Conditions Flashcards
Why do you get a BBB?
Impaired electrical activity in the heart
What lead do you look at to identify heart block?
The last lead
What type of heart block has no association between the P wave and QRS?
Third degree heart block
How would you work out if you have a Mobits 1 or Mobits 2 Heart block? (Type 2 heart block)
In Mobits 1 there is a progressive delay in the P wave and QRS complex and a constant delay in type 2
What is a normal PR interval?
3-5 small boxes (60-100bpm)
What is meant by drop beats?
Some of the QRS’s are missing after the p wave
What is lead aVR assessing?
Right arm to left arm
A normal ECG’s QRS complex is ?
Narrow
How can you assess an irregular rhythm strip?
Count the amount of QRS intervals in the bottom lead and multiply by 6
Narrow QRS tachycardia’s either have a regulaar or irregular rhythm. What are the three types of regular rhythms?
- Sinus tachycardia
- Atrial flutter
- Supraventricular tachycardia
How would you treat ventriuclar tachycardia?
Cardioversion
How would you treat ventricular fibrillation?
Defibrillator
What are the three types of wide QRS tachycardia’s?
- Ventricular tachycardia
- Torsade de points
- Ventricular fibrillation
What is ventricular tachycardia ? What would you expect to see on ECG? (3 things)
An arrhythmia where the electrical activity in the ventricles undergoes rapid depolarisation. Commonly due to scarring of the ventricles.
On ECG:
- Rapid, monomorphic regular broad QRS complex(>120ms)
- Absent P wave
- T waves difficult to identify
- There will be a return to sinus rhythm
What is Ventricular fibrillation and what would you expect to see on ECG?
An irregular broad complex tachycardia.
On ECG:
- Chaotic heart rhythm
What is Torsades de pointe and what causes it? (7 things)
A Polymorphic ventricular tachycardia caused by a prolonged QT interval
Causes:
- Congenital long QT syndrome
- Medication
- Hypothyroidism
- AV block
- MI
- Renal/liver failure
- Toxins
What would you expect to see on ECG LBBB ? (5 things)
- V1 a dominant S wave
- QRS >120ms
- Broad notched “M” shaped R wave
+
- LAD
- Poor R wave progression
What would you expect to see on ECG in RBBB? (3 things)
- QRS >120ms
- RSR pattern (M shaped QRS) IN v1-v3
- Slurred S wave in lateral leads (1,AvL, V5+V6)
What would you expect to see on ECG in a first degree heart Block?
- Slow signal from atria - ventricles (prolonged QR interval) >0.200
What is a paroxysmal supraventricular tachycardia and what would you expect to see on ECG?
An abnormal erratic heart rhythm that affects the atria. It has an abrupt onset and offset
How are ventricular tachycardias treated? (2 things if stable and 2 things if unstable ptx.)
If stable-
1. vagal manœuvres:
- Valsalva: they blow into a syringe whilst laying down face up, for 15 seconds
- Carotid sinus massage
If unstable-
- CPR +shock patient (Defibrillator)
- IV adrenaline + amiodarone after 3rd shock
- Adrenaline should be administered every 3-5 mins after (every alternate shock)
What broad complex tachycardia is always a pulseless rhythm?
Ventricular fibrillation
What is meant by polymorphic and monomorphic?
Polymorphic:
The QRS varies in size
Monomorphic:
The QRS is. consistent
What causes LBBB? (5 things)
- MI
- Ischaemic heart disease
- Hyperkalaemia
- Digoxin toxicity
- Aortic stenosis
What causes RBBB? (5 things)
- RVH
- PE
- Ischaemic heart disease
- Congenital heart disease
- Normal variant (atypical finding)
What would you expect to see on ECG in a second degree heart Block? (Type 1 3 points, Type 2, 4 points)
Mobitz 1:
- Progressive elongation of the PR interval.
- Dropped beats
- Narrow QRS
Mobitz 2:
- Irregular PR interval NO proceeding pr prolongation
- Occasional dropped beat
- Usually occurs following pre-existing LBBB
- Broad QRS
What would you expect to see on ECG in a third degree heart Block?
Complete heart block.
- No relationship between P waves and QRS complexes
-
How would a type 3 heart block be treated?
What is a common cause of this?
- Pacemaker
- Lyme disease
What is this a stereotypical history of?
A 50-year-old woman with a history of rheumatic fever presents with dyspnoea. On examination she is found to be in atrial fibrillation, with a loud S1, split S2 and a diastolic murmur
Mitrial stenosis
- Loud S1 and split s2, diastolic murmur
What medication typically causes angioedema ?
ACEi
What is the most common mechanism resulting in heart failure in patients with arrhythmias?
Systolic dysfunction.
What is High output HF ? What causes it? (6 things)
Where a normal heart is unable to pump enough blood to meet the bodies demands.
Causes:
- Pregnancy
- Paget’s disease
- Thyrotoxicosis
- Anaemia
- Arteriovenous malformation
- Thiamine deficiency (wet ber beri)
What would you expect to see on ECG in a patient with hypokalaemia?
- ST depression
- T wave inversion
- U waves
- Long QT interval
What leads do posterior MI’s effect?
Leads 1,2 and 3
What is the most reliable way to test for arterial insufficiency?
ABPI test (0.8 -1.3 are normal values) – outside of this and pressure stockings should be avoided
Note:
It is important to exclude arterial insufficiency before prescribing compression stockings.
What. does contraction band necrosis indicate?
Recent myocardial infarction
What is the most common cause of dilated cardiomyopathy?
Alcohol consumption
