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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
Q

What can sinus bradycardia be caused by

A

Drugs or hypothyroidism

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25
Q

What is another term for atria ventricular block

A

Heart block

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26
Q

When does atrioventricular block occur

A

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
Q

What can cadiovasuiclar reflex disorders result in

A

Syncope due to transient bradycardias

28
Q

What can arrhythmias present with

A

Can be asymptomatic or present with:
1. Palpitations
2. Heart failure
3. Syncope

29
Q

What clinical assessments do you need to make at the time of suspected arrhythmia

A
  1. Basic life support
  2. Pulse
  3. Blood pressure
  4. ECG
30
Q

How are tachycardias usually treated

A

By drugs such as:
1. digoxin
2. beta blockers
3. Amiodarone

31
Q

Why is beta blockers given to tachycardias patientss

A

To control the ventricular rate in atrial fibrillation

32
Q

Why is digoxin given to tachycardias patients

A

To control the ventricular rate in atrial fibrillation

33
Q

Why is Amiodarone given to tachycardias patients

A

Can sometimes revert atria fibrillation to sinus rhythm

34
Q

How are drugs used to treat arrhythmia classified

A
  1. Can be classified by what they act on
  2. Classified using the Vaughan Williams classification
35
Q

How are drugs used to treat arrhythmia classified by what they act on

A
  1. Acting on supraventicular arrhythmia
  2. Acting on supraventricular arrhythmia
  3. Acting on ventricular arrhythmia
36
Q

Give an example of an arrhythmia managing drug that acts on supraventicular arrhythmia

A

Verapamil

37
Q

Give an example of an arrhythmia managing drug that acts on venticular arrhythmia

A

Lidocaine

38
Q

Give an example of an arrhythmia managing drug that acts on supraventicular and ventricular arrhythmia

A

Amiodarone

39
Q

What is the Vaughan Williams classification based on

A

antidysrhythmic action based in class I-IV

40
Q

Describe class I arrhythmia managing drug

A

Membrane stabilising drugs

41
Q

Describe class II arrhythmia managing drug

A

Beta adrenorecpetors antagnost

42
Q

Describe class III arrhythmia managing drug

A

Agents influencing potassium channels

43
Q

Describe class IV arrhythmia managing drug

A

Calcium channel blockers

44
Q

What can class I antiarrhythmics be further divided into?

A

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
Q

What do class I a drugs do

A

Prolong the action potential

46
Q

What do class I b drugs do

A

Shorten the action potential

47
Q

What do class I c drugs do

A

Have little or no effect on the action potential

48
Q

Talk through the mechanism of action of class I membrane stabilising drugs

A

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
Q

Do antiarrhythmic drugs have a greater effect on dysrhythmic or normal hearts? why?

A

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
Q

Give examples of class I membrane stabilising drugs

A

Procainamide and quinidine

51
Q

what effect can class I membrane stabilising drugs have on oral structures and dental management

A

They may produce angioedema that can effect the lips tongue and floor of the mouth

52
Q

What drug interaction should we be aware of if a patient is on a class I membrane stabilising drugs

A
  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
Q

Take through the mechanisms of action for class II beta adrenorecpetors antagonist

A

These drugs decrease cardiac sympathetic activity by selectivity blocking beta adrenergic receptors

54
Q

Take through the mechanisms of action for class III agents influencing potassium channels

A

By blocking potassium channels these drugs prolong repolarisation

55
Q

what effect can class III agents influencing potassium channels have on oral structures and dental management

A

Patients on amiodarone may complain of a metallic taste and this drug can produce Thrombocytopenia

56
Q

What drug interaction should we be aware of if a patient is on a class III agents influencing potassium channels

A
  1. Bupivicaine
  2. Erythromycin increases the risk of ventricular arrhythmias when combines with amiodarone so should be avoided
57
Q

Take through the mechanisms of action for class IV calcium channel blocker

A

Acts on non-dihydropyridines verapamil and diltiazem on cardiac L-type calcium channels resulting in slowing of the sino-atrial node pacemaker.

58
Q

Give one example of cardiac glyocsides

A

Digoxin

59
Q

Talk through the mechanisms of action of cardiac glycosides

A

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
Q

What impact can digoxin have on oral structures

A

Can produce a pain solar to trigeminal neuralgia in the lower part of the face

61
Q

What is digoxin toxicity perciprated by

A

hypokalaemia

62
Q

Give examples of drugs in dentistry that can produce hypokalaemia

A

LA with adrenaline
Amphotercin \

63
Q

Give examples of drugs in dentistry that can produce hypokalaemia

A

LA with adrenaline
Amphotercin

64
Q

Give examples of drugs that can increase the plasma concentration of digoxin

A
  1. NSAIDS
  2. Erythromycin
  3. Itraconazole

5TH YR- CMS2 (7 decks)

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