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5TH YR- CMS2 > Cardiac arrhythmias > Flashcards

Cardiac arrhythmias Flashcards

1
Q

How can the normal electrical control of the heartbeat be recorded

A

Using an ECG

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2
Q

What is an ECG reading made up of

A

P wave
QRS Complex
T wave

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3
Q

What is the P wave

A

Atrial contraction

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4
Q

What is the QRS complex

A

Ventricles contractracting

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5
Q

What is the T wave

A

Repolarisation of the ventricles after contraction

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6
Q

Which nervous system controls the heart rate

A

Autonomic nervous system

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7
Q

What effect does the sympathetic nervous system have on heart rate

A

Increases heart rate and contractility

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8
Q

What effect does the sympathetic nervous system have on heart rate

A

Slows down heart rate

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9
Q

What can cardiac arrhythmia be divided into

A

Tachycardia
Bradycardia

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10
Q

What can cardiac arrhythmia be divided into

A

Tachycardia
Bradycardia

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11
Q

What is Tachycardia

A

Pulse rate over 100 beats per min

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12
Q

What is bradycardia

A

Pulse rate les than 60 beats per min

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13
Q

Give examples of tachycardia

A
  1. Sinus tachycardia
  2. Supraventricular tachycardia
  3. Ventricular tachycardia
  4. Atrial fibrillation
  5. Ventricular fibrillation
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14
Q

What is sinus tachycardia

A

Heart rate of above 100 beats per min with ECG showing a normal P wave before each QRS complex

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14
Q

When does sinus tachycardia occur

A

Normal response to exercise

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15
Q

What can sinus node disease lead to

A

Both bradycardia and tachycardia due to malfunction of the Sino atrial node

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16
Q

What is supra ventricular tachycardia

A

A term used for abnormal tachycardias originating in or above the AV node

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17
Q

Where can supraventricualr tachycardia result from

A

May arise from the atria where a P wave will still be seen or from the AV node itself

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18
Q

When does a ventricular tachycardia arise

A

Arises within the ventricle because the electrical impulse spreads from the abnormal focus directly through the heart muscle

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19
Q

What might the ECG of a person suffering from ventricular tachycardia show

A

A wider than normal QRS complex

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20
Q

What is atrial fibrillation

A

where the atrial acirtvity becomes completely disorded with constant electrical activity throughout the atria and loss of co ordinated atrial contraction

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21
Q

Describe the ECG of a patietn with atrial fibrillation

A

No P waves

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22
Q

What can ventricular fibrillation cause

A

Causes chaotic ventricular activity that can cause a cardiac arrest

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23
Q

Give examples of some bradycardias

A
  1. Sinus bradycarida
  2. Atrio ventricular block
  3. Sinus node disease
  4. Cardiovascular reflex disorders
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24
What can sinus bradycardia be caused by
Drugs or hypothyroidism
25
What is another term for atria ventricular block
Heart block
26
When does atrioventricular block occur
When conduction of the impulse from the atria to the ventricles is impaired as a result of disease of the AV node or bundle of HIS
27
What can cadiovasuiclar reflex disorders result in
Syncope due to transient bradycardias
28
What can arrhythmias present with
Can be asymptomatic or present with: 1. Palpitations 2. Heart failure 3. Syncope
29
What clinical assessments do you need to make at the time of suspected arrhythmia
1. Basic life support 2. Pulse 3. Blood pressure 4. ECG
30
How are tachycardias usually treated
By drugs such as: 1. digoxin 2. beta blockers 3. Amiodarone
31
Why is beta blockers given to tachycardias patientss
To control the ventricular rate in atrial fibrillation
32
Why is digoxin given to tachycardias patients
To control the ventricular rate in atrial fibrillation
33
Why is Amiodarone given to tachycardias patients
Can sometimes revert atria fibrillation to sinus rhythm
34
How are drugs used to treat arrhythmia classified
1. Can be classified by what they act on 2. Classified using the Vaughan Williams classification
35
How are drugs used to treat arrhythmia classified by what they act on
1. Acting on supraventicular arrhythmia 2. Acting on supraventricular arrhythmia 3. Acting on ventricular arrhythmia
36
Give an example of an arrhythmia managing drug that acts on supraventicular arrhythmia
Verapamil
37
Give an example of an arrhythmia managing drug that acts on venticular arrhythmia
Lidocaine
38
Give an example of an arrhythmia managing drug that acts on supraventicular and ventricular arrhythmia
Amiodarone
39
What is the Vaughan Williams classification based on
antidysrhythmic action based in class I-IV
40
Describe class I arrhythmia managing drug
Membrane stabilising drugs
41
Describe class II arrhythmia managing drug
Beta adrenorecpetors antagnost
42
Describe class III arrhythmia managing drug
Agents influencing potassium channels
43
Describe class IV arrhythmia managing drug
Calcium channel blockers
44
What can class I antiarrhythmics be further divided into?
I a, I b, I c Depending upon the kinetics of their binding to the sodium channel and their effect on the cardiac action potential
45
What do class I a drugs do
Prolong the action potential
46
What do class I b drugs do
Shorten the action potential
47
What do class I c drugs do
Have little or no effect on the action potential
48
Talk through the mechanism of action of class I membrane stabilising drugs
They act on sodium channel blockers this means the binding site for these drugs is only available when the sodium channel is in the open or refractory state Accessibility to the target is governed by the rate of openign of the channel
49
Do antiarrhythmic drugs have a greater effect on dysrhythmic or normal hearts? why?
dysrhythmic as the more a channel is open the more likely the drug is to achieve its effect and in dysrhythmic hearts the channels are open more frequently
50
Give examples of class I membrane stabilising drugs
Procainamide and quinidine
51
what effect can class I membrane stabilising drugs have on oral structures and dental management
They may produce angioedema that can effect the lips tongue and floor of the mouth
52
What drug interaction should we be aware of if a patient is on a class I membrane stabilising drugs
1. bupivacaine as myocardial depression can occur 2. Erythromycin increases the likelihood of ventricular arrhythmia when given with quinidine 3. Antifungals should not be prescribed to patients taking quinidine due to risk of ventricular arrythmias
53
Take through the mechanisms of action for class II beta adrenorecpetors antagonist
These drugs decrease cardiac sympathetic activity by selectivity blocking beta adrenergic receptors
54
Take through the mechanisms of action for class III agents influencing potassium channels
By blocking potassium channels these drugs prolong repolarisation
55
what effect can class III agents influencing potassium channels have on oral structures and dental management
Patients on amiodarone may complain of a metallic taste and this drug can produce Thrombocytopenia
56
What drug interaction should we be aware of if a patient is on a class III agents influencing potassium channels
1. Bupivicaine 2. Erythromycin increases the risk of ventricular arrhythmias when combines with amiodarone so should be avoided
57
Take through the mechanisms of action for class IV calcium channel blocker
Acts on non-dihydropyridines verapamil and diltiazem on cardiac L-type calcium channels resulting in slowing of the sino-atrial node pacemaker.
58
Give one example of cardiac glyocsides
Digoxin
59
Talk through the mechanisms of action of cardiac glycosides
They inhibit the membrane bound sodium potassium ATPase which result sin an increase in intracellular sodium As a consequence of this intracellular calcium rises producing an increase in contractility
60
What impact can digoxin have on oral structures
Can produce a pain solar to trigeminal neuralgia in the lower part of the face
61
What is digoxin toxicity perciprated by
hypokalaemia
62
Give examples of drugs in dentistry that can produce hypokalaemia
LA with adrenaline Amphotercin \
63
Give examples of drugs in dentistry that can produce hypokalaemia
LA with adrenaline Amphotercin
64
Give examples of drugs that can increase the plasma concentration of digoxin
1. NSAIDS 2. Erythromycin 3. Itraconazole

5TH YR- CMS2 (7 decks)

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