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1 Cardiothoracic > Tachy and bradyarrhythmias > Flashcards

Tachy and bradyarrhythmias Flashcards

1
Q

What would be an appropriate first line treatment for atrial fibrillation in a sedentary 78 year old lady with a new diagnosis of atrial fibrillation who has no other health problems and no allergies? She is normotensive and has no evidence of heart failure.

A

beta blocker-atenolol

NICE guidelines suggest all patients with AF should have rate control as first line unless:
There is reversible cause for their AF
Their AF is of new onset
Their AF is causing their heart failure

Principles of treating AF

Rate or rhythm control
Anticoagulation

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2
Q

Which tests must you perform prior to starting amiodarone treatment?

A

TFTs (thyroid dysfunction)
LFTs (liver fibrosis and hepatitis)
U+Es (hypokalaemia risk)
CXR (pulmonary fibrosis)

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3
Q

Patient’s ECG demonstrates complete heart block. What intervention should be done?

A

transvenous pacing

(catheter ablation for AF and WPW)
(synchronised electrical cardioversion is for AF or tachyarrhythmia with adverse signs of shock)

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4
Q

What is the indication for unsynchronised DC cardioversion?

A

life-threatening tachyarrhythmias= defibrillation

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5
Q

Define tachyarrhythmia

A

> 100 HR

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6
Q

Where does sinus tachy originate from?

A

SA node

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7
Q

Name two triggers for tachy arrhythmia

A 
macrolides
haloperidol
tricyclic antidepressants
ondansetron
electrolyte imbalance
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8
Q

Three causes of AF?

A

heart disease- structural
Infection
Dehydration

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9
Q

Name two rate control drugs for AF

A

bisoprolol
digoxin
CCB

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10
Q

When is digoxin used in AF?

A

heart failure + AF

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11
Q

What are the principles for AF treatment?

A

rate/rhythm control (rate preferred)

anticoag

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12
Q

When is flecainide used?

A

NOT used for structural heart disease, therefore most typically used in young patients=pill in pocket

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13
Q

What CHADVASC score implies the need to anticoagulate

A

> 1 in men

>2 in women

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14
Q

Which score must CHADVASC be compared to?

A

HAS-BLED

risk of bleeding versus cerebrovascular event

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15
Q

What are the indications for warfarin?

A

prosthetic valves
antiphospholipid syndrome
high risk of GI bleeding
(?obesity, ?renal hepatic impairment)

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16
Q

Where does atrial flutter originate?

A

tricuspid annulus

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17
Q

Two risk factors for AVNRT?

A

young female
caffeine
drugs

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18
Q

Which is the most common AVRT?

A

wolf parkinson white

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19
Q

Name one ECG feature of WPW

A

delta wave

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20
Q

What is the aberrant pathway in WPW?

A

bundle of kent

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21
Q

How is VT described?

A

monomorphic

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22
Q

How is torsades de pointes described?

A

polymoprhic

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23
Q

What is the general management of tachyarrhtyhmias?

A
  1. Is this sinus?
  2. Are they unstable? If yes then synchronised DC cardioversion
  3. If no signs of haemodynamic instability then try: vagal manoeuvres followed by adenosine
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24
Q

What are the signs of an unstable patient with tachyarrythmia?

A

Shock, MI, HF, syncope (poor blood to organs, heart, congestion, and brain)

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25
Q

When would you do cardioversion in AF patient?

A

if proven acute episode (ECG and <48hr)

26
Q

In which tachyarrhtymias would ablation be appropriate?

A

AF

AVRT/AVNRT

27
Q

Name two methods to carry out vasalva manouvre

A

blow into syringe

carotid massage

28
Q

How to do synchronised DC shock on monitor?

A

point arrow to QRS and sync (not T wave!)

29
Q

Can you do synchronised DC in conscious patient?

A

need to sedate beforehand

30
Q

What is the management of torsades de pointes?

A

Place pads on patient before turning to magnesium. Phone cardio reg

31
Q

Patient with D&V, what electrolyte abnormality will be present?

A

hypokalaemia

32
Q

Causes of prolonged QT?

A 
low calcium, potassium, magnesium
congenital
clarithromycin/erythromycin (macrolides)
Haloperidol SSRIs
Amiodarone
33
Q

Two differentials for irregularly irregular pulse?

A

AF
AF with variable block
atrial multifocal tachy

34
Q

You see a new LBBB on ECG. What do you do?

A

Concern for STEMI, escalate. Don’t assume NSTEMI

35
Q

Signs of right heart strain on ECG?

A

RBBB

T wave inversion in anterior leads

36
Q

Triggers for AF?

A

sepsis, thyrotoxicosis, HF, MI (NOT hyperkalaemia…)

37
Q

Signs of hyperkalaemia on ECG?

A

think of dance…
tall T waves
Widened QRS
short p waves

38
Q

What is Brugada syndrome?

A

Na+ channelopathy
cause of sudden cardiac death
genetic association

39
Q

What is HOCM?

A

muscle hypertrophy

thickening of myocardium, septal and ventricular

40
Q

Which ECG change would indicate aortic root abscess following infective endocarditis?

A

1st degree AV block (aortic root=close proximity to AV node)

41
Q

Define bradyarrhythmia

A

<60 HR (<50 is when you would worry)

42
Q

How do you determine if bradyarrhythmia is nodal or subnodal?

A

nodal would give rate 40-55 whilst subnodal would give 25-40

Wherein the rate reduces the further down the electrical pathway you go i.e. to the Purkinje fibres

43
Q

What is the pathway of electrical activity in the heart

A

SA node - AV node - Bundle of His (atrioventricular) - Left and right bundle branches - purkinje fibres

44
Q

MI affecting which coronary arteries can result in heart block?

A

RCA + proximal LAD

45
Q

Three differentials for bradyarrhythmia?

A

neuro, cariac, infections, infiltrative, metabolic

46
Q

Examples of cardiac causes of brady?

A

ischaemia
conduction
cardiomyopathy

47
Q

Name two infective causes of bradyarrhtyhmias?

A

IE

Lyme’s disease

48
Q

Name one infiltrative cause of brady arrhythmia?

A

sarcoidosis

49
Q

Management of acute bradyarrhtymia?

A 
ECG
atropine (affects SA and AV nodes but not subnodal therefore if problem originates elswhere then atropine won't be effective)
Isoprenaline
Pacing leads
Call cardio reg if atropine doesn't work
50
Q

Should you treat sinus brady or tachy?

A

NO. Treat underlying problem, withhold drugs but don’t administer anything

51
Q

Why is a QRS dropped few cycles in Mobitz type 1?

A

affects AV node, cells fatigue and don’t pass on conduction. Patient is usually stable and no intervention unless haemodynamically unstable

52
Q

What is a normal PR interval?

A

120-200ms

53
Q

How to tell whether CXR shows pulmonary oedema or pleural effusion?

A

pulmonary oedema- patchy consolidation (alveolar oedema) while pleural effusion: complete hazy white out
Apical sparing in pulmonary oedema due to gravity

54
Q

Why does ventricular depolorisation occur sporadically in mobitz type 2?

A

some fibrosis exists within fibres but some healthy fibres. therefore conduction sometimes arises. = all or nothing phenomenon

55
Q

Three differentials for bradyarrhtyhmia?

A 
hypothermia
hyperkalaemia 
MI
cardiomyopathy
hypothyoridism
56
Q

Which additional blood tests should you always add on in brady and tachy arrhtyhmias?

A 
bone profile (calcium, vit D, PTH)
Magnesium
57
Q

Normal QT interval?

A

9-11 small squares

360-440ms

58
Q

Signs on ECG of digoxin overdose?

A

Flattened, inverted, or biphasic T waves
Shortened QT
Mustache ST depression!

59
Q

Pulse is described as weak and late. Which valvular abnormality?

A

aortic stenosis= pulsus parvus et tardus

only aortic valves give abnormal pulse, the other is collapsing for AR

60
Q

How to accentuate murmur of HOCM?

A

valsalva manoeuvre

HOCM is subvalvular lesion, septum, dynamic obstruction

1 Cardiothoracic (19 decks)

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