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Rhythm abnormalities of heart > Lecture notes > Flashcards

Lecture notes Flashcards

1
Q

which leads do you look at to determine a RBBB or LBBB

A

V1 and V6

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2
Q

Ventricular cardia (wide complex)

A

Dissociated P waves

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3
Q

Wide complex regular tachycardia differential

A
  1. Ventricular Tachycardia
  2. Supraventricular tachycardia that conducts with R or L BBB
  3. Pre-excited tachycardia over an accessory pathway (Antidromic AVRT)-uncommon
  4. Ventricular paced rhythm-pacemakers
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4
Q

VT vs SVT with BBB

A

Compare morphology of QRS complexes in V1 or V2 and V6

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5
Q

What does a RBBB look like?

A

V1: rSR’ with R’ wave is broad
V6: normally small Q wave with rapid R upstroke and small terminal S wave

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6
Q

What does a LBBB look like?

A

V1 and V2: negative, initial sharp deflection
V5 and V6: postive

sharp R wave followed by rapid S wave

V6: slurred R wave, absent septal q wave, followed by inverted T wave

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7
Q

VT signs

A
  1. Initial R wave more than 30ms
  2. Notching of downstroke of S wave (FLATTENS A BIT)
  3. time interval from begin R wave to latter S wave: if more than 70ms
    all in V1 and V2

AV dissociation is DIAGNOSTIC BUT RARELY SEEN
Looking for P wave is last step in analysis of wide complex tachycard

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8
Q

In which condition is fusion beats and capture beats seen?

A

slow Ventricular Tachycardia

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9
Q

Look for WPW pattern

A

Could be SVT with WPW

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10
Q

old MI clues

A

Q waves
scar tissue in ventricles
VENTRICULAR TACHY

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11
Q

Differential diagnosis of narrow-complex regular tachycardia

A
  1. Sinus tachycardia
  2. Atrial flutter-flutter wave caused by rentry circuit in RA
  3. AVJunctionalRentryT (AVNodalRT/AVRentryT)
  4. Atrial tachycardia
  5. Uncommon in adults: Junctional ectopic tachycardia

ALL CAN CAUSE A WIDE COMPLEX TACHYCARDIA IF THERE IS A BBB OR IT CONDUCTS OVER AN ACCESSORY PATHWAY

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12
Q

Narrow irregular tachyarrhythmias

A

Afib
Atrial flutter/tachy plus variable AVB
Multifocal atrial tachycardia

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13
Q

Wide irregular

A

AF with BBB
A flutter, variable AVB and BBB
Pre-excited AF
Polymorphic VT

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14
Q

IMMEDIATE management Vtachy

A

perform an ECG then synchronised DC cardioversion

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15
Q

which 2 drugs should you NOT give to patients with a WIDE complex tachy

A

Verapamil

Adenosine

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16
Q

Causes of Vtachy

A

above 35: coronary artery disease
below 35: hypertrophic CM
sometimes IDIOPATHIC, young patients

17
Q

Look for underlying struct. HD

A

dilated cardiomyopathy

18
Q

look for features systemic disease

A

cardiac sarcoidosis

19
Q

which electrolyte abnormality can precipitate a Vtachy

A

K

20
Q

Medication VT

A

Beta-blocker and amiodarone(prevents Vtachy)
Consider ICD
Immunosuppressive treatment: sarcoidosis
Idiopathic: structurally normal heart, amiodarone and ICD CONTRAINDICATED so VT ablation

21
Q

Transient LOC differentials

A
  1. Syncope
  2. Epileptic seizure
  3. Psychogenic
  4. Rare
22
Q

absent prodrome suggests

A

Cardiac cause of syncope

23
Q

what type of syncope: tongue biting, tonic clonic movements, head posturing, confusion after LOC

A

Epilepsy

24
Q

What type of syncope: prodrome (sweat, nausea, light-headedness)
Situational: prolonged standing/sitting

A

Vasovagal

25
Q

Orthostatic syncope

A

postural dizziness

26
Q

Cardiac syncope

A

Structural HD
Exertional syncope
NO PRODROME, unpredictable
Palpitations at time of syncope

27
Q

Look at QRS complexes to determine

A

regularity

28
Q

Bradycardia questions

A
  1. Due to AV block-P waves not conducted to ventrciles (complete Heart block or secondary heart block)
  2. Due to Sinus bradycardia: sinus node dysfunction, no AV block

Leads 3 and aVF, V1: inferior leads best for looking at P waves

29
Q

Irregular P waves, outnumber QRS complexes

A

AV dissociation

3rd degree or complete HB

30
Q

Complete HB

A
  1. P waves must outnumber QRS complexes
  2. Underlying rhythm regular: because it is an escape rhythm (ventricular if complexes are wide and regular)
  3. No assoc between P waves and QRS complexes
31
Q

2 mechanisms of bradycardia

A 
1. Sinus node problem: 
sinus bradycardia
sinus arrest
tachy-brady syndrome
sino-atrial exit block: absent p waves in set timing
  1. Impulse conduction problem:
    AV node or HPS problem

1st, 2nd, 3rd degree heart block

32
Q

Which degree Heart Block?

P waves outnumber QRS complexes

A

2nd/3rd degree

33
Q

Causes of sinus node dysfunction: intrinsic

A

Degen of sinus node
elderly
syncope, intermittent dizziness
symptomatic: sick sinus syndrome

34
Q

Causes of sinus node dysfunction: extrinsic

A

Hyper: K, carbia, vagotonia
Hypo: temp, thyroid, hypoxia
Head injury
Drugs (beta-blockers, calcium blockers, digoxin)

35
Q

Causes of Heart Block

A

DID I Count All Hairy Cats
D: degen (most common)
I: Inf STEMI
D: drugs (digoxin)

I: infiltrative (sarcoid, amyloidosis-inflammation of sinus node and purkinje system)

Count: CT disorders-anyklysing spondy, SLE
All: Aortic root abscess
Hairy: hyperthyroid
Cats: congenital

36
Q

Where is the HB: 1st/2nd degree (Type 1 Mobitz and 2:1 AV block

A

AV node level usually but also HIS PURKINJE level

37
Q

Type 2 :
Type 2 Mobitz
3rd degree

A

usually at His-purkinje but 3rd degree can be at AV node level

38
Q

Cause of disease in AV node that causes heart block

A

Digoxin toxicity

QRS narrow if HP system intact

39
Q

Clinical features Complete HB

A 
intermittent dizziness
Syncope
Bradycardia: 30-40 bpm, regular
Variable S1
HIGH systolic BP NBBBBBBB
Cannon a waves: due to AV dissociation, atrial contraction against closed Tricuspid valve

Rhythm abnormalities of heart (1 decks)

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