fibrillations

Question 1

define superventricular tachycardia

Answer 1

supreventricular tachyarrthymias with uncoordinated atrial electrical activation and consequently ineffective atrial conduction

Question 2

what is paroxysmal AF?

Answer 2

recurrent AF that reverts spontaneously

Question 3

what is persistent AF?

Answer 3

if recurrent AF reverts spontaneously and needs pharmacological/ cardioversion to manage

Question 4

what are the RF for AF?

Answer 4

age. hypertension, diabetes, obstructive sleep aponea, CAD, valve disease, alcohol, congenital heart disease, lung disease

Question 5

what is the most common type of cardiac arrhthymia?

Answer 5

atrial fibrillation

Question 6

how does cardiac remodelling contribute to the pathophysiology of AF?

Answer 6

particularly in the atria
results in structural/ electrical chnages that causes a derrnaged rhythm.
changes in myocytes/ ECM, fibrous tissue deposition

Question 7

how does the unsynchronised firing pathophysiology result in AF?

Answer 7

initiating triggers from an ectopic focus in the atria - usually pulmonary veins .

Question 8

what are the consequences of the unsynchronised firing?

Answer 8

turbulent and abnormal blood flow through heart decreasing effectiveness in pumping blood, increasing likelihood of thrombus formation in atria, most commonly left atrial appendage

Question 9

what manual diagnostic test can you perform to detect AF?

Answer 9

manual pulse palpitations to assess for irregular pulse

Question 10

describe the clinical presentation of AF

Answer 10

dyspnoea, palpitations, syncope/ dizziness, chest discomfort, stroke/ TIA, anxiety, fatigue, symptomatic hypotension <90mmHg

Question 11

what do you look for on an ECG showing AF?

Answer 11

irregular RR intervals
absence of distinct repeating P waves
irregular atrial activations

Question 12

if you suspect paroxysmal AF, would monitoring would you use?

Answer 12

24hr electrical activity monitor

Question 13

what is the general management of chronic AF?

Answer 13

personalised package of care
stroke awareness
rate control meds
contacts with helplines
psychological advice
up to date education
anticoagulants
networking charities for support

Question 14

what medications is for stroke prevention in regards to AF management?

Answer 14

direct- acting oral anticoagulant

Question 15

name some anticoagulants used to treat AF

Answer 15

apixaban, dabigatran, edoxaban, rivaroxaban

Question 16

if a patient is contraindicated to anticoagulants but need medication for stroke prevention following AF, what do you use?

Answer 16

vitamin K antagonist

Question 17

if a patient is already using anticoagulants and experienced a MI, what drugs are best to use as well?

Answer 17

anti-platelets

Question 18

what are 1st line drugs in managing AF (rate and rhythm)

Answer 18

beta blocker
non-dihydropyridine calcium channel blocker - dilitizam/ verpamil

Question 19

if a patient with chronic AF does little amounts of physical exercise - what drug is best?

Answer 19

digoxin monotherapy

Question 20

what are second line drug management for AF?

Answer 20

combination of b blocker, diltiazem, dogoxin

Question 21

what do antiarrthymic drug therapy aim to do?

Answer 21

long term rhythm control

Question 22

what drugs are antiarrhythmics?

Answer 22

flecainde
propafenone
dronedarone
amiodarone
pill pocket strategy

Question 23

what antiarrhythhymics do you not give if known ischaemia/ structural heart disease?

Answer 23

class 1c - flecainide/ propafedone

Question 24

amiodarone is used in patients with AF that always have…?

Answer 24

left ventricular impairment
heart failure

Question 25

what is the pill pocket strategy?

Answer 25

only taking antiarrhythymic drugs when needed eg after doing something that triggers it eg exercise/ caffeine intake

Question 26

when would cardioversion be suitable?

Answer 26

AF symptoms presenting >12hrs

Question 27

when would you start amiodarone before cardioversion?

Answer 27

ideally 4 weeks prior - chronic AF

Question 28

what is cardioversion?

Answer 28

a device that delivers low-energy shocks to the heart

Question 29

when would you do left atrial ablation?

Answer 29

if the drugs were unsuccessful

Question 30

describe left ablation process

Answer 30

uses small burns/ freezes and cause scarring on the inside of the heart to help break up electrical signals

Question 31

after undergoing cardioversion, how long should be on antiarrhythymics for?

Answer 31

3 months following

Question 32

what is atrial fibrillation better care?

Answer 32

ABC Anticoagulants/ avoid stroke Better symptom management Cardiovascular and comorbidity optimisation - lifestyle changes

Question 33

in acute AF and someone is haemodynamically instable, what is best course?

Answer 33

emergency electrical cardioversion

Question 34

what medications are best to control rate/ rhythm in acute AF?

Answer 34

flecainade/ amiodarone

Question 35

what drugs are contraindicated for acute AF?

Answer 35

Mg2+/ CCB

Question 36

what drug types should be given to acutely AF patients?

Answer 36

antiarrthymics and anticoagulants - heparin

Question 37

what is atrial fibrillation?

Answer 37

heart rhythm problem where atria beats irregularly

Question 38

what is supraventricular fibrillation?

Answer 38

has electrical signals orginating at or above the AN - defines by narrow QRS <120ms adn a heart rate >100bpm

Question 39

what is the pathophysiology of supraventricular fibrillation?

Answer 39

orthodromic re-entry phenomenom tachycardia is secondary to normal anterograde electrical conduction from atria to AVN signal can also go from ventricles back to atria narrow QRS - ventricles being activated prior to AVN

Question 40

how does the ventricles get depolarised before the AVN in supraventricular fibrillation?

Answer 40

may develop an ectopic foci of electrical activity within the atria, AVN, ventricles impulse conduction - conduction blocks and forms re-entrant circuits impulse formation - enahnced autorhtyhmaticity (pacemaker away from SAN) or triggered activity activity during repolarisation

Question 41

what are re-entrant circuits within SVT?

Answer 41

continuous wave of depolarisation in circular path - depolarising wave returns to original site

Question 42

name 5 examples of SVT rhythyms

Answer 42

sinus tachycardia, atrial tachycardia, atrial flutter, atrial fibrillation, atrioventricular nodal re-entrant tachycardia, atrioventricular re-entrant tachycardia

Question 43

describe the symptoms of SVT?

Answer 43

anxiety, palpitations, chest discomfort, light-headed, syncope, dyspnea shock, hypotnesion, signs of HF can be asymptomatic but tachycardia seen within screening

Question 44

what are the diagnostic signs on a ECG of SVT?

Answer 44

narrow QRS complex, regular tachycardia HR - 180-220 bpm no P waves

Question 45

what investigation is crucial in SVT?

Answer 45

find initial cause assess for haemodynamic stability

Question 46

what symptoms would suggest haemodynamic instabilities?

Answer 46

hypotension, hypoxia, SoB, chest pain, evidence of poor end organ failure perfusion, altered mental status

Question 47

what is the management for a haemodynamic unstable patient with SVT?

Answer 47

immediate synchronised cardioversion adensosine

Question 48

what is the initial management for a haemodynamically stable patient with SVT?

Answer 48

Vagal manoeuvres can be attempted carotid sinus massage adenosine

Question 49

what are valsalva movements?

Answer 49

popping ears motion by holding nose

Question 50

how do you perform a carotid sinus massage?

Answer 50

patients neck must be extended and turned away - firm pressure applies for linger than 5 seconds

Question 51

what is the second line management of SVT?

Answer 51

CCB/ B blockers CCB must by di-hydropidines

Question 52

if pharmacological actions do not work to treat SVT, what are next options?

Answer 52

catheter ablation pacemaker

Question 53

what is ventricular tachycardia?

Answer 53

wide complex tachycardia >100bpm

Question 54

what is non sustained VT?

Answer 54

lasts less than 30s and presents tachycardia with tachyarrthymias with >3 beats of ventricular origin

Question 55

what is sustained VT?

Answer 55

>30s, haemodynamically unstablility occurs in less than 30s from tachycardia

Question 56

what is monomorphic VT?

Answer 56

stable QRS morphology

Question 57

what is polymorphic VT?

Answer 57

has changing or multiform QRS - torsades de pointes

Question 58

what is bidirectional VT?

Answer 58

beat to beat alteration in QRS frontal plane linked to digitalis toxicity/ catecholaminergic polymorphic VT

Question 59

what is the aetiology of VT?

Answer 59

usually ischaemic HD can be structural HD, channelopathies, infiltrative cardiomyopathy, electrolyte imbalance illicit drugs hypokalemia followed by hypomagnesemia

Question 60

what is the pathophysiology of VT?

Answer 60

enhanced normal automaticity/ abnormal automaticity

Question 61

what causes the pathology of SVT?

Answer 61

activity triggered by early/ late afterdepolarisation and re-entry in acute MI - transient ischaemia causes hyperkalaemia and triggers partial depolarisation injury currents between infarcted tissue and healthy myocardium and triggers spontaneous activity

Question 62

when history taking how would you differentiate between VF and SVT?

Answer 62

those VF are more likely to be older

Question 63

what would an ECG show if a patient had SVT?

Answer 63

broad complexes fast HR

Question 64

other than ECG, what other tests can be used to diagnosis VT?

Answer 64

stress test bloods - potassium, magnesium, calcium

Question 65

how would you manage non sustained VT and asymptomatic?

Answer 65

no therapies

Question 66

how would you manage non sustained VT but was symptomatic?

Answer 66

b blockers CCBs 2nd line

Question 67

how do you manage sustained monomorphic VT that is haemodynamically unstable

Answer 67

advanced cardiac life support

Question 68

what do haemodynamically stable VT patients need?

Answer 68

antiarrthymic medication

Question 69

when would a VT patient get an implanted cardiac defibrillator

Answer 69

- ischaemic HD and survive a cardiac arrest if they have haemodynamically unstable/ sustained VT