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Cardio Vascular Year 1 > Cardiac Arrhythmias > Flashcards

Cardiac Arrhythmias Flashcards

1
Q

What is arrhythmia generally named for

A

Anatomical site of chamber of origin
Mechanism or pathway
Tachycardia (>100 bpm)
Bradycardia (<60 bpm)
Can occur as single beats (ectopy)
Or continuously (persistent/sustained)
Or paroxysmal/non-sustained

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2
Q

Where does Supraventricular (SVT) arrhythmia originated and what does it look like on an ECG

A

Anatomically above the ventricle
ECG shows narrow QRS

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3
Q

Where does the ventricular arrhythmia originates and what does the ECG look like

A

Ventricular myocardium (common)
Fascicles of the conducting system (uncommon)
ECG shows wide QRS

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4
Q

What are types of supra ventricular tachycardia

A

Atrial Fibrillation
Atrial Flutter
Ectopic atrial tachycardia

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5
Q

What are types of Bradycardia

A

Sinus Bradycardia
Sinus pauses

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6
Q

What are the different types of ventricular arrhythmia

A

Ventricular ectopics or premature ventricular complex (PVC)
Ventricular tachycardia (VT)
Ventricular Fibrillation (VF)
Asystole

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7
Q

What are the degrees of Atrio-ventricular Node Arrhythmias (AVN)

A

1st
2nd
3rd

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8
Q

What are clinical causes of arrhythmias

A

Abnormal anatomy
Autonomic nervous system (ANS)
Metabolic
Inflammation
Drugs
Genetics

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9
Q

What are abnormal anatomies that allow re-entrant circuits

A

Accessory pathways
Congenital HD

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10
Q

What are aspects of the autonomic nervous system that can cause Arrhythmias

A

Sympathetic stimulation: stress, exercise, hyperthyroidism
Increased vagal tone causing bradycardia

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11
Q

What are Metabolic diseases causing Arrhythmias

A

Hypoxia: chronic pulmonary disease, pulmonary embolus
Ischaemic myocardium: acute MI, angina
Electrolyte imbalances: K+, Ca2+, Mg2+

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12
Q

What are the 2 Electrophysical mechanisms of arrhythmia

A

Ectopic beats (focal activity)
Re-entry: requires more than one conduction pathway with different speed of conduction and recovery of excitability

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13
Q

What can cause ectopic beats

A

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

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14
Q

What causes Re-entry

A

A ccessory pathway tachycardia
Previous MI
Congenital heart disease

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15
Q

What abnormal physiology and pathology causes increase in heart rate - ectopics

A

Hyperthermia
Hypoxia
Hypercapnia (elevation in the arterial carbon dioxide tension)
Myocardial stretch
SNS

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16
Q

What abnormal physiology and pathology causes slowed conduction (bradycardia, heart block)

A

Hypothermia
Hyperkalaemia
PNS

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17
Q

What are the symptoms of Arrhythmias

A

Palpitations
Dyspnoea (uneasy breathing)
Faintness
Transient loss of consciousness
Shock
Sudden cardiac death
Angina
Heart failure
Anxiety

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18
Q

What are investigations for Arrhythmias

A

12 lead ECG
Bloods: FBC, biochemistry, thyroid function
CXR (chest X ray)
Echocardiogram
Stress ECG
24 hour ECG
Electrophysiological (EP) study

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19
Q

What does the ECG asses

A

Signs of previous MI (Q waves)
Pre-excitation

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20
Q

What does Exercise ECG asses

A

Ischaemia
Exercise induced arrhythmia

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21
Q

What does a 24 hour ECG asses

A

Paroxysmal arrhythmia
Link symptoms to underlying heart rhythm

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22
Q

What does echocardiography assess

A

Structural heart disease e.g.
enlarged atria in AF
LV dilation
Previous MI scar
Aneurysm

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23
Q

What does the electrophysiological study asses

A

Trigger clinical arrhythmia and study its mechanisms/pathways
Opportunity to treat arrhythmia by delivering rediofrequency ablation to extra pathway

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24
Q

What is a 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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25
How do you treat Bradycardia
B-blocker Atropine (if acute) Pacing if haemodynamic compromised
26
What is the treatment for Tachycardia
Treat underlying cause B-adrenergic blockers
27
What are the symptoms of Ectopic beats
Asymptomatic Palpitations
28
What is the treatment for Ectopic Beats
Generally no treatment B-adrenergic blockers may help Avoid stimulants
29
What could regular supraventricular tachycardia be due to
AV nodal re-entrant tachycardia (AVNRT) AV reentrant tachycardia (AVRT) Ectopic atrial tachycardia (EAT)
30
What is the acute management of supra ventricular Tachycardia
Increase vagal tone: valsalva, carotid massage Slow conduction in AVN (IV adenosine, IV verapamil)
31
What is the chronic management of supra ventricular tachycardia
Avoid stimulants Electrophysiological study and Radiofrequency ablation (first line in young) Beta blockers Antiarrhythmic drugs
32
What is Radiofrequency catheter ablation (RFCA)
Selective cautery of cardiac tissue to prevent tachycardia targeting either an automatic focus or part of a re-entry circuit
33
What are causes of AVN conduction disease (heart block)
Ageing MI Myocarditis Infiltrative disease Drugs Calcific aortic valve disease Post-aortic valve disease Post-aortic calve surgery Genetic
34
What is 1st degree AV block
Conduction following each P wave but takes longer P-R interval longer No treatment
35
What is 2nd degree AV block
Intermittent block at AVN (dropped beats) Mobitz 1 Mobitz 2
36
What is 2nd degree AV block Mobitz 1
Progressive lengthening of the PR interval eventually resulting in a dropped beat usually vagal
37
What is 2nd degree AV block Mobitz 2
Pathological may progress to complete heart block Permanent pacemaker indicated
38
What is 3rd degree AV block and how is it treated
Complete heart block No action potentials from SA node get through to AV node Ventricular pacing
39
What are the different types of pacemakers
Single chamber (right atria or right ventricle only) Dual chamber (paces RA and RV)
40
What are the different ventricular arrhythmias
Ventricular ectopic or premature ventricular complex (PVC) Ventricular tachycardia Ventricular fibrillation Systole
41
What causes Ventricular Ectopics
Structural cause: LVH, HF, myocarditis Metabolic: Ischaemic heart disease, electrolytes Inherited cardiac conditions
42
What is the management of Ventricular Ectopics
Investigate cause and treat condition: Beta-blockers Ablation of ectopic focus AAD
43
What are the causes for ventricular tachycardia (VT)
Significant heart disease: Coronary heart disease Previous MI HF Less frequent causes Inherited cardiomyopathy Inherited Channelopathy
44
What is Ventricular fibrillation
chaotic ventricular electrical activity which causes heart to lose ability to function as pump
45
What is the treatment for ventricular fibrillation
Defibrillation Cardiopulmonary resuscitation
46
What is the acute treatment for VT
Direct current cardio version (DCCV) if unstable If stable: AAD in meantime prepare for DCCV If unsure adenosine to make diagnose
47
What is the long term treatment for VT
Correct ischaemia (revascularisation) Optimise CHF therapies Implantable cardiovertos defibrillators (ICD) if life threatening VT catheter ablation
48
Are anti-arrhythmic drugs effective?
No ineffective
49
What is Atrial Fibrillation (AF)
Chaotic and disorganised atrial activity Irregular heart beat Can be paroxysmal, persistent or permanent Symptomatic or asymptomatic
50
What are associated diseases and causes of AF
Congenital: Heart disease Genetics Infection Inflammation: myocarditis, pericarditis, MI, obesity Vascular: coronary HD, hypertension Metabolic: electrolytic distribution Structural: valve disease, HF, left ventricular hypertrophy Lifestyle: alcohol, obesity, high endurance athletes
51
What is long (idiopathic) AF
absence of any heart disease and no evidence of ventricular dysfunction Diagnosis of exclusion Genetic
52
What are AF symptoms
Palpitations Pre-syncope (dizziness) Syncope Chest pain Dyspnea Sweatiness Fatigue
53
What is the pattern of paroxysmal AF
Paroxysmal and lasting less than 48 hours Often recurrent
54
What is the pattern of persistent AF
Episode of AF lasting greater than 48 hours but can still be cardioverted to NSR Unlikely to spontaneously revert to NSR
55
What is the pattern of permanent AF
Inability of pharmacology or non-pharmacology methods to restore NSR
56
What is the mechanism of AF
Ectopic foci (abnormal pacemaker sites within the heart (outside of the SA node) that display automaticity) in muscle sleeves in Ostia of pulmonary veins
57
How does and ECG look like with someone with AF
Atrial rate >300 bpm Irregular irregular QRS Ventricular rate depending on: AV conduction properties; sympathetic and parasympathetic tone, presence pf drugs with act on AV node Absence of P waves Presence of f waves
58
What is the pathophysiology of AF
Lost atrial kick and decreased filling times (reduced diastole) ->reduced cardiac output Can result in congestive HF especially in presence of stiff ventricle
59
How do you control the rate during AF
Pharmacologic therapy to slow AVN conduction: Digoxin Beta-blockers Verapamil, diltiazern If unsuccessful Pacemaker
60
How do you restore the NRS during AF
Pharmacologic cardioversion (anti-arrhythmic drugs) Direct current cardioversion (DCCV)
61
How do you maintain the NSR during AF
Anti-arrhythmic drugs Catheter ablation of atrial focus/pulmonary veins Surgery (Maze procedure
62
How can AF be terminated
Spontaneous reversion to sinus rhythm may occur (paroxysmal AF) Pharmacologic cardioversion with anti-arrhythmic drugs Electrical cardioversion by direct current
63
What increases the risk of a Thrombo-embolitic stroke in the presence of AF
Thyrotoxicosis Hypertrophic cardiomyopathy Mitral valve disease especial mitral stenosis
64
What are the risk factors for thrombosis embolic stroke in non valvular AF
Female Age >75 Hypertension Heart failure Previous stroke CAD Diabetes
65
What is done to prevent stroke in AF
Oral anti-coagulation Long term anti-coagulation in high risk OAC: warfarin, apixaban, rivaroxaban, dabigatran, endoxaban
66
What is the CHADS2-VASc Score
C: congestive heart failure = 1 H: Hypertension = 1 A: Age >75 = 2 D: Diabetes = 1 S2: Prior TIA or stroke = 2 V: Vascular disease (MI, aortic plaque...) = 1 A: Age 65-74 = 1 Sc: Sex category female = 1
67
What is the recommended therapy for a 0 male score or 1 female score
No anticoagulation therapy
68
What is the recommended therapy for a 1 male score
Oral anticoagulation should be considered
69
What is the recommended therapy for a 2 score
Oral anticoagulant is recommended
70
What is Atrial Flutter (A-Flutter)
Rapid and regular form of atrial tachycardia Paroxysmal or persistent pattern Sustained by macro-reentrant circuit Circuit confined to right atrium Episodes can last from seconds to years Usually progresses to atrial fibrillation Risk of thrombosis-embolitic stroke
71
What is the treatment for A-Flutter
Radio frequency ablation Pharmacological therapy Cardioversion OAC for prevention of stroke
72
What is the purpose of pharmacological treatment for A-flutter
Slow ventricular rate Restore sinus rhythm Maintain sinus rhythm once converted

Cardio Vascular Year 1 (23 decks)

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