arrest 2. ECG shows electrical activity
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2
Q

Management of PEA

A
  1. e.g. Asystole / normal electrical activity on ECG w/o pulse - No shock - CPR only - Adrenaline
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3
Q

Ventricular tachycardia

A
  1. Fine VF - small amplitude, gets weaker and weaker 2. Coarse VF - greater amplitude 3. Originates from ventricles -> Broad complex tachycardia 4. Ventricular tachycardia - no P waves, broad and regular
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4
Q

Cardiac causes of bradycardia

A
  1. Cardiac conduction blocks

2, no cardiac - drugs, toxins, metabolic ( beta blockers)

  1. electrolytes - K and Mg
  2. Hypothyroidism
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5
Q

initial management of adult bradycardia

A
  1. Heart rate < 50 bpm
  2. A, B , C ( airway, breathing and circulation)
  3. Blood pressure and IV access
  4. ECG
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6
Q

Which redflags identified in bradycardia management

A
  1. Hypotension 2, Altered mental state 3. Signs of shock 4. Ischaemic discomfort 5. Acute heart failure If no - MONITOR + OBSERVE
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7
Q

Redflags have been identified in bradycardia

A
  1. Give atropine if ineffective ; 2. Transcutaneous pacing 3. Dopamine or epinephrine infusion
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8
Q

atropine - use - MoA - contraindication

A
  1. used in the treatment of bradycardia 2, an ACh receptor antagonist to decrease Parasympathetic nervous system and increase sympathetic nervous system 3, Contraindic - patient is predisposed to narrow-angle glaucoma
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9
Q

First degree heartblock

A
  1. PR interval is longer than expected 2. slower conduction mabe due to beta blocker use
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10
Q

Second degree heart block ( Mobitz type I)

A
  1. PR interval gets longer and longer –> until QRS suddenly disappears
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11
Q

Second degree heart block (Mobitz type II)

A
  1. QRS suddenly drops - no PR prolonging 2. Risk of deteriorating int o asystole
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12
Q

Third degree heart block

A
  1. regular P waves and QRS but they do not talk to each other 2. SAN creates own rythm - atria contract but not contact via AV noe 3. No AVN firing - escape beats only 4. risk of asystole is high and pacemaker is needed
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13
Q

Managment of atrial tachycardia

A
  1. Heart rate > 150 bpm 2. A, B , C 3. IV access and ECG 4. Check for red flags 1. Vagal manoeuvres - increase activity of Vagus nerve 2, Adenosine - to chemically cardiovert the heart
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14
Q

Redflag in supraventricular tachycardia

A
  1. hypotension 2. acutely altered mental status 3. signs of shock 4. chest pain 5. heart failure –> NO 6. is QRS wider than > 0.12 secs? —>NO 1. Vagal maneuvers 2. Adenosine 3. Beta blocker/Calcium channel blockers
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15
Q

management of Ventricular tachycardia

A
  1. Shock + CPR 2. Amiadorone
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16
Q

What’s the purpose of CPR?

A

CPR = pressing on the chest -> heart is artificially pumped (blood around the

coronary arteries -> perfusion of myocardium is increased; possibly back flow back to the heart -> hope to restart the heart working)

17
Q

Do we shock the patients with PEA?

A

Patients who have electrical activity (PEA, asystole) -> no need to shock, as it’s not going to help them

  • cardiac compressions will help them more
  • adrenaline
18
Q

Where does the electrical impulse start in:

A. broad complex

B. narrow complex

A

If the impulse start from VENTRICLE = it is BROAD

If the impulse start in the ATRIA -> it is NARROW complex

19
Q

ALgorithm for the management of bradycardia

A
20
Q

What’s 1st line drug treatment for bradycardia?

A

Atropine

*Atropine will speed up HR, make it to pump quicker and generate better BP)

*before giving atropine, leads to pace the heart needed to be put on in case if we need to pacethe patient

21
Q

Management of bradycardia, after atropine was given and it was ineffective

A

electricity to pace -> transcutaneous pacing (to ‚take over’ patient’s heart activity, we need to pace at higher HR than normally for patient is)

*this is notcomfortable for patient - minor sedation needed

22
Q

What types of bradycardia have a higher risk of becoming asystole?

A
  • recent asystole
  • Mobitz II
  • Complete Heart Block with wide QRS
  • Ventricular Pause > 3s
  • these patients should be monitored closely
  • pacemaker needs to be placed in (to avoid asystole)
23
Q

Atropine

  • uses
  • MoA
  • contraindication
A

Uses:

  • treatment of pesticide and nerve agents poisoning
  • to decrease salivation during surgery
  • treatment of bradycardia

Mode of action: anti-muscarinic (anti-cholinergic) -> inhibits PNS

Contraindication: patients predisposed to narrow- angle glaucoma

24
Q

Atropine in cardiac treatment

  • MoA
A

In cardiac treatment:

  • it acts as muscarinic ACh receptor antagonist -> increased firing of SA and

conduction via AV nodes (as it decreases PNS input so more SNS like picture)

  • it also opposes the action of Vagus, blocks ACh receptor sites
25
Q

Possible causes of narrow tachycardia

A

Narrow = comes from atria e.g. sinus tachycardia

Causes:

PE, anxiety, hyperthyroid, AF, flutter

26
Q

Treatment of Supraventricular tachycardia (2)

A

Management:

  • Vagal Manoeuvres -> trying to increase activity of Vagus nerve (e.g. people block the nose, carotid sinus massage, blowing into syringe)

  • Adenosine -> (if Vagal Manoeuvres do not work) -> to reset the heart / chemically cardiovert

It is useful, but scary to give- patient will feel like ‘everything will go’ - there will be a pause on the monitor

27
Q

Treatment of ventricular tachycardia

A
  • shock (electric)
  • medication (Amiodarone)

*Amiodarone -> anti-arrhythmic medication -> used to treat and prevent

III class anti-arrhythmic -> prolongs phase 3

28
Q

Algorithm for treatment of supra-ventricular tachycardia

A