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PHA 222 > cardiac arrthmias 4 > Flashcards

cardiac arrthmias 4 Flashcards

1
Q

what is the purpose of rhythm control

A

restore & maintain sinus rhythm

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2
Q

what ways can you restore sinus rhythm?

A

electrical cardioversion- DC
Pharmacological cardioversion-amiodarone
flecainide
propafenone

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3
Q

what do you do if the patient has haemodynamic instability?

A

electrical cardioversion

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4
Q

how do you maintain sinus rhythm and prevent cardiac AF?

A

Pharmacological therapy-β-blocker (other than sotalol)amiodarone, dronedarone flecainide, propafenone
non-pharm therapy :Non-Pharmacological therapy Left atrial catheter ablation –use of radiofrequency or cryoenergy to isolate pulmonary veins or other ectopic foci Surgical ablation –using the COX-Maze procedure

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5
Q

how do you control rate?

A

controlor slowing of the fast ventricular response via AV blockade

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6
Q

when is urgent control of ventricular rate needed?

A

during Paroxysmal & Persistent AF

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7
Q

what bb do you not use when managing AF?

A

sotalol

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8
Q

what drug would you give for rate control for heart failure?

A

β-blocker±Digoxin

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9
Q

what drug would you give for rate control for CAD?

A

β-blockerCalcium Channel Blocker Combination Rx

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10
Q

what treatment would give for AF if the patient didn’t have heart failure or CAD

A

β-blockerCalcium Channel Blocker Digoxin Combination Rx

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11
Q

what is an atrial flutter?

A

rapid, regular (or slightly irregular) & organised rhythm with atrial rate ~250-400/min, usually with 2:1 AV conduction

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12
Q

what is the main cause of atrial flutter?

A

usually due to a macro-reentrant mechanism in the right atrium involving the tricuspid valve annulus

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13
Q

what is atrial flutter very responsive to?

A

DC cardioversion

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14
Q

what is 1st line for restoration of sinus rhythm in atrial

A

RF catheter ablation

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15
Q

what is the two types of ventricular arrhythmias?

A

A wide spectrum of abnormal cardiac rhythms

Sustained Ventricular Arrhythmias

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16
Q

what is a ventricular tachyarrhythmias?

A

apid, regular run of 3 or more consecutive beats that originate from the ventricle
a150-250 beats/mint a rate of >100 beats/min

17
Q

what are the underlying mechanisms for VT?

A

reentry
triggered activity
enhanced/abnormal automaticity

18
Q

what does acute VT depend on?

A

depends on degree of haemodynamic compromise, type & duration of arrhythmia

19
Q

what is the most lethal ventricular arrhythmias?

A

Ventricular Fibrillation

20
Q

how many beats does a VF usually have per minute?

A

200

21
Q

what is the underlying mechanism for VF?

A

random/ multiple wavelength reentry

22
Q

what are the potential consequences of VF?

A

circulatory collapse death or irreversible brain damage

23
Q

what ways do you manage VF?

A 
electrical defibrillation (non-synchronisedcardioversion)
cardiopulmonary resuscitation (CPR)
pharmacological defibrillation amiodarone lidocaine
implantable cardioverter defibrillator (ICD)
24
Q

what is an atrioventricular block?

A

block of conduction through AV node and/or His-bundle or bundle branches

25
Q

what are the possible causes of atrioventricular block?

A

functional/pharmacological block of AV nodal Ca channels
heightened vagal tone
hyperkalaemia
organic lesions –degenerative or fibrotic disease

26
Q

what are the features of a first degree block?

A

prolonged PR interval > 0.2 seach atrial impulse is regularly transmitted to ventricles, but with delayusually due to impaired conduction in AV node

27
Q

what are the features of a second degree block?

A

intermittent blocked beats
some atrial impulses are not transmitted to ventricles
block could be in AV node or His-bundle or bundle branch

28
Q

what are the two types of second degree block?

A

Mobitztype I –progressively lengthening PR interval

Mobitztype II –constant PR interval

29
Q

what is a 3rd degree block?

A

complete AV or heart block
no transmission of atrial impulses to the ventricles
emergence of ‘escape’ or idioventricular rhythm (30-50 bpm)

30
Q

what may a 3rd degree block lead to?

A

asystolic cardiac arrest

‘Stokes-Adamssyndrome’

31
Q

how do you manage atrioventricular block?

A

withdraw culprit drug

pacemaker implantation

PHA 222 (40 decks)

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