Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Emergency medicine > ECGs/arrhythmias > Flashcards

ECGs/arrhythmias Flashcards

You may prefer our related Brainscape-certified flashcards:
Royal College: Emergency Medicine flashcards
1
Q

Questions to ask to clarify palpitations?

A

Onset:

  • When and how did it start?
  • Sudden vs gradual onset?
  • Dehydration, fear, food

Character:

  • Fast, slow, or irregular?
  • Did you check your pulse at the time?

Timecourse:

  • Precipitating/relieving factors (exercise is a red flag)
  • Duration
  • Resolution - fast/slow, confusion?
  • Previous episodes/FHx (e.g. sudden death)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Associated symptoms of palpitations

A

Dyspnoea

Syncope -> seizures/witnesses

Dizziness/light-headedness

Chest pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Differential for irregular fast palpitations

A

Atrial flutter, atrial fibrillation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Important PMHx for palpitations

A

Rheumatic fever

Angina/IHD

Previous ECG monitoring/angiograms

Diabetes

HTN

Operations (e.g. CABG)

Thyroid function

Valvular heart disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Differential for slow palpitations

A

Drug-related bradycardias, ventricular bigeminy, heart block

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Differential for regular fast palpitations

A

SVTs:

AVNRT (young women, 70% of SVTs)

AVRT: Assoc w/ WPW syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Differential for ‘missed beats’

A

Atrial, ventricular ectopics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is atrial fibrillation?

A

Irregular atrial rhythm from extranodal depolarisation –> variable conduction through AVN leads to irregular ventricular rhythm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the main risk/complication of AF?

A

Embolic stroke

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Causes of AF?

A

IHD

Mitral valve disease/rheumatic heart disease

Hypertension

Thyrotoxicosis

Precipitants:

  • Pneumonia/endocarditis
  • PE
  • Caffeine, alcohol, post-op
  • Hypokalaemia/Hypomagnasaemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Management of acute AF in unstable patient

A

DC cardioversion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Management of acute AF in stable patient within 48h of onset

A

Rate OR rhythm control (DC cardioversion or flecainide)

Give heparin if DC cardioversion delayed

Correct underlying

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Management of acute AF in stable patient >48h from onset

A

Rate control only!

Need >3wks anticoagulation before rhythm control (incl. DC cardioversion)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Pharmacological rate control in AF

A

Ca channel blockers (non-dihydropiridine, e.g. verapamil/diltiazem not amlodipine)

Beta blockers (e.g. bisoprolol)

Digoxin/amiodarone if evidence of heart failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Rhythm control for AF

A

Beta blocker

Sotalol

Amiodarone

Flecainide

Electricity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Contraindications for flecainide

A

Structural heart disease (e.g. previous MI)

Ischaemic heart disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Management of chronic AF

A

Anticoagulate with DOAC (e.g. apixaban) or warfarin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Management of atrial flutter

A

Same as atrial fibrillation!

DC cardioversion preferred

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Lifestyle risk factors for atrial flutters/arrhythmias

A

Stress

Caffeine

Alcohol

Nicotine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Contraindications of atropine for bradycardia

A

Mobitz Type II/complete heart block (only affects SAN not AVN)

Long Q-T –> increase risk of ectopics –> torsades de pointes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Differential for narrow-complex tachycardia

A

Irregular: AF

Regular:

Atrial flutter, atrial tachycardia

AV nodal reentrant tachycardia (75% of SVTs, younger women)

AV reentrant tachycardia (associated with WPW)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Which tachycardia is treated with adenosine

A

AVNRT (adenosine blocks AVN only!)

In atrial flutter re-entrant circuit is in wall of atrium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

ECG features of WPW

A

Short PR interval

Delta wave (slurred upstroke of QRS)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Differential of broad-complex tachycardia

A

Ventricular tachycardia (80% of broad-complex tachys, 95% of those w/ pre-existing heart disease)

SVT + WPW/BBB

Assume VT until proven otherwise!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Differentiating VT from SVT + BBB

A

LAD, regularity, QRS >160ms –> Suggest VT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is pre-excited AF?

A

AF + re-entry circuit (e.g. WPW) –> Fast + irregular QRS (>200) –> predispose to VT/VF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Causes of prolonged Q-T syndrome

A

Anti-arrhythmic drugs: e.g. amiodarone, sotalol

Psychiatric drugs: Tricyclic antidepressants, antipsychotics

Antimicrobial drugs: macrolides, antimalarials

5 hypos: Hypothyroid, hypothermia, hypokalaemia, hypocalcaemia, hypomagnasaemia

28
Q

What causes torsades de pointes

A

QRS ectopic landing on T-wave

29
Q

How do you calculate corrected Q-T interval (should be <450)

A

QT/sqrt(RR interval)

30
Q

Prolonged PR interval

A

First degree heart block

31
Q

Mobitz Type II block

A

Form of second degree heart block

Some P waves not followed by QRS complexes

32
Q

Leads where T-wave inversion is normal

A

VR

III

V1-V2

(V3-V4 in black people)

33
Q

Normal septal Q waves

A

I, VL, V6

<1x2mm

34
Q

Causes of LBBB

A

MI

Myocardial fibrosis: HTN/AS/HCM –> LV hypertrophy

35
Q

Peaked P waves

A

P Pulmonale

RA hypertrophy: Tricuspid stenosis, pulmonary HTN

36
Q

Bifid P waves

A

M-shaped –> P mitrale

LA hypertrophy (mitral stenosis)

37
Q

ECG changes RV hypertrophy

A

Dominant R wave in V1, deep S wave in V6

RAD

Peaked P waves

?T-wave inversion in V1-V2

38
Q

Posterior MI

A

Dominant R wave

ST depression

Upright T waves

in V1-V3

39
Q

T-wave inversion differential

A

STEMI (if Q waves or ST changes)

NSTEMI: no Q-waves/ST changes

LV hypertrophy/LBBB: Aortic stenosis, HTN

RV hypertrophy: Pulmonary HTN

Digoxin treatment (reverse tick)

Hypertrophic cardiomyopathy (young patients)

40
Q

ECG effects of hypokalaemia/hypomagnasaemia

A

Flattened T wave

Presence of U wave

Prolonged PR interval

Increased P-wave amplitude

41
Q

ECG effects of hyperkalaemia/hypermagnasaemia

A

Peaked T waves

Prolonged PR interval

Flattened P waves

Broad QRS complexes

42
Q

Symmetric T-wave inversion in non-coronary distribution

A

HOCM

43
Q

Causes of raised troponin

A

MI

Myocarditis

SVT

HF

PE

Renal failure

severe sepsis

44
Q

Mechanisms of bradyarrhythmias

A

Reduced automaticity (sick sinus syndrome)

Reduced condution (heart blocks, SAN/AVN)

45
Q

Mechanisms of tachyarrhythmias

A

Conduction - reentry:

AVNRT (aka SVT)

AVRT (aka WPW)

Atrial lutter

Automaticity:

Junctional/atrial/ventricular ectopics

Atrial fibrillation

46
Q

Atrial flutter ECG

A

P-wave sawtooth (approx 300bpm)

2:1 or 4:1 block –> 75 or 150 ventricular rate

Narrow-complex

Adenosine makes sawtooth pattern more visible

47
Q

Presentation of sick sinus syndrome

A

Symptoms: Lightheadedness, syncope, angina, palpitations

ECG: Sinus arrhythmia, sinus bradycardia, sinus arrest/pause

48
Q

Aetiology of sick sinus syndrome

A

Age-related: Atherosclerosis of SAN, fibrosis

Inf/inflamm: Pericarditis, Lyme, RF

49
Q

ECG of Brugada syndrome

A

Coved ST elevation with downsloping ST segment + T-wave inversion

RBBB

50
Q

ECG of torsade de pointes

A

Sinusoidal cycling of QRS axis and amplitude

Self-limiting or progress to VF

Occus in patients with hypomagnasaemia/hypokalaemia + Q-T prolongation

51
Q

Adverse features of tachycardia

A

Syncope

Shock

MI (incl. just chest pain!!)

Heart failure

Indications for DC cardioversion!

52
Q

Management of tachycardia w/ adverse features

A

Synchronised DC cardioversion (up to 3 times)

300mg amiodarone IV over 10-20min + repeat shock

then 900mg amiodarone over 24h

53
Q

Management of regular narrow-complex tachycardia

A

Valsalva manoeuvre

Adenosine 6mg –> if restores sinus rhythm probable SVT

If fails –> probable atrial flutter, consider beta blocker, seek expert help + similar management as acute AF

Consider fleicanide or amiodarone for WPW AVRT

54
Q

Management of regular broad-complex tachycardia

A

Amiodarone 300mg over 20-60min

Then amiodarone 900mg over 24h

Correct K+/Mg2+ (via central line)

DC cardioversion

OR

adenosine if previously confirmed BBB (SVT +BBB –> broad complex, but can cause haemodynamic instability in VT)

55
Q

Management of irregular broad-complex tachycardia

A

Seek expert help

Differential:

pre-excited AF (amiodarone)

AF + BBB (amiodarone)

torsade de pointes (magnesium 2g)

VF (non-synchronised DC shock)

56
Q

Management of torsade de pointes

A

Stop predisposing drugs

Correct K+/Mg

Consider Mg sulfate

High dose beta blockers if congenital long Q-T

57
Q

Management of bradycardia

A

Correct underlying disturbances!

Atropine 500 mcg IV if adverse features/recent asystole

Isoprenaline 5mcg/min OR adrenaline 2-10 mcg/min for heart block

Inform cardiology/ITU for transcutaneous pacing

58
Q

Cardiac causes of bradycardia

A

​Cardiac:

  • Post-MI (esp inferior, RCA)
  • Degenerative –> heart block
  • Aortic valve disease
  • Sick sinus syndrome
  • Myocarditis, cardiomyopathy, amyloid, sarcoid, SLE
59
Q

Non-cardiac causes of bradycardia

A

Vasovagal

Hypothyroidism, adrenal insufficiency

Hyperkalaemia, hypoxia, hypothermia

Raised ICP

60
Q

Drugs causing bradycardia

A

Beta blockers

Verapamil, diltiazem

Reverse above with glucagon

Digoxin

Reverse with anti-dig antibody fragments

61
Q

When to give non-synchronised DC shockes

A

Pulseless VF/VT

62
Q

Leads V1-V2 view and blood vessel

A

Proximal LAD, septal

63
Q

Leads V3-V4 view + blood vessel

A

Anterior, LAD

64
Q

Inferior ECG leads

A

II, III, aVF

RCA occlusion

65
Q

Lateral MI

A

I + aVL

Left Circumflex

(also V5-V6)

66
Q

Synchronised DC cardioversion energy

A

Narrow-complex: 70-120J

Broad complex: 120-150J

Emergency medicine (4 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions