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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
Q

How do you treat Bradycardia

A

B-blocker
Atropine (if acute)
Pacing if haemodynamic compromised

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26
Q

What is the treatment for Tachycardia

A

Treat underlying cause
B-adrenergic blockers

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27
Q

What are the symptoms of Ectopic beats

A

Asymptomatic
Palpitations

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28
Q

What is the treatment for Ectopic Beats

A

Generally no treatment
B-adrenergic blockers may help
Avoid stimulants

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29
Q

What could regular supraventricular tachycardia be due to

A

AV nodal re-entrant tachycardia (AVNRT)
AV reentrant tachycardia (AVRT)
Ectopic atrial tachycardia (EAT)

30
Q

What is the acute management of supra ventricular Tachycardia

A

Increase vagal tone: valsalva, carotid massage
Slow conduction in AVN (IV adenosine, IV verapamil)

31
Q

What is the chronic management of supra ventricular tachycardia

A

Avoid stimulants
Electrophysiological study and Radiofrequency ablation (first line in young)
Beta blockers
Antiarrhythmic drugs

32
Q

What is Radiofrequency catheter ablation (RFCA)

A

Selective cautery of cardiac tissue to prevent tachycardia targeting either an automatic focus or part of a re-entry circuit

33
Q

What are causes of AVN conduction disease (heart block)

A

Ageing
MI
Myocarditis
Infiltrative disease
Drugs
Calcific aortic valve disease
Post-aortic valve disease
Post-aortic calve surgery
Genetic

34
Q

What is 1st degree AV block

A

Conduction following each P wave but takes longer
P-R interval longer
No treatment

35
Q

What is 2nd degree AV block

A

Intermittent block at AVN (dropped beats)
Mobitz 1
Mobitz 2

36
Q

What is 2nd degree AV block Mobitz 1

A

Progressive lengthening of the PR interval eventually resulting in a dropped beat usually vagal

37
Q

What is 2nd degree AV block Mobitz 2

A

Pathological may progress to complete heart block
Permanent pacemaker indicated

38
Q

What is 3rd degree AV block and how is it treated

A

Complete heart block
No action potentials from SA node get through to AV node
Ventricular pacing

39
Q

What are the different types of pacemakers

A

Single chamber (right atria or right ventricle only)
Dual chamber (paces RA and RV)

40
Q

What are the different ventricular arrhythmias

A

Ventricular ectopic or premature ventricular complex (PVC)
Ventricular tachycardia
Ventricular fibrillation
Systole

41
Q

What causes Ventricular Ectopics

A

Structural cause: LVH, HF, myocarditis
Metabolic: Ischaemic heart disease, electrolytes
Inherited cardiac conditions

42
Q

What is the management of Ventricular Ectopics

A

Investigate cause and treat condition:
Beta-blockers
Ablation of ectopic focus
AAD

43
Q

What are the causes for ventricular tachycardia (VT)

A

Significant heart disease:
Coronary heart disease
Previous MI
HF
Less frequent causes
Inherited cardiomyopathy
Inherited Channelopathy

44
Q

What is Ventricular fibrillation

A

chaotic ventricular electrical activity which causes heart to lose ability to function as pump

45
Q

What is the treatment for ventricular fibrillation

A

Defibrillation
Cardiopulmonary resuscitation

46
Q

What is the acute treatment for VT

A

Direct current cardio version (DCCV) if unstable
If stable: AAD in meantime prepare for DCCV
If unsure adenosine to make diagnose

47
Q

What is the long term treatment for VT

A

Correct ischaemia (revascularisation)
Optimise CHF therapies
Implantable cardiovertos defibrillators (ICD) if life threatening
VT catheter ablation

48
Q

Are anti-arrhythmic drugs effective?

A

No ineffective

49
Q

What is Atrial Fibrillation (AF)

A

Chaotic and disorganised atrial activity
Irregular heart beat
Can be paroxysmal, persistent or permanent
Symptomatic or asymptomatic

50
Q

What are associated diseases and causes of AF

A

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
Q

What is long (idiopathic) AF

A

absence of any heart disease and no evidence of ventricular dysfunction
Diagnosis of exclusion
Genetic

52
Q

What are AF symptoms

A

Palpitations
Pre-syncope (dizziness)
Syncope
Chest pain
Dyspnea
Sweatiness Fatigue

53
Q

What is the pattern of paroxysmal AF

A

Paroxysmal and lasting less than 48 hours
Often recurrent

54
Q

What is the pattern of persistent AF

A

Episode of AF lasting greater than 48 hours but can still be cardioverted to NSR
Unlikely to spontaneously revert to NSR

55
Q

What is the pattern of permanent AF

A

Inability of pharmacology or non-pharmacology methods to restore NSR

56
Q

What is the mechanism of AF

A

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
Q

How does and ECG look like with someone with AF

A

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
Q

What is the pathophysiology of AF

A

Lost atrial kick and decreased filling times (reduced diastole) ->reduced cardiac output
Can result in congestive HF especially in presence of stiff ventricle

59
Q

How do you control the rate during AF

A

Pharmacologic therapy to slow AVN conduction:
Digoxin
Beta-blockers
Verapamil, diltiazern
If unsuccessful Pacemaker

60
Q

How do you restore the NRS during AF

A

Pharmacologic cardioversion (anti-arrhythmic drugs)
Direct current cardioversion (DCCV)

61
Q

How do you maintain the NSR during AF

A

Anti-arrhythmic drugs
Catheter ablation of atrial focus/pulmonary veins
Surgery (Maze procedure

62
Q

How can AF be terminated

A

Spontaneous reversion to sinus rhythm may occur (paroxysmal AF)
Pharmacologic cardioversion with anti-arrhythmic drugs
Electrical cardioversion by direct current

63
Q

What increases the risk of a Thrombo-embolitic stroke in the presence of AF

A

Thyrotoxicosis
Hypertrophic cardiomyopathy
Mitral valve disease especial mitral stenosis

64
Q

What are the risk factors for thrombosis embolic stroke in non valvular AF

A

Female
Age >75
Hypertension
Heart failure
Previous stroke
CAD
Diabetes

65
Q

What is done to prevent stroke in AF

A

Oral anti-coagulation
Long term anti-coagulation in high risk
OAC: warfarin, apixaban, rivaroxaban, dabigatran, endoxaban

66
Q

What is the CHADS2-VASc Score

A

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
Q

What is the recommended therapy for a 0 male score or 1 female score

A

No anticoagulation therapy

68
Q

What is the recommended therapy for a 1 male score

A

Oral anticoagulation should be considered

69
Q

What is the recommended therapy for a 2 score

A

Oral anticoagulant is recommended

70
Q

What is Atrial Flutter (A-Flutter)

A

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
Q

What is the treatment for A-Flutter

A

Radio frequency ablation
Pharmacological therapy
Cardioversion
OAC for prevention of stroke

72
Q

What is the purpose of pharmacological treatment for A-flutter

A

Slow ventricular rate
Restore sinus rhythm
Maintain sinus rhythm once converted

Cardio Vascular Year 1 (23 decks)

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