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AB 4th Year Gen Med > Cardiovascular - Arrhythmias > Flashcards

Cardiovascular - Arrhythmias Flashcards

1
Q

what is atrial flutter?

A

rapid and regular form of atrial tachycardia

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2
Q

risk factors for atrial flutter?

A 
cardiac surgery
valve disease
COPD
asthma
HF
hyperthyroid
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3
Q

features of arrythmias?

A 
palpitations
chest pain 
syncope
pre syncope
fatigue
sweating
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4
Q

why does atrial flutter occur?

A

re entrant circuit in the RA (where SA node is located)

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5
Q

what does atrial flutter usually progress to?

A

AF

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6
Q

features of an atrial flutter EGC?

A

saw tooth baseline

tachycardia

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7
Q

treatment for atrial flutter?

A

rhythm: amiodarone or cardioversion

rate: verapamil
bisoprolol
digoxin
amiodarone

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8
Q

why does AF occur?

A

ectopic foci in the pulmonary veins cause re-entry circuits

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9
Q

what are the different types of AF?

A

paroxysmal 48hrs-7days
persistent > this time
permanent (cannot be restored)

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10
Q

risk factors for AF?

A 
HT
HF
obesity
thyroid disease
valve disease
congenital heart disease
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11
Q

ecg changes for AF?

A

irregularly irregular
absent p waves
f waves replace instead

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12
Q

acute AF treatment?

A

<48hrs - anticoag and
cardiovert if haem unstable OR

amiodarone (structural disease)
flecanide if not
(rhythm)
rate control (Bb/CCB)

> 48hrs - anticoag for 3 weeks pre cardioversion

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13
Q

what drugs can be used for rate control?

A

verapamil
diltiazem
bisoprolol
digoxin

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14
Q

what are people with AF.at high risk of? why?

A

stroke

blood begins to pool in atria due to irregular contractions

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15
Q

what is bradycardia?

A

HR <60bpm

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16
Q

causes of bradycardia?

A 
hypothyroid
physical fitness
infections
raised ICP
hyperkalaemia
hypothermia
increased vagal tone
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17
Q

what drugs can cause bradycardia?

A

Bb
CCB
digoxin
anti arrythmia drugs

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18
Q

Ix for bradycardia?

A

ECG
holter monitoring
find the cause (CT, bloods..)

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19
Q

when is bradycardia treated? how?

A

if rate <40bpm and symptomatic

atropine IV
if no response -> pacing wire
pacemaker for permanent fix

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20
Q

what is SVT?

A

rapid regular rhythm arising from atria or involving SA node

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21
Q

what must be excluded before SVT is diagnosed?

A

AF
atrial flutter
sinus tachycardia

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22
Q

what type of tachycardia is SVT?

A

regular narrow complex

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23
Q

what is a junctional rhythm?

A

impulse starts at AV node not SA

impulse travels to atria and ventricles at same time

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24
Q

what is an example of a junctional rhythm?

A

AV nodal re entry tachycardia

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25
Q

what occurs in WPW?

A

congenital accessory pathway between atria and ventricles

ventricles are pre excited

26
Q

what changes occur on an ECG in WPW?

A 
broad complex QRS
delta wave (slurred upstroke to QRS)

can present as SVT

27
Q

changes on an ECG in SVT?

A

narrow QRS

no p waves (atrial depol)

28
Q

treatment for SVT?

A

vagal manouvres
rhythm: IV adenosine (verapamil if asthmatic)
DC cardioversion

prevent future episodes: verapamil/atenolol

29
Q

what type of rhythms are broad complex?

A

ventricular

30
Q

features of VF?

A

loss of consciousness

31
Q

what is VT associated with?

A

haemodynamic compromise

32
Q

ECG changes for VT?

A

regular broad complex tachycardia

33
Q

ECG changes for VF?

A

no clear waveforms

34
Q

what can cause torsades des pointes? what is it?

A

type of VT

overuse of antiarrythmic drugs

35
Q

treatment for VF?

A

3 shocks

1mg adrenaline and 300mg amiodarone

repeat CPR and give medications every 3-5 mins (alternating with shocks)

36
Q

treatment for VT?

A

pulseless: same as VF
pulse: cardioversion/amiodarone

37
Q

what long term treatment can be given after VT?

A

ICD/radiofrequency ablation

38
Q

treatment for torsades des pointes?

A

IV magnesium sulphate

39
Q

what is heart block?

A

conduction is blocked through the AV node

40
Q

causes of heart block?

A 
age
MI
myocarditis
drugs (Bb, CCB)
surgery
amyloidosis
41
Q

ECG changes of 1st degree heart block?

A

PR interval prolonged

42
Q

ECG changes of 2nd degree heart block?

A

Mobitz I: progressive lengthening of PR interval until eventual beat dropped
can have a vagal cause

Mobits II: ratio of 2:1/3:1 of eventual beat dropped
always pathological

43
Q

ECG changes of 3rd degree heart block?

A

no action potential from SA to AV

no relationship with P and QRS

44
Q

treatment of heart block types?

A

1: none

2: ventricular pacing for Mobitz II
Mobitz I no treatment unless severe

3: ventricular pacing

45
Q

what happens in bundle branch block?

A

one of the L/R bundle branches is no longer conducting

46
Q

causes of RBBB?

A

RVH
cor pulmonale
PE
CVD

47
Q

causes of LBBB?

A

MI
HT
cardiomyopathy

48
Q

what leads are used to determine BBB?

A

V1 and V6

49
Q

ECG features of BBB?

A 
broad QRS
William Morrow (LHS)
williaM morroW (RHS)
50
Q

treatment for BBB?

A

pacemaker

51
Q

causes of tachycardia?

A

hyperthermia
hypoxia
hypercapnia
hypokalaemia

52
Q

causes of narrow complex tachycardias?

A

AF
atrial flutter
SVT
sinus tachycardia

53
Q

causes of sinus tachycardia?

A 
anaemia
anxiety
pain
PE
pregnancy
drugs (caffeine)
54
Q

treatment for sinus tachycardia?

A

vagal manouvres e.g valsalva

55
Q

treatment for LVH?

A

optimise BP control

56
Q

who gets rate control in AF? what does this mean?

A

> 65yrs
ischaemic heart disease
heart disease

accepts pulse will be irregular

57
Q

who gets rhythm control in AF? what does this mean?

A

younger
asympt
first time
hear failure

gets them back to sinus

58
Q

in what scenario is digoxin used for rate control in AF?

A

patient has co existing heart failure

59
Q

what can be used for rhythm control in AF?

A

sotalol
amiodarone
flecanide
catheter ablation

60
Q

what scoring is used to determine if anticoagulation is needed in AF?

A

Cha2Ds2VASc

61
Q

after cardioversion, how long should patients be anticoagulated for?

A

4 weeks

AB 4th Year Gen Med (27 decks)

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