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C21 Phase 1 > Case 12 - Cardiac Arrhythmias > Flashcards

Case 12 - Cardiac Arrhythmias Flashcards

1
Q

Role of Ca2+ in vascular smooth muscle contraction

A

Begins an IP3 signal

Causes actin-myosin formation

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2
Q

Role of Ca2+ in cardiomyocyte contraction

A

Causes calcium-induced-calcium-release

Induced actin-myosin bridging

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3
Q

Definition of cardiac failure

A

Heart failing to pump effectively to meet the body’s oxygen and nutrient demands

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4
Q

Features of systolic failure

A

Weak contraction, reduced ejection fracture

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5
Q

Features of diastolic failure

A

Compromised relaxation, preserved ejection fracture

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6
Q

Describe the renin-angiotensin-aldosterone system

A

When low BP is detected:

angiotensinogen -> angiotensin I -> angiotensin II

This activates the angiotensin II receptors which releases aldosterone and causes blood pressure to increase

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7
Q

How do ACE (angiotensin converting enzyme) inhibitors work and give an example

A

Occupy the active site of the ACE that would normally taken by angiotensin I. Eg, ramipril

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8
Q

How do ARBs (angiotensin receptor blockers) work and give an example

A

Shift the balance of receptors that angiotensin II binds to. If angiotensin I receptors are full then they occupy angiotensin II receptors which has an opposing effect and reduces blood pressure. Eg, Candesartan

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9
Q

How do beta blockers work

A

Beta 1 adrenoceptor blockers than reduce cardiac output by having a negative chronotropic and inotropic effect

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10
Q

How does digoxin work and what is it used to treat

A

Positive inotrope used for elderly/sedentary patients. Used to treat congestive heart failure, atrial fibrillation and atrial flutter

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11
Q

How do loop diuretics work and give an example

A

Inhibits the Na+/K+/2Cl- symporter in the ascending loop. Eg, furosemide

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12
Q

How do thiazide diuretics work and give an example

A

Acts on early distal convoluted tubules and may cause hypokalaemia. Eg, Bendroflumethiazide

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13
Q

How do potassium sparing diuretics work

A

works by competing aldosterone for its mineralocorticoid receptor

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14
Q

What is an SVT

A

Tachycardia not affecting the ventricles alone

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15
Q

What is an ILR and what is it used for

A

An implantable loop recorder used to record heart arrhythmias over a long time

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16
Q

Direction of travel of accessory pathways

A

Atria to ventricles or vice versa

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17
Q

Presentation of compensated heart failure

A

Warm, perfused, stable

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18
Q

Presentation of decompensated heart failure

A

Cold, decreased BP, congested lungs

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19
Q

Triggers for cardiac failure decompensation

A

arrhythmia
non-compliance with medication
infection
acute coronary syndrome

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20
Q

Common co-morbidities to cardiac failure

A

Sleep apnoea
Anaemia
Mitral regurgitation
AF

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21
Q

Types of non-ischaemic cardiomyopathy

A

Hypertrophic
Dilated
Restrictive

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22
Q

Causes of non-ischaemic cardiomyopathy

A

genetics
acquired
idiopathic

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23
Q

ECG findings of hypertrophic cardiomyopathy

A

Sinus rhythm
AF
T wave inversion

24
Q

Features of dilated cardiomyopathy

A

Cardiac enlargement, reduced systolic function

25
Q

Features of restrictive cardiomyopathy

A

Normal cardiac size, reduced systolic and diastolic function, bi-atrial enlargement, usually results from myocardial infiltration

26
Q

Symptoms of arrhythmia

A 
May be asymptomatic
chest pain
dizziness
breathlessness
palpitations
syncope
sudden death
27
Q

Ectopic beats ECG presentation

A

Atrial - narrow QRS
Ventricular - broad QRS
May be followed by a compensatory pause

28
Q

Types of AF

A

Paroxysmal - episodes last less than 48hrs
Persistent - episodes last 48hrs-1 week
Permanent - Permanent

29
Q

AF ECG presentation

A

Absent clear P waves

30
Q

Atrial flutter presentation on ECG

A

Saw-tooth p waves

31
Q

Symptoms of AF

A

Palpitations, breathlessness, chest pain, cerebral thromboembelotic events

32
Q

Causes of AF

A

Structural - valvular disease, IHD, cardiomyopathies

Non-structural - severe infections, drugs, caffeine

33
Q

Treatment for AF

A

Rate and rhythm control drugs

Warfarin/DOACs

34
Q

Indications of accessory pathway on ECG

A

short PR interval

35
Q

Features of a pacemaker

A

Requires lifestyle change

  • can’t work as a welder, pilot or diver
  • requires regular check ups and battery changes
36
Q

Features of heart block

A

Occurs when conduction from atria -> ventricles is blocked or slowed

37
Q

1st degree heart block on ECG and treatment

A

Slow conduction at AV node, long PR interval

Usually doesnt need treatment

38
Q

2nd degree heart block on ECG and treatment

A

intermittent conduction from atria to ventricles, P waves may occur with no QRS complexes

treatment = pacemaker/drugs

39
Q

3rd degree heart block on ECG and treatment

A

failed conduction from atria to ventricles. Heart may beat if escape rhythm is present, otherwise causes ventricular asystole

treatment = pacemaker/drugs

40
Q

Causes of heart block

A

age-related, ischaemia, drugs, congenital heart conditions, hypothermia, hypothyroidism

41
Q

Investigations following broad complex tachycardia

A

echo, cardiac MRI, coronary angiogram

42
Q

Symptoms of broad complex tachycardia

A

Palpitations, breathlessness, chest pain, cardiac arrest

43
Q

What is an ICD and what does it do

A

An implantable cardiac defibrillator

  • constantly monitors heart rhythm
  • will deliver shock if in abnormal heart rhythm
44
Q

Examples of inherited cardiac diseases

A

Cardiomyopathies
Long QT syndrome
Wolff-Parkinsson-White syndrome

45
Q

Which ECG leads look at the inferior aspect of the heart

A

II
III
aVF

46
Q

Which ECG leads look at the lateral aspect of the heart

A

I
aVL
V5
V6

47
Q

Which ECG leads look at the anterior/septal aspect of the heart

A

V1
V2
V3
V4

48
Q

Features of long QT syndrome

A

Long QT syndrome (LQTS) is a condition in which repolarization of the heart after a heartbeat is affected. It results in an increased risk of an irregular heartbeat which can result in fainting, drowning, seizures, or sudden death. These episodes can be triggered by exercise or stress

49
Q

Features of bundle branch block

A

Left bundle branch block is a cardiac conduction abnormality seen on the electrocardiogram. In this condition, activation of the left ventricle of the heart is delayed, which causes the left ventricle to contract later than the right ventricle

50
Q

Parasympathetic and Sympathetic innervation to the heart

A

Parasympathetic - vagus nerve

Sympathetic - sympathetic nerve, adrenaline

51
Q

Symptoms of decompensated heart failure

A 
•	weakness
•	fatigue
•	irregular or fast heartbeat
•	coughing and wheezing
•	spitting up pink phlegm
•	decreased ability to concentrate
increased weight
52
Q

Risk factors for cardiac failure

A
  • High blood pressure. Your heart works harder than it has to if your blood pressure is high.
  • Coronary artery disease. Narrowed arteries may limit your heart’s supply of oxygen-rich blood, resulting in weakened heart muscle.
  • Heart attack. A heart attack is a form of coronary disease that occurs suddenly. Damage to your heart muscle from a heart attack may mean your heart can no longer pump as well as it should.
  • Diabetes. Having diabetes increases your risk of high blood pressure and coronary artery disease.
  • Some diabetes medications. The diabetes drugs rosiglitazone (Avandia) and pioglitazone (Actos) have been found to increase the risk of heart failure in some people. Don’t stop taking these medications on your own, though. If you’re taking them, discuss with your doctor whether you need to make any changes.
  • Certain medications. Some medications may lead to heart failure or heart problems. Medications that may increase the risk of heart problems include nonsteroidal anti-inflammatory drugs (NSAIDs); certain anaesthesia medications; some anti-arrhythmic medications; certain medications used to treat high blood pressure, cancer, blood conditions, neurological conditions, psychiatric conditions, lung conditions, urological conditions, inflammatory conditions and infections; and other prescription and over-the-counter medications.
  • Sleep apnoea. The inability to breathe properly while you sleep at night results in low blood oxygen levels and increased risk of abnormal heart rhythms. Both of these problems can weaken the heart.
  • Congenital heart defects. Some people who develop heart failure were born with structural heart defects.
  • Valvular heart disease. People with valvular heart disease have a higher risk of heart failure.
53
Q

Features of Class I anti-arrhythmics

A

Sodium channel blockers

All class I drugs may worsen VTs. Class I drugs also tend to depress ventricular contractility.

54
Q

Features of Class II anti-arrhythmics

A

Beta blockers

adverse effects include lassitude, sleep disturbance, and gastrointestinal upset. These drugs are contraindicated in patients with asthma.

55
Q

Features of Class III anti-arrhythmics

A

Potassium channel blockers

risk of ventricular proarrhythmia, particularly torsades de pointes VT and are not used in patients with torsades de pointes VT

56
Q

Features of Class VI anti-arrhythmics

A

Calcium-channel blockers

side effects including constipation, upset stomach, heart failure, AV block, bradycardia, hypotension, and erectile dysfunction

57
Q

NYHA classification of heart failure patients

A
  • Class I - No symptoms and no limitation in ordinary physical activity, e.g. shortness of breath when walking, climbing stairs etc.
  • Class II - Mild symptoms (mild shortness of breath and/or angina) and slight limitation during ordinary activity.
  • Class III - Marked limitation in activity due to symptoms, even during less-than-ordinary activity, e.g. walking short distances (20—100 m).Comfortable only at rest.
  • Class IV - Severe limitations. Experiences symptoms even while at rest. Mostly bedbound patients.

C21 Phase 1 (45 decks)

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