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Finals: Medicine > Tachyarrhythmia's > Flashcards

Tachyarrhythmia's Flashcards

1
Q

Define the term “Tachyarrhythmia’s”

A

Refers to an abnormally fast heart rate (>100bpm)

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2
Q

Define paroxysmal tachyarrhythmia

A

It is when a tachyarrhythmia occurs intermittently

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3
Q

Tachyarrhythmias are broadly divided into two groups.

Name these two groups?

A

Supraventricular tachyarrhythmias

and

Ventricular tachyarrhythmias

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4
Q

Supraventricular tachyarrhythmias refers to a problem ____ the ventricles

a) Above
b) Within

A

a) Above

Supraventricular tachyarrhythmias refers to a problem Above the ventricles

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5
Q

Ventricular tachyarrhythmias refers to a problem ____ the ventricles

a) Above
b) Within

A

b) Within

Ventricular tachyarrhythmias refers to a problem Within the ventricles

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6
Q

What is the key ECG feature of Supraventricular tachyarrhythmias

A

Characterised by narrow QRS complexes

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7
Q

What is the key ECG feature of ventricular tachyarrhythmias

A

Characterised by broad QRS complexes

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8
Q

Name 4 examples of Supraventricular tachycardia’s (SVT)

A

Sinus tachycardia

Atrial tachycardia

Atrial flutter

Atrial fibrillation (AF)

Atrioventricular nodal reentrant tachycardia (AVNRT)

Atrioventricular reentrant tachycardia (AVRT)

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9
Q

Name 3 examples of Ventricular tachycardia’s (VT)

A

Ventricular tachycardia (VT)

Polymorphic ventricular tachycardia (Torsades de pointes)

Ventricular fibrillation (VF)

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10
Q

Sinus tachycardia is an example of what type of tachyarrhythmias:

a) Supraventricular tachycardia (SVT)
b) Ventricular tachycardia (VT)

A

a) Supraventricular tachycardia (SVT)

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11
Q

Atrial tachycardia is an example of what type of tachyarrhythmias:

a) Supraventricular tachycardia (SVT)
b) Ventricular tachycardia (VT)

A

a) Supraventricular tachycardia (SVT)

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12
Q

Atrial flutter is an example of what type of tachyarrhythmias:

a) Supraventricular tachycardia (SVT)
b) Ventricular tachycardia (VT)

A

a) Supraventricular tachycardia (SVT)

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13
Q

Atrial fibrillation is an example of what type of tachyarrhythmias:

a) Supraventricular tachycardia (SVT)
b) Ventricular tachycardia (VT)

A

a) Supraventricular tachycardia (SVT)

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14
Q

Ventricular tachycardia (VT) is an example of what type of tachyarrhythmias:

a) Supraventricular tachycardia (SVT)
b) Ventricular tachycardia (VT)

A

b) Ventricular tachycardia (VT)

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15
Q

Torsades de pointes is an example of what type of tachyarrhythmias:

a) Supraventricular tachycardia (SVT)
b) Ventricular tachycardia (VT)

A

b) Ventricular tachycardia (VT)

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16
Q

Ventricular fibrillation (VF) is an example of what type of tachyarrhythmias:

a) Supraventricular tachycardia (SVT)
b) Ventricular tachycardia (VT)

A

b) Ventricular tachycardia (VT)

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17
Q

What is the ECG features of sinus tachycardia

A

Sinus rhythm with a heart rate > 100 bpm

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18
Q

What are the ECG features of atrial tachycardia

A

Occurs due to an abnormal focus of activity undergoing rapid depolarisation in the atria

ECG features:

  • Tachycardia (>100 bpm)
  • Narrow QRS complexes
  • Abnormal P waves
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19
Q

Describe what is going on in the heart to cause atrial flutter

A

It is caused by an aberrant macro-circuit within the right atrium i.e. the depolarised wave returns to the SA node reactivating the depolarisation of the atria

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20
Q

What is the ECG features of atrial flutter

A

Sawtooth baseline (fluttering P waves), which is best visualised in the inferior leads (II, III, aVF)

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21
Q

Sawtooth baseline is characteristic ECG pattern of which arrhythmia

A

Atrial flutter - a type of supraventricular tachycardia

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22
Q

What leads are the sawtooth baseline ECG pattern best seen on

A

The inferior leads (II, III and aVF)

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23
Q

Why is 2:1 block classically seen in atrial flutter

A

This is due to the fast atrial rate some of the atrial activity is not conducted to the ventricles

Higher degrees of block can occur

24
Q

What is this ECG pattern

A

Sinus tachycardia

25
Q

What is this ECG pattern

A

Atrial tachycardia

26
Q

What is this ECG pattern

A

Atrial flutter - Sawtooth baseline (fluttering P waves),

27
Q

What is this ECG pattern

A

Ventricular tachycardia (VT)

28
Q

Describe what is going on in the heart to cause ventricular tachycardia

A

Occurs due to rapid, recurrent ventricular depolarisation from a focus within the ventricles

29
Q

What is the most common cause of ventricular tachycardia

A

Commonly due to scarring of the ventricles following MI

30
Q

What are the ECG features of ventricular tachycardia

A

Rapid, broad-complex tachycardia (QRS >120 ms)

31
Q

Ventricular tachycardia (VT) without a pulse is what kind of cardiac arrest rhythm

A

‘Shockable’ cardiac arrest rhythms

32
Q

What is this ECG pattern

A

Torsades de pointes

33
Q

Describe what is going on in the heart to cause Torsades de pointes

A

Type of VT that is due to depolarisation of multiple foci within the ventricles leading to variable QRS complexes

34
Q

What are the ECG features of Torsades de pointes

A

Similar to normal ventricular tachycardia however it looks like QRS complex is twisting around the baseline

35
Q

What is the management of atrial flutter

A

Control rate with beta blocker

36
Q

What is the management of Ventricular tachycardia (VT)

A

Shockable

Adrenaline should be given after the third shock, and then during alternate cycles.

Amiodarone should be given after the third shock, and another dose considered after five shocks

37
Q

What is the management of Torsades de pointes

A

Usually are self-limiting and terminate spontaneously however they can progression into ventricular tachycardia

38
Q

What is this ECG pattern

A

Ventricular fibrillation (VF)

39
Q

Describe what is going on in the heart to cause ventricular fibrillation (VF)

A

Incompatible with life

Occurs when the ventricular muscle fibres contract independently

40
Q

What are the ECG features of Ventricular fibrillation (VF)

A

No coordinated electrical activity with a chaotic, fibrillating baseline.

41
Q

What is the management for Ventricular fibrillation (VF)

A

‘Shockable’ cardiac arrest rhythms that requires immediate DC cardioversion

42
Q

Name the 4 possible rhythms in a pulseless unresponsive patient

A

Ventricular tachycardia

Ventricular fibrillation

Pulseless electrical activity (all electrical activity except VF/VT, including sinus rhythm without a pulse)

Asystole (no significant electrical activity)

43
Q

Name the two shockable cardiac arrest rhythms

A

Ventricular tachycardia

Ventricular fibrillation

44
Q

Name the two non-shockable cardiac arrest rhythms

A

Pulseless electrical activity (all electrical activity except VF/VT, including sinus rhythm without a pulse)

Asystole (no significant electrical activity)

45
Q

In stable patients with Supraventricular Tachycardia (SVT) what is the first line managment option

A

Vagal manoeuvres e.g. Valsalva manoeuvre

Valsalva manoeuvre is a breathing method in which the patient breathes out strongly through their mouth whilst holding their nose. This creates a forceful strain that can trigger their heart to go back into sinus rhythm

46
Q

In stable patients with Supraventricular Tachycardia (SVT) what is the second line managment option (if vagal manoeuves are not successful or are contra-indicated)

A

IV adenosine 6mg

47
Q

What is an appropriate alternative to IV adenosine 6mg as a second line therapy for managing supraventricular tachycardia

A

Verapamil, a calcium channel blocker

48
Q

What is the mechanism of action of adenosine as a pharmaeutical tool for managing supraventricular tachycardia’s

A

It works by temporarily blocking conduction through the AV node “resetting” it back to sinus rhythm

49
Q

When you are giving IV bolus adenosine to managing supraventricular tachycardia what do you need to warn the patient of?

A

Patients should be warned that they may have trouble breathing, chest tightness and feeling of dying / impending doom when adenosine is injected

50
Q

IV adenosine is given rapidly (over 1-3 seconds) followed by what?

A

20mL IV normal saline bolus

51
Q

Adenosine can be given maximum 3 times.

Describe the dosing of these adenosine bolus doses?

A

1st dose is IV adenosine 6mg

If no improvement IV Adenosine 12mg can be administered, followed by a further 12mg

52
Q

What is happening in the heart to cause Wolff-Parkinson White Syndrome

A

Pre-excitation syndrome i.e. the ventricles contract early

Characterised by a congenital accessory pathway i.e. an extra electrical pathway connecting the atria and ventricles

Normally there is only one pathway connecting the atria and ventricles called the atrio-ventricular node

The extra pathway that is present in Wolff-Parkinson White Syndrome is often called the Bundle of Kent

53
Q

Adenosine should be avoided in which patient groups?

A

Those that have any of the following co-morbidities:

Asthma / COPD / heart failure / heart block / severe hypotension

54
Q

What is the definitive management of Wolff=Parkinson White Syndrome

A

Radiofrequency ablation of the accessory pathway

55
Q

What are the hallmark ECG features of Wolff-Parkinson White Syndrome

A
  • Short PR interval (< 0.12 seconds) – as there is no AV conduction delay
  • Wide QRS complex (> 0.12 seconds)
  • “Delta wave” which is a slurred upstroke on the QRS complex
56
Q

What is the main concern in patients with Wolff-Parkinson White Syndrome?

A

The main concern in WPW is if the patient develops AF

The chaotic atrial electrical activity characterised by AF can pass through the accessory pathway leading to a rapid ventricular response. This could deteriorate into ventricular fibrillation.

57
Q

Other than atrial fibrillation, what can cause an irregularly irregular pulse?

A

Ventricular ectopics

ventricular ectopics disappear when the heart rate gets over a certain threshold (therefore exercise can be a useful way of differentiating AF from VEs without an ECG).

Finals: Medicine (91 decks)

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