Clinical Management of Arrhythmias

Question 1

What is an arrhythmia?

Answer 1

Abnormal heart beat

Question 2

What can arrhythmias be defined as?

Answer 2

Too fast
Too slow
Extra beats
Missed beats

Question 3

What is bradycardia?

Answer 3

<60 bpm

Question 4

What is tachycardia?

Answer 4

> 100 bpm

Question 5

What is associated with tachyarrhythmia?

Answer 5

Atrial fibrillation
Atrial flutter
Supraventricular tachycardia
Ventricular tachycardia
Ventricular fibrillation

Question 6

What are the different types of atrial fibrillation?

Answer 6

Paroxysmal AF
Persistent AF
Permanent AF

Question 7

What is paroxysmal AF?

Answer 7

Episode stops within 48hrs without treatment

Question 8

What is persistent AF?

Answer 8

Episode lasts >7 days

Question 9

What is permanent AF?

Answer 9

Present all the time

Question 10

What is supraventricular tachycardia?

Answer 10

Fault in electrical impulses above ventricles

Question 11

What is associated with bradyarrhythmia?

Answer 11

Sick sinus syndrome
Heart block

Question 12

What are the different types of arrhythmias?

Answer 12

Premature heartbeats
Premature atrial contractions
Premature ventricular contractions

Question 13

What does arrhythmias present as?
SYMPTOMS

Answer 13

Fluttering sensation in chest
SOB
Dizziness
Fatigue
Fainting
Sweating
Anxiety

Question 14

What are the causes?

Answer 14

Coronary artery disease
High B.P= uncontrolled
Diabetes
Caffeine
Thyroid toxicosis
Alcohol
Smoking
ACS
Valvular disease

Question 15

What are the complications of arrhythmias?

Answer 15

Stroke
Heart failure
Sudden death

Question 16

What is an ischaemic stroke?

Answer 16

Ischaemic tissue from clot = artery blocked

Question 17

What is a haemorrhage stroke?

Answer 17

Clot bursts = bleed in brain

Question 18

What is catheter ablation?

Answer 18

Pushed into heart to find where impulse is coming from
Create scar tissue = doesn’t conduct

Question 19

Which drugs are used for rate control?

Answer 19

Beta blockers
CCB
Cardiac glycoside

Question 20

What is an example of a beta blocker you would use?

Answer 20

Bisoprolol

Question 21

What is an example of CCB you would use?

Answer 21

Diltiazem
Verapamil

Question 22

What is an example of cardiac glycoside you would use?

Answer 22

Digoxin

Question 23

Which drug would you use to control rhythm?

Answer 23

Amiodarone

Question 24

What do you council a patient on taking beta blockers?

Answer 24

Fatigue
Nightmares
Cold peripheries
Bronchospasm
Mask hypoglycaemia = diabetes
Bradycardia

Question 25

What does anticoagulation do?

Answer 25

Inhibit blood clotting pathways

Question 26

What do the NICE guidelines say about anticoagulate?

Answer 26

NOT for those under 65 + NO other risk factors other than sex

Question 27

When do you consider anticoagulation with CHA2DS2-VASc score?

Answer 27

1 for males with AF 2 or above for females with AF

Question 28

What are the types of anticoagulants?

Answer 28

DOACS Warfarin (vitamin K antagonist) Heparins/low molecular weight heparins = injections

Question 29

What is aspirin?

Answer 29

Anti-platelet = used when plaque is involved

Question 30

What is CHA2DS2-VASc?

Answer 30

C = congestive heart failure H = hypertension A2 = age > 75 (scores 2) D = diabetes S2 = stroke (scores 2) V = vascular disease A = age 65-74 S = sex (female)

Question 31

What is in a Trimbow inhaler?

Answer 31

Steroid LABA LAMA

Question 32

What is the assessment for bleeding?

Answer 32

ORBIT

Question 33

When do you NOT use DOAC for anticoagulation?

Answer 33

>120kg

Question 34

How long does Warfarin take to work?

Answer 34

2-3 days

Question 35

Because Warfarin takes 2-3days to work, what does this mean?

Answer 35

Offer another anti-coagulant till it is a correct level in system CALLED BRIDGING

Question 36

How does Warfarin work?

Answer 36

Inhibit vitamin K epoxide = decrease clotting factors

Question 37

What colour Warfarin tablet is 0.5mg?

Answer 37

White

Question 38

What colour Warfarin tablet is 1mg?

Answer 38

Brown

Question 39

What colour Warfarin tablet is 3mg?

Answer 39

Blue

Question 40

What colour Warfarin tablet is 5mg?

Answer 40

Pink

Question 41

What does the INR scale mean?

Answer 41

INR = 1 = normal INR = 2 = 2x longer takes to clot than normal And so on … 3, 4, 5

Question 42

What is the yellow book?

Answer 42

Patients on Warfarin should always carry it around with them Says dose, indication, range, INR, hospital + ect

Question 43

What is a contraindication of DOACS?

Answer 43

Mechanical heart valve

Question 44

Why is amiodarone a high risk medication?

Answer 44

Extensive side effect profile Very long t1/2

Question 45

What does amiodarone interact with?

Answer 45

CYP enzyme inhibitor QT prolongation Hypokalaemia Drugs lowering HR

Question 46

What are the side effects of amiodarone?

Answer 46

Night time glare Blindness Photosensitivity Slate grey skin Scarring in lungs Hypo/hyperthyroidism Unhealthy liver Peripheral neuropathy

Question 47

What are the loading dose for amiodarone?

Answer 47

100mg 3x a day for 7 days 100mg 2x a day for 7 days 200mg 1x a day so after

Question 48

What are the side effects of Warfarin?

Answer 48

Increased time of bless Painful skin rash

Question 49

What does Warfarin interact with?

Answer 49

CYP450 inhibitors/inducers Alcohol Herbal medication Food - leafy greens, liver Antibiotics

Question 50

What does DOACS interact with?

Answer 50

CYP450 inhibitors/inducers