Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

RACP Written 2018 > Cardiology - Arrythmias: Tachycardias > Flashcards

Cardiology - Arrythmias: Tachycardias Flashcards

1
Q

Inappropriate sinus tachycardia

  • when does it occur
  • how does it present
A

Presents in WOMEN in 3rd and 4th decades

With fatigue, chest pain, headaches, syncope and dizziness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Inappropriate sinus tachycardia

- treatments

A
  • Symptoms: beta blockers and CCBs
  • Others: clonidine and SSRIs
  • Ivabradine has some use
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Postural orthostatic tachycardia syndrome (POTS)

  • what is it?
  • When does it occur
A

= symptomatic sinus tachycardia with hypotension

Occurs post viral autonomic dysfunction
Resolves by 3-12 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Postural orthostatic tachycardia syndrome

- Treatments?

A

Salt tabs
Fludrocortisone
Compression stockings
Alpha agonist MIDODRINE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Focal Atrial Tachcardia

- ? how to treat

A

Carotid massage / valsalva / adenosine to see the p wave

Then treat as per SVT

Catheter ablation is an option, effective in >80% if recurrent focal AT and no response to medical treatments

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Atrial Flutter

- is ? percent of all SVTs

A

10% of all SVTs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Atrial Flutter

- Associated comorbidities?

A

60% of flutter have CAD or hypertensive disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

PITX2 gene

  • ? where is it
  • ? associated with what
A 
PITX2 gene (paired like homeodomain 2)
on Chromosome 4q25

Associated with atrial flutter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Atrial flutter

What heart rate and what does the ECG look like?

A

HR >250bpm

ECG: Sawtooth (esp in inferior leads and V1)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Atrial Flutter Treatment

A

1) Adenosine (can unmask the diagnosis AND 15% will terminate)
2) if HD unstable then cardioversion (NEED anticoagulation prior)
3) Antiarrythmics for recurrent episodes:
sotolol, ibutiline, dofetilide and flecainide
4) Ablation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the problem with flecainide in treating Atrial Flutter?

A

It can organise the pathways to cause an A flutter with 1:1 conduction
ALWAYS use with a BETA BLOCKER

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the problem with antiarrythmics used in treatment of Atrial Flutter

A

Sotolol, ibulitide, dofetilide and flecainide

Need to commence them as an inpatient due to risk of pause dependent torsade in first 48 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

In Atrial Flutter treatment WHERE is ablation targeted?

A

Cavotricuspid isthmus

abolishes arrythmia in 90%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How many atrial flutter presentations develop AF in the next 5 years?

A

50%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Aside from developing AF, what are the complications of atrial flutter?

A

LA thrombus (<20%)
Thromboembolism (14% at 5 years)
Stroke risk 4.1% per year

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Multifocal Atrial Tachycardia

  • what is it?
  • who gets it?
  • what is it associated with?
A

= at least 3 different distinct P wave morphologies due to triggered automaticity from multiple foci

Seen mainly in older males

Associated with:

  • Chronic pulmonary disease
  • Acute illness
17
Q

Multifocal Atrial Tachycardia

- treatment

A
  • Treat precipitating cause
  • Keep O2 >90%
  • CCBs verapamil or diltiazem
  • Beta blockers MAY work BUT if they have lung disease they might not tolerate them
18
Q

AV Nodal Re-Entry Tachycardia

  • what proportion of SVTs?
  • Which gender and age get it?
A

Most common SVT

Females more common in 2nd to 4th decades

19
Q

What JVP sign do you get in AV nodal re-entrant tachycardia and why?

A

Cannon a waves due to simultaneous atrial and ventricular contractions

20
Q

AV nodal re-entrant tachycardia

What rate is it usually?

A

Rate 150 - 200bpm

21
Q

AV nodal re entrant tachycardia

How does it form?

A

In 10% it is induced by a PVC

Two ways it develops.
TYPICAL: conduction down slow pathway then back up by fast (so short PR)

ATYPICAL: conduction down fast pathway then back up by slow (so long RP)

22
Q

AV nodal re entrant tachycardia

- treatments??

A

Physical:
- Physical vagal manouvres

Pharmaco:
- Adenosine
- AV node blockade/slowing:
EITHER
Beta blocker
Verapamil or diltiazem
Flecainide

Catheter Ablation:
Curative in >95% but 1% need a PPM

DCT if HD compromise

23
Q

Accessory Pathway Atrial Tachycardia

- what 5 disease associations?

A
  • Ebstein anomoly
  • HOCM
  • PAKAG2 mutation
  • Danon’s disease
  • Fabry’s disease
24
Q

Accessory Pathway Atrial Tachycardia

- what fails to cause this?

A

Failure of electrical partitioning between atrium and ventricle

As a result you get conduction from atrium to ventricle faster than going via the normal pathway
SO that ventricle is “pre-excited”

THEREFORE if you have a ‘Right Sided Pathway’ it means RV is pre-excited and there is LBBB

if you have a ‘left sided pathway’ it means the LV is pre-excited and there is RBBB

25
Q

What indicates a pre-excited ventricle?

A

Short PR
Slurred initial QRS (Delta)
Prolonged QRS

26
Q

What IS WPW?

A

A pre-excited QRS during sinus rhythm with episodes of SVT

27
Q

ECG Features of WPW:

A
  • Short PR
  • Wide QRS with delta wave
  • LAD if R sided accessory pathway
  • RAD if L sided accessory pathway
28
Q

Conditions associated with WPW

A 
HOCM
MVP
Ebstein's
Thyrotoxicosis
Secundum ASD
29
Q

AV Re-Entrant Tachycardia

? what is it?

A

NOT a pre-excitation syndrome

The impulse goes down the NORMAL conduction system then goes back UP via the ACCESSORY pathway

30
Q

Orthodromic (‘normal’) AV re-entrant tachycardia
? heart rate and ECG findings
? treatment

A

Rate 200 - 300bpm

ECG: QRS alternans and TWI

Treat with vagal manouvres
Adenosine or CCB

31
Q

Antidromic AV re-entrant tachycardia

A

Most common PRE-EXCITATION SVT

Conduction goes down the ACCESSORY path and then back UP via conduction path

32
Q

Antidromic AV Re-entrant Tachycardia

  • ? ECG findings
  • ? treatment to AVOID
A

Wide QRS complexes

DONT given AV blockade as it will provoke VT (beta blocker, adenosine, verapamil or diltazem)

33
Q

Best antiarrythmic to use with WPW?

A

Flecainide

34
Q

Ebstein anomoly?

A

Right heart enlargement with TR

35
Q

What to avoid in WPW?

A

Beta blockers
Adenosine
Verapamil
Diltiazem

36
Q

Lown-Ganong-Levine’s Syndrome (LGL)

A

Get paroxysms of tachycardia, type of pre-excitation syndrome

37
Q

Management of a Pre-Excitation Syndrome?

A

Do exercise stress test
IF LOSS of pre-excitation (happens in 20%) then it is a PREDICTOR OF LOW RISK

Then do EP if persistent pre-excitation.
If you can induce an arrythmia then ABLATE

RACP Written 2018 (167 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions