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General Med > Cardiac Arrhythmias > Flashcards

Cardiac Arrhythmias Flashcards

1
Q

Fast AF

A

?Heart failure, hypotension, impaired consciousness, Tachy >200bpm —- DC cardiovert + anti-coagulation

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2
Q

Paroxysmal AF

A

Should be self limiting

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3
Q

Persistent AF

A

Fails to self-terminate within 7 days
Rhythm control - B-blocker, amiodarone, flecainide
(Rate control - B-blocker, verapamil/diltazem, digoxin

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4
Q

Permanent AF

A

Rate control - B-blocker, verapamil/diltazem, digoxin

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5
Q

SVT

A

Adenosine

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6
Q

VT

A

Defibrilator + amiodarone 300mg IV/adrenaline 1mg IV post third shock

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7
Q

VF

A

Defibrilator + amiodarone 300mg IV/adrenaline 1mg IV post third shock

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8
Q

1st degree Heart block

A

Monitor + remove AVN blocking drugs + pacing (rare)

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9
Q

2nd degree: Mobitz Type 1 Heart block

A

Monitor + remove AVN blocking drugs + pacing (rare)

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10
Q

2nd degree: Mobitz Type 2 Heart Block

A

Removing AVN blocking drugs + Pacing

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11
Q

3rd degree/complete heart block

A

Removing AVN blocking drugs + Pacing

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12
Q

Bradyarrhythmia causes

A

“DIVISIONS”

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13
Q

Indications for pacing

A

Complete HB/Mobitz type 2 HB
Symptomatic Bradycardia
Tachycardia prevention
…

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14
Q

Indications for rhythm control over rate control (x5)

A 
New onset AF
Reversible cause
Heart failure primarily caused by AF
A. flutter that can be ablated 
Clinical judgement
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15
Q

Dihydropyridine CCB

A

Nefidipine and Amlodipine
- Vasodilatory
- DO NOT EFFECT RATE
SE: flushing, peripheral oedema + gum hypertrophy (nefidipine)

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16
Q

Non-dihydropyridine CCB

A

Diltazem and verapamil
- Negative inotrope
- slow SA/AV conduction
SE: constipation, peripheral oedema, gynaecomastia
CI: LVF + bradycardia, 2nd/3rd degree heart block

17
Q

Drugs that cause gynaecomastia

A

DISCO

  • Digoxin
  • Isoniazid
  • spirinolactone
  • cimetidine
  • Oestrogens

Diltazem + verapamil ?

18
Q

Nitrates (x6)

A

GTN
Isosorbide mono/dinitrate

Nicorandil

Ivabradine

Trimetazidine
Ranolazine

19
Q

GTN and ISMN MoA, SE

A

Increase cGMP causing vasodilation and therefore decreasing preload

SE: hypotension, syncope, headache, flushing

CI: AS/MS, constrictive pericarditis/tamponade, HOCUM, anaemia, glaucoma, raised ICP

ISMN has longer half life

20
Q

Nicorandil MoA, SE, CI

A

Activates SM K channel causing hyperpolarisation which inhibits Ca influx leading to vasodilation

SE: headaches, flushing, GI ulcers

CI: cardiogenic shock

21
Q

Alpha-1 blocker

A

Prazosin
Tamsulosin
Doxazosin

22
Q

Non-selective alpha blocker

A

Phenoxybenzamine

Phentolamine

23
Q

Dobutamine

A

mixed alpha 1 and beta 1 agonist

Inotropic and chrontropic effect

24
Q

Adrenaline

A

alpha and beta agonist

25
Phenyeprhine
Alpha 1 agonist
26
Noradrenaline
Beta 1 greater than alpha agonist
27
Isoprenaline
Beta agonist
28
Vaughn-Williams classification of antiarrhythmics
``` Class 1 (interfere with sodium channel) - 1a = Fast channel blockers + QRS effect (quinidine, procainamide) - 1b = Fast channel blockers (phenytoin, lignocaine) - 1c = slow blockers (flecanide) Class 2 (B-blockers) ... Class 3 (K outflux blocker) - Amiodarone, sotalol Class 4 (Ca Channel blocker) - Verapamil, diltazem Class 5 (unknown mechanism) - Adenosine, digoxin, MgSO4 ```
29
Flecanide Indications, SE
Vaughn-Williams Class 1c Indications: WPW, AF, ectopic suppression SE: Oedema, dyspnoea
30
Amiodarone indications, SE
Vaughn-Williams Class 3 (Inhibit Na/K ATPase in mycardium) Indications: SVT, AF/flutter, VF SE: - eyes: corneal deposits - lungs: fibrosis - Thyroid: dysfunction - GI: N&V, deranged LFTs - Skin: photosensitivity, pheblitis, blue-grey discolouration CI: Thyroid disease, sinus bradycardia, prologed QT
31
Digoxin
``` Vaughn-Williams Class 5 Indications: AF/flutter, SVT, HF (nb evidence low) SE: Eyes: yellow vision Heart: arrhythmias Gynaecomastia reverse tick ECG and raised K CI: complete HB, VF/VT, HOCUM, WPW Increased toxicity with amiodarone, CCB and diuretics ```
32
Adenosine
Indications SVT SE: bronchospasm, impending doom CI: asthma, heart block, sick sinus syndrome, low BP, prolonged QT
33
Aspirin
Irreversible COX inhibitor therefore decreased thromboxane A2 + prostacyclin produciton SE: gastritis/ulceration, bleeding, bronchospasm, ototoxic, gout, renal failure CI: <16 years (Reye's syndrome - except Kawasakis), active peptic ulcer disease, gout, pregnancy Stop 7 days before any surgery
34
Clopidogrel
Prodrug Inhibits ADP-induced platelet aggregation (inhibits binding to GpIIb/IIIa) SE: bleeding, GI upset, TTP, blood dyscrasia
35
Abciximab and Tirofiban
monoclonal Ab/synthetic GpIIa/IIIb inhibitor | SE: thrombocytopenia, bleeding

General Med (17 decks)

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