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cardio disease profiles > cardiac arrhythmias > Flashcards

cardiac arrhythmias Flashcards

1
Q

what are arrhythmia’s generally named for

A
  • The anatomical site or chamber of origin
  • Mechanism or pathway
  • includes tachycardia and bradycardia
  • Can occurs as single beats or continuously or repeated episodes of limited duration
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2
Q

what is an arrhythmia

A

abnormalities in the cardiac rhythm generated by abnormal electrical conduction

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3
Q

Supraventricular (SVT)

A
  • Origin is above the ventricles anatomically (SAN, atrial myocardium, AV node, HIS origin)
  • ECG shows narrow QRS
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4
Q

Ventricular Tachycardia

A
  • ventricular myocardium (common)
  • or fascicles of the conducting system (uncommon)
  • The ECG shows a wide QRS as the arrhythmia path is outside the fast His PK system
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5
Q

common types of Atrial tachycardia

A

Atrial Fibrillation
Atrial Flutter
Ectopic atrial tachycardia

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6
Q

common types of bradycardia

A

Sinus bradycardia
Sinus pauses

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7
Q

Ventricular Arrhythmias

A
  • Ectopics or Premature Ventricular Complexes
  • Ventricular Tachycardia (VT)(>3 beats @ >100bpm)
  • Ventricular Fibrillation (VF) (fast chaotic irregular)
  • Asystole ( no contractions)
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8
Q

causes of arrhythmias

A

-Abnormal anatomy which
allows re-entrant circuits
-Autonimic nervous system
-Metabolic
-Inflammation
-drugs
-genetics

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9
Q

Abnormal anatomy which allows re-entrant circuits

A
  • Accesory pathways
  • Congenital HD
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10
Q

Autonimic nervous system

A
  • Sympathetic stimulation
  • Increased vagal tone = bradycardia
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11
Q

Metabolic

A
  • Hypoxia
  • Ichaemic myocardium
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12
Q

Inflammation

A

viral myocarditis

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13
Q

drugs

A

direct electrophysiological effect or via ANS

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14
Q

genetics

A

mutation of genes coding cardiac ion channels e.g. congenital long QT syndrome

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15
Q

‘Heart block’ = AVN block

A
  • Means delayed or nonconduction through the AV node
  • May be intermittent or permanent
  • Varying degrees, described according to the pattern of block
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16
Q

First degree AVN block =

A

slow conduction (long PR interval)

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17
Q

Second degree =

A

intermittent, PR interval may be varying

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18
Q

Complete or third degree=

A

complete nonconduction

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19
Q

symptoms

A
  • Palpitations, ”pounding heart”, “skipped beat”
  • Dyspnoea
  • Faintness: “presyncope”
  • Transient loss of consciousness; ”Syncope”
  • Shock
  • Sudden cardiac death
  • Angina
  • Heart failure
  • Anxiety
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20
Q

consequences

A

Tachycardia
- may be life-threatning depending on how it affects CO

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21
Q

investigations

A
  • 12 lead ECG (during SR and in tachycardia ideally)
  • Bloods: FBC, Biochemistry, thyroid function
  • CXR
  • Echocardiogram
  • Stress ECG
    • Look for myocardial ischaemia, exercise related arrhythmias
  • 24-hour ECG Holter monitoring
  • Event recorder: (capture the arrhythmia)
  • Electrophysiological (EP) study
    • catheter inserted, inside of heart
22
Q

Electrocardiogram ECG

A

Recording of cardiac electrical activity from the body surface
To assess rhythm, cardiac conduction system,
Signs of
- pre-excitation (delta waves)
- abnormal repolarization (a prolonged QT interval)

23
Q

Exercise ECG

A

To assess for ischaemia
Exercise induced arrhythmia

24
Q

24hr Holter ECG

A

To assess for paroxysmal arrhythmia

To link symptoms to underlying heart rhythm

25
Q

Echocardiography

A

To assess for structural heart disease e.g
- Valve disease
- LV, RV dilatation,
- Hypertrophic cardiomyopathy
- Previous MI scar, aneurysm

26
Q

Electrophysiological study

A

To trigger the clinical arrhythmia and study its mechanism/pathways

Opportunity to treat the arrhythmia by delivering radiofrequency ablation to extra pathway

27
Q

Normal Sinus Arrhythmia

A

Variation in heart rate, due to reflex changes in vagal tone during the respiratory cycle.

Inspiration reduces vagal tone and increases heart rate

28
Q

Sinus Bradycardia

A

< 60 beats/min
Physiological i.e., athlete
Drugs (B-Blocker)
Sinus node disease
Channelopathies eg long QT syndrome

29
Q

Treatment if symptomatic or unstable for sinus bradycardia

A

Atropine (if acute, e.g. acute MI)

Pacing if haemodynamic compromise: hypotension, CHF, angina, collapse

30
Q

Sinus Tachycardia

A

HR > 100 beats/min

Physiological (Anxiety, fever, hypotension, anaemia)

Inappropriate (drugs, etc)

31
Q

Sinus Tachycardia treatment

A

Treat underlying cause
B-adrenergic blockers

32
Q

Regular Supraventricular Tachycardia may be due to

A
  • AV nodal re-entrant tachycardia (AVNRT)
  • AV reentrant tachycaria (via an accessory pathway) (AVRT)
  • Ectopic atrial tachycardia (EAT)
33
Q

Supraventricular Tachycardia acute management

A

Increase vagal tone: valsalva, carotid massage
Slow conduction in the AVN
IV Adenosine
IV Verapamil

34
Q

Supraventricular Tachycardia chronic management

A
  • Avoid stimulants
  • Electrophysiologic study and Radiofrequency ablation (first line in young, symptomatic patients)
  • Beta blockers
  • Antiarrhythmic drugs
35
Q

What is Radiofrequency Catheter Ablation ? (RFCA)

A

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

36
Q

AVN Conduction Disease (Heart Block) Causes

A
  • Ageing process
  • Acute myocardial infarction
  • Myocarditis
  • Infiltrative disease
    Amyloid, sarcoid
  • Drugs
    B-adrenergic blockers
    Calcium channel blockers
  • Calcific aortic valve disease
  • Post-aortic valve surgery
  • Genetic : Lenegre’s disease, myotonic dystrophy
37
Q

1st Degree A-V Block

A

Not really “block”, conduction to the ventricles following each P wave but takes longer.

P-R interval longer than normal (> 0.2 sec)

38
Q

2nd Degree AV Block

A

Intermittent block at the AVN (dropped beats)

39
Q

Mobitz I

A

progressive lengthening of the PR interval, eventually resulting in a dropped beat.
Usually vagal in origin

40
Q

Mobitz II:

A

Pathological, may progress to complete heart block (3rd degree HB)
Usually 2:1, or 3:1, but may be variable
Permanent pacemaker indicated

41
Q

types of pacemakers

A

Single chamber (paces the right atria or right ventricle only)

Dual chamber (paces the RA and RV)

(Implanted under local anesthesia)

42
Q

what is ectopy most likely to be

A

symptomatic if associated with reduction in BP

43
Q

causes of ventricular ectopics

A

Structural causes: LVH, heart failure, myocarditis

Metabolic: Ischaemic heart disease, electrolytes

Inherited cardiac conditions e.g. hypertrophic cardiomyopathy

44
Q

management of ventricular ectopics

A

investigate cause and treat accordingly

  • Beta-blockers, Ablation of ectopic focus, AAD
45
Q

Ventricular Fibrillation

A

Chaotic ventricular electrical activity which causes the heart to lose the ability to function as a pump

46
Q

treatment for Ventricular Fibrillation

A

Defibrillation, Cardiopulmonary resuscitation

47
Q

VT acute treatment

A

Direct current cardioversion (DCCV) if unstable.

If stable: consider initial pharmacologic cardioversion with AAD, in meantime prepare for DCCV.

48
Q

Correct triggers for VT

A

Electrolytes
Ischaemia
Hypoxia
Pro-arrhythmic medications (eg drugs that prolong the QT interval eg., sotalol).

49
Q

Long term treatment for VT

A

Correct ischaemia if possible (coronary artery disease management , including PCI, bypass surgery)

Optimise CHF therapies.

Anti-arrhythmic drugs to date have been shown to be ineffective and are associated with worse outcomes.

Implantable cardiovertor defbrillators (ICD) if life threatening and high risk of recurrence.

VT catheter ablation.

50
Q

ICD

A
  • Does everything pacemmaker does +
    • ICD used for monitoring heart rythmns

cardio disease profiles (16 decks)

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