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JazCardio > Cardiac Arrhythmias > Flashcards

Cardiac Arrhythmias Flashcards

1
Q

2 categories of electrical dysfunction in the heart

A

defect in impulse formation or conduction

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2
Q

Defects in impulse formation causes of arrhythmias

A

altered automaticity - escapes, ectopics

triggered activity - early + delayed afterdepolarisations

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3
Q

defects in impulse conduction causes of arrhythmias

A

re-entry, conduction block, accessory tracts

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4
Q

Escape beat/rhythm occurs when

A

SAN impulse is pathologically low frequency or its conduction is impaired and latent pacemaker causes a beat/s

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5
Q

ectopic beat/rhythm occurs when

A

latent pacemaker fires faster than SAN

due to ischaemia, hypokalaemia, ^sympathetics and fibre stretch

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6
Q

early afterdepolarisation occurs in ____

ass. with

A

Purkinjes(often during Phase 2/3) can be self perpetuating

prolongation of AP and sotalol (prolonging QT drugs)

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7
Q

delayed afterdepolarisation caused by ___

ass. with __

A

transient Na influx

Ca2+ overload due to catecholamines, digoxin, HF

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8
Q

re-entry occurs when ___

A

damage of an area causes unidirectional block and so retrograde current not cancelled out and = circus rhythm

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9
Q

First degree heart block =

A

PR interval prolonged

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10
Q

Mobitz type 1 2nd degree heart block

A

PR gradually increases until QRS dropped

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11
Q

2nd degree Mobitz Type 2 heart block

A

PR interval constant but every nth QRS iis dropped

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12
Q

complete/ 3rd degree heart block

A

atria and ventricles beat independently

Purkinje pacemaker is slow and unreliable = bradycardia and low CO

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13
Q

accessory pathway that bypasses AVN =

A

bundle of Kent

may => tachyarrhythmias

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14
Q

Atrial arrhythmias =

A 
AF
atrial flutter
ectopic atrial tachy
sinus brady
sinus pauses
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15
Q

AVN arrhythmias =

A

AVN re-entry
accessory pathway
AVN block

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16
Q

Ventricular arrhythmias =

A

PVC (premature ventricular complex)
VT
VF
asystole

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17
Q

6 causes of cardiac arrhythmias:

A

anatomical - congenital, accessory pathways
autonomic - symp/vagal tone
metabolic - hypoxic myocardium (COPD, PE) iscahemic myocardium (MI, angina), electrolyte imbalances
drugs - esp if block K+ channels
inflammation - viral myocarditis
genetic

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18
Q

Causes of altered automaticity:

A

ischaemia, catecholamines

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19
Q

hyperthermia, hypoxia, hypercapnia, cardiac dilation, hypokalaemia _____ the Phase 4 pacemaker potential slope in nodal cells

A

increase

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20
Q

Hypokalaemia cause the pakemaker potential slope in nodal cells to ___
____ ectopics
_____ repolarisation

A

increases slope
increases ectopics
prolongs repolarisation

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21
Q

Hypothermia and hyperkalaemia ___ the Phase 4 pacemaker potential slope in nodal cells

A

decrease

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22
Q

Hyperkalaemia _____ conduction in nodal cells

A

slows

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23
Q

Pause dependant triggered activity causes a _____ in phase ____
= _____ after-depolarisation

A

after depolarisation in phase 3

early after-depolarisation

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24
Q

Catechol dependant triggered activity causes a ____ in phase ____
= _____ after-depolarisation

A

afterdepolarisation in late phase 3 / 4

delayed after-depolarisation

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25
Q

Triggered activity is behind ____ toxicity, _____ in long QT syndrome and ____kalaemia

A

digoxin toxicity
torsades de pointes in long QT
hypokalaemia

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26
Q

conditions that ___ conduction velocity or ____ refractory period promote functional block =>

A

depress conduction velocity / shorten refractory period

re-entry

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27
Q

eg.s of re-entry arrhythmia causes

A

WPW - accessory pathways
previous MI
AVN re-entry

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28
Q

Electrophysiological (EP) study =

A

induce arrhythmia and study it

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29
Q

24hr Holt ECG is used to diagnose

A

paroxysmal arrhythmias

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30
Q

used to look for a structural cause behind arrhythmias =

A

echocardiogram

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31
Q

Use an exercise ECG to see if there is ___

A

exercise related arrhythmia

myocardial ischaemia eg. Stable angina

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32
Q

Treatment for atrial ectopics =

A

none - usually asymptomatic / palpitations
can give β-blockers if needed
avoid stimulants

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33
Q

A bp of less than ___ indicates sinus bradycardia
common in _____ STEMI
Treatment =

A

60bpm
inferior
acute = atropine
haemodynamically unstable = pacing

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34
Q

A bp of more than ___ indicates sinus tachycardia

Treatment =

A

100bpm

β-blockers

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35
Q

Management of acute SVT
1st line =
2nd line =

A 
1st = vagal manoeuvre -> carotid massage (not if stroke risk)
2nd = IV adenosine / verapamil
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36
Q

carotid massage is not done for acute SVT if ____

A

at risk of stroke

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37
Q

Management of chronic SVT:

A

avoid stimulants
β-blockers/verapamil
radiofrequency ablation - must have no anti-arrhythmics for 3-5 days before

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38
Q

Anti-arrhythmics that can cause heart block

A

β-blockers

CCB - verapamil

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39
Q

Acquired complete heart block seen in the elderly due to idiopathic fibrosis and calcification of the conduction system

A

Lenegre-Lev disease

40
Q

Treatment for 1st degree heart block

A

none

41
Q

Treatment for 2nd degree heart block

A

dual chamber pacemaker (RA + RV)

42
Q

Treatment for complete heart block

A

Dual chamber pacemaker (RA and RV)

43
Q

RA pacemakers are used in ____

A

SAN disease with normal AVN

44
Q

RV pacemakers are used in ____

A

AF with slow ventricular rate

45
Q

Transcutaneous pacemakers are given in ____ scenarios until a ____ can be placed

A

acute - emergencies - painful to place

transvenous pacemaker

46
Q

PVC - premature ventricular complex are usually ____ but may get ____ as bp drops after beat

A

asymptomatic
brief dizziness
If is worse on exertion investigate further

47
Q

Common causes of PVC -

A

structural/ischaemic HD
LV hypertrophy
HF

48
Q

Treatment of PVC - premature ventricular complexes

A

β-blockers

49
Q

broad complex tachycardia are associated with ___ or ____

A

significant heart disease - coronary artery disease/MI

cardiomyopathy/inherited - eg. Brugada

50
Q

Treatment of VF:

A

defibrillate
cardiopulmonary resuscitation
ICD dual chamber

51
Q

Treatment of acute VT:

A 
DC cardioversion (unstable)
anti-arrhythmics - amiodarone / lidocaine (stable)
if non-confirmed diagnosis - adenosine
52
Q

In VT _____ must be corrected if are the cause

A

electrolytes

53
Q

chronic VT treatment:

A

ICD - dual chambers (life-threatening)

β-blockers

54
Q

anatomically AF usually arise from ____

A

near pulmonary veins in LA

55
Q

Paroxysmal AF =

A
56
Q

Persistent AF =

A

> 48hrs

can be cardioverted to normal (but doesnt occur spontaneously)

57
Q

Permanent/chronic AF =

A

not able to be cardioverted by treatment

58
Q

Sick sinus syndrome is caused by ___

causes ____

A

dysfunction of the SAN causing arrhythmias eg. AF

tachy - brady

59
Q

Causes of AF:

A 
alcohol
congenital
heart surgery
COPD
pneumonia
pericarditis
vagal causes
60
Q

lone/idiopathic AF occurs in ___ of HD w ___ ventricular dysfunction

A

absence of HD

no ventricular dysfunction

61
Q

Treatment to terminate AF (rhythm control):

A

DC cardioversion - 90% effective
Flecainide/sotalol/amiodarone - 30% effective
β-blockers and CCB can stop VT developing

62
Q

In AF ECG:
HR = ____
Rhythm = ___
Defining characteristic = ___

A

> 300bpm
irregularly irregular
no p waves - fine f waves

63
Q

If AF with VT then treat with ___

A

pacemaker

to stop pseudo-regularisation => coronary hypoperfusion

64
Q

Treatment for rate control of AF (slow AVN conduction + stop VT developing)

A

Digoxin, β-blockers and CCB - diltiazem and verapamil

65
Q

Treatment to chronically stop AF =

A

anti-arrhythmics

catheter ablation - of near pulm veins/AVN

66
Q

Given in all cases of AF (except valvular):

A

anti-coagulation

67
Q

Torsades de Pointes
HR=
ECG features =
causes=

A

200-250bpm
polymorphic, wide QRS, long QT
hypokalaemia, AP prolonged (by drugs), renal impairment (increases drug levels)

68
Q

Score used to decide whether or not to give anti-coagulants by risk of thrombo-embolism:

A

CHA2DS2 - VASc

or if have mitral valve disease give anticoag.s

69
Q

CHA2DS2 - VASc score

A 
CCF/LV dysfunction
Hypertension
Age >=75yo 2 points
Diabetes mellitus
Stroke 2 points
Vascular disease
Age 65-74yo
Sex = Female
70
Q

Score used to measure haemorrhage risk:

A

HASBLED

71
Q

HASBLED factors =

more likely to haemorrhage

A 
Hypertension
Abnormal renal/liver function
Stroke
Bleeding
Labile INRs
Elderly >65yo
Drug/alcohol
72
Q

Rapid regular form of ren-entrant atrial tachycardia

A

Atrial flutter

73
Q

Usually paroxysmal, caused by macro-re-entry circuit in RA:

A

atrial flutter

74
Q

Atrial flutter if chronic can lead to

A

AF

75
Q

ECG features for atrial flutter

A

saw tooth F wave

2V to 1A beat - so Ventricular rate is slower

76
Q

Treatment for atrial flutter if doesn’t spontaneously resolve:

A

RF ablation (80-90%)
Ia, Ic, III anti-arrhythmics to restor sinus rhythm/slow vent. rate
cardioversion
warfarin

77
Q 
Congenital Long QT syndrome
Brugada Syndrome
Catecholaminergic Polymorphic Ventricular tachycardia (CPVT)
Short QT syndrome
Progressive familial conduction disease
Familial AF 
Familial WPW
ALL =
A

inherited arrhythmogenic channelopathies

78
Q

KVLQT1 (K+ channel) defect is main cause of

A

Long QT syndrome

79
Q

Long QT causes ___ triggered by adrenergic stimulation

A

torsades de pointes

80
Q

Autosomal dominant isolated LQT syndrome =

A

Romano-Ward syndrome

81
Q

Autosomal dominant LQT syndrome with extra-cardiac features (2)

A 
Andersen-Tawil syndrome (muscle weakness and abnormal features)
Timothy syndrome (webbed digits)
82
Q

Autosomal recessive LQT w deafness

A

Jervell-Lange-Neilson syndrome

83
Q

___ repolarisating current OR ____ depolarising current increase AP duration

A

decreasing repol

increasing depol

84
Q

Increase in the Na+ current in myocytes is a ___ form of LQTS and is 90% penetrant for ____

A

rare

sudden cardiac death

85
Q

Brugada syndrome is autosomal ___
8x more likely in ___
Have a risk of ++__

A

dominant
males
torsades de pointes, VF, AF

86
Q

Main channels affected in Brugada syndrome

A

Na+ (SCNSA)

Ca2+ (CaCN1Ac)

87
Q

ECG in Brugada syndrome shows:

may only be seen with provocative testing with ___/___ as block Na+ channels

A

STE and RBBB in V1-3

flecainide/ajmaline

88
Q

In Brugada syndrome avoid:

A

anti-arrhythmics, psychotropics, analgesics, anaestesia

89
Q

Catecholaminergic polymorphic VT (CPVT) is ___ if inherited due to ___ mutation
___ if inherited due to ___ mutation

A

autosomal dom - ryanodine (ryR2) receptor

autosomal recessive - cardiac calsequestrin gene (CASQ2)

90
Q

In CPVT treatment =

A

avoid exercise
β-blockers
ICD if necessary (flecainide if can’t)

91
Q

Atrial flutter has regular/irregular QRS complexes

A

regular - commonly 2:1

92
Q

Drugs that cause a lengthened QT

A 
sotalol
quinidine
antihistamines
macrolides
amiodarone
phenothiazines
tricyclics
93
Q

Low __,___+___ (electrolytes) causes lengthened QT

A

K+ Ca+ Mg2+

94
Q

ECG pattern seen in RBBB

A

MaRRoW
M in V1
W in V6

95
Q

ECG pattern seen in LBBB

A

WiLLiaM
W in V1
M in V6

96
Q

Causes of RBBB

A

normal variant
PE
cor pulmonale

97
Q

Causes of LBBB

A

IHD
hypertension
cardiomyopathy
idiopathic fibrosis

JazCardio (15 decks)

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