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S2 Case 5 - Heart Failure & Cardiac Arrhythmias > Clinical Management of Arrhythmias > Flashcards

Clinical Management of Arrhythmias Flashcards

1
Q

What is an arrhythmia?

A

Abnormal heart beat

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2
Q

What can arrhythmias be defined as?

A

Too fast
Too slow
Extra beats
Missed beats

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3
Q

What is bradycardia?

A

<60 bpm

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4
Q

What is tachycardia?

A

> 100 bpm

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5
Q

What is associated with tachyarrhythmia?

A

Atrial fibrillation
Atrial flutter
Supraventricular tachycardia
Ventricular tachycardia
Ventricular fibrillation

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6
Q

What are the different types of atrial fibrillation?

A

Paroxysmal AF
Persistent AF
Permanent AF

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7
Q

What is paroxysmal AF?

A

Episode stops within 48hrs without treatment

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8
Q

What is persistent AF?

A

Episode lasts >7 days

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9
Q

What is permanent AF?

A

Present all the time

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10
Q

What is supraventricular tachycardia?

A

Fault in electrical impulses above ventricles

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11
Q

What is associated with bradyarrhythmia?

A

Sick sinus syndrome
Heart block

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12
Q

What are the different types of arrhythmias?

A

Premature heartbeats
Premature atrial contractions
Premature ventricular contractions

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13
Q

What does arrhythmias present as?
SYMPTOMS

A

Fluttering sensation in chest
SOB
Dizziness
Fatigue
Fainting
Sweating
Anxiety

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14
Q

What are the causes?

A

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

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15
Q

What are the complications of arrhythmias?

A

Stroke
Heart failure
Sudden death

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16
Q

What is an ischaemic stroke?

A

Ischaemic tissue from clot = artery blocked

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17
Q

What is a haemorrhage stroke?

A

Clot bursts = bleed in brain

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18
Q

What is catheter ablation?

A

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

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19
Q

Which drugs are used for rate control?

A

Beta blockers
CCB
Cardiac glycoside

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20
Q

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

A

Bisoprolol

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21
Q

What is an example of CCB you would use?

A

Diltiazem
Verapamil

22
Q

What is an example of cardiac glycoside you would use?

A

Digoxin

23
Q

Which drug would you use to control rhythm?

A

Amiodarone

24
Q

What do you council a patient on taking beta blockers?

A

Fatigue
Nightmares
Cold peripheries
Bronchospasm
Mask hypoglycaemia = diabetes
Bradycardia

25
Q

What does anticoagulation do?

A

Inhibit blood clotting pathways

26
Q

What do the NICE guidelines say about anticoagulate?

A

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

27
Q

When do you consider anticoagulation with CHA2DS2-VASc score?

A

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

28
Q

What are the types of anticoagulants?

A

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

29
Q

What is aspirin?

A

Anti-platelet
= used when plaque is involved

30
Q

What is CHA2DS2-VASc?

A

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)

31
Q

What is in a Trimbow inhaler?

A

Steroid
LABA
LAMA

32
Q

What is the assessment for bleeding?

A

ORBIT

33
Q

When do you NOT use DOAC for anticoagulation?

A

> 120kg

34
Q

How long does Warfarin take to work?

A

2-3 days

35
Q

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

A

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

36
Q

How does Warfarin work?

A

Inhibit vitamin K epoxide
= decrease clotting factors

37
Q

What colour Warfarin tablet is 0.5mg?

A

White

38
Q

What colour Warfarin tablet is 1mg?

A

Brown

39
Q

What colour Warfarin tablet is 3mg?

A

Blue

40
Q

What colour Warfarin tablet is 5mg?

A

Pink

41
Q

What does the INR scale mean?

A

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

42
Q

What is the yellow book?

A

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

43
Q

What is a contraindication of DOACS?

A

Mechanical heart valve

44
Q

Why is amiodarone a high risk medication?

A

Extensive side effect profile
Very long t1/2

45
Q

What does amiodarone interact with?

A

CYP enzyme inhibitor
QT prolongation
Hypokalaemia
Drugs lowering HR

46
Q

What are the side effects of amiodarone?

A

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

47
Q

What are the loading dose for amiodarone?

A

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

48
Q

What are the side effects of Warfarin?

A

Increased time of bless
Painful skin rash

49
Q

What does Warfarin interact with?

A

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

50
Q

What does DOACS interact with?

A

CYP450 inhibitors/inducers

S2 Case 5 - Heart Failure & Cardiac Arrhythmias (12 decks)

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