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Tachy + Bradycardias + Arrhythmias Flashcards

1
Q

Adult tachycardia algorithm: initial steps

A

A-E
ECG
Identify reversible causes (4Ts + 4Hs)
Any adverse signs?

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2
Q

What are the adverse signs in tachycardias?

A

Shock
Syncope
MI
Heart failure

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3
Q

What do you do when there are adverse signs in a tachycardia?

A 
Pt unstable
Synchronised DC shock
Amiodarone 300mg over 10-20 mins
Repeat shock
Amiodarone 900mg over 24hrs
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4
Q

What to do if there are no adverse signs in a tachycardia?

A

Assess whether tachycardia is broad, narrow, regular or irregular

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5
Q

What to do with a broad, regular tachycardia?

A

If VT or unsure:
Amiodarone 300mg over 24hrs then 900mg over 24hrs
If SVT w/ BBB: treat as regular narrow complex (Vagal)

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6
Q

What to do with a broad, irregular complex?

A

Seek help!! AF w/ BBB

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7
Q

What to do with a narrow, regular tachycardia?

A 
Vagal manouvres (vasalva, carotid sinus massage, blowing into syringe)
Adenosine 6mg rapid IV - if no effect give another 12mg, then another 12mg
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8
Q

What happens after treating a narrow, regular tachycardia?

A

If sinus rhythm achieved = probably re-entry paroxysmal SVTIf not achieved = could be atrial flutter - control with BB

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9
Q

What to do with a narrow, irregular tachycardia?

A

Probably AF - treat rate with BB or dilitiazem
Digoxin or amiodarone in HF
Assess thrombosis risk

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10
Q

Management of a polymorphic VT (eg Torsades de Point)?

A

Magnesium 2g

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11
Q

When is amiodarone used?

A

Broad complex QRS arrhythmias

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12
Q

ECG findings for VF

A

Small fib waves

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13
Q

Management of AVRT + AVNRT (stable vs unstable)

A

If stable - vagal then adenosineIf unstable, synchronised cardioversion then amiodarone

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14
Q

What is AVNRT?

A

Electrical activity circuits around the AV node

Caused by fast + slow fibres

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15
Q

What is AVRT?

A

AV re-entrant tachycardia
Due to accessory pathway between ventricles + atria
Signal is conducted back to atria so atria contract before SAN sends next impulse
Causes fast heart rate
EG Wolff Parkinson White - accessory pathway is bundle of Kent

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16
Q

What is SVT?

A

Narrow complex

Any impulse beginning above the bundle of His - any tachycardia that is not ventricular in origin (AF/ flutter/ AVRT)

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17
Q

How can you distinguish between different forms of tachycardias on ECG?

A 
Broad or narrow?
Broad irregular = AF with BBB
Broad regular = VT or SVT with BBB
Narrow Reg: VT, SVT
Irregular: AF
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18
Q

Types of ventricular tachycardia

A

Monomorphic VT = short circuit coming from 1 place in the heart
Polymorphic VT = Torsades de Point, due to long QT interval

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19
Q

S+S of AVNRT

A

Palpitations, dizziness, light headedness, SOB

Sudden onset

20
Q

AVNRT on ECG

A

Sudden onset, following atrial premature beat, spontaneous termination with AV block in absence of premature atrial beat
Loss of P waves

21
Q

Management of AVNRT

A

Stable = vagal maneuvres, adenosine, then verapamil, diltiazem, metoprolol or digoxin
Unstable = cardioversion
Long term = BB, diltiazem, digoxin
2nd line = flecainide, propafenone

22
Q

Bradycardia guidelines - initial step

A 
Assess using A-E approach 
Any adverse features:
Shock
Syncope 
Myocardial ischaemia 
HF
23
Q

Bradycardia guidelines - what to do if adverse features are present?

A

Atropine 500mcg IV
If satisfactory response - move onto assessing risk of asystole

If not, consider interim measures: 
Atropine 500mcg IV repeat to max of 3mg 
OR 
Transcutaenous pacing 
OR 
Isoprenaline 5mcg min IV
Adrenaline 2-10mcg min IV

Ultimately - arrange transvenous pacing!!

24
Q

Bradycardia guidelines: what to do if there are no adverse features?

A 
Assess risk of asystole:
Recent asystole 
Mobitz II AV block 
Complete heart block w/ broad QRS 
Ventricular pause >3s
25
Bradycardia guidelines: what to do if there is no risk of asystole?
Continue obs
26
Bradycardia guidelines: what to do if there is a risk of asystole?
``` Consider interim measures: Atropine 500mcg IV repeat to max of 3mg OR Transcutaenous pacing OR Isoprenaline 5mcg min IV Adrenaline 2-10mcg min IV ``` Ultimately - arrange transvenous pacing!!
27
Types of bradycardias
``` Sinus bradycardia Sinoatrial block Sinus arrest AV block Junctional rhythm Idioventricular rhythm ```
28
Types of regular narrow complex tachycardias
``` Sinus tachycardia Atrial tachycardia Junctional tachycardia AVNRT AVRT Atrial flutter ```
29
Types of regular wide complex tachycardias
SVT with BBB VT AVRT
30
Types of irregular narrow complex tachycardias
AF Atrial flutter with variable block Premature atrial contraction
31
Types of irregular wide complex tachycardias
AF with BBB Atrial flutter with variable + BBB Polymorphic VT (Torsades de Point) Premature ventricular contraction
32
Management of sick sinus syndrome
Atropine
33
What are the types of premature beats?
Premature atrial contraction | Junctional premature beat - originates from vicinity of AV nodes
34
Describe WPW
Congenital defect of Bundle of Kent causing AVRT + AF
35
ECG changes in WPW
PR interval <120 Slurred upstroke of QRS (delta wave) Widened QRS
36
Describe AF in WPW
>200 blm ventricular rate - AF is conducted through bypass tract
37
What are the types of AVRT?
``` Orthodromic = stimulus from premature complex travels up bypass tract + down AV node with narrow complex Antidromic = signal goes up AV node + down bypass tract, causes wide + abnormal QRS ```
38
Management of AVRT
Same as AVNRT except avoid digoxin + verapamil | Long term = ablation
39
What is a premature ventricular contraction?
Usually benign but can be significant if consecutive or multiform, or if falling on T wave of previous beat
40
ECG changes for premature ventricular contraction
ARS >120 No P wave Bizarre QRS
41
What is an accelerated idioventricular rhythm?
Ectopic ventricular rhythm with rate 50-100 | Occurs in acute MI or heart disease
42
What is Torsades de Point?
Variation of polymorphic VT that occurs with baseline QT prolongation QRS complexes twist around baseline
43
What drugs predispose to Torsades?
``` Anything that prolongs QT: Quinidine Sotalol TCAs Erythromycin Quinolones Antihistamines ```
44
What electrolyte disturbances can cause Torsade de Point?
Hypokalaemia | Hypomagnesemia
45
Management of Torsades de Point?
Magnesium, temporary pacing, isoproterenol
46
What is a pre-excitation syndro,e?
AVRT + symptoms of tachyarrhythmia | eg WPW or LGL
47
What is ortho vs antidromic?
``` Orthodromic = impulse goes down AVN up accessory pathway Anti = impulse goes down accessory pathway and up AVN - dangerous because its uncontrolled ```

Cardiovascular (15 decks)

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