Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Cardio Qns > Tachyarrhythmias > Flashcards

Tachyarrhythmias Flashcards

1
Q

Case 1

  • 27 y.o. man with asthma
  • 3 days runny nose, sore throat, headache, feverish
  • Clenil and PRN salbutamol inhalers
  • HR 112 reg/strong, BP 125/55, CRT<2s
  • sats 98% (A), RR 18, chest clear
  • temp 36.0 / abdo SNT / GCS 15
  • throat little red, no exudate, no cervical lymphadenopathy
A

-

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

1a) This is his ECG. What is your dx?

A

sinus tachycardia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

2b) what are the causes of sinus tachycardia?

A
  • physiological: exercise, pregnancy
  • infection
  • dehydration
  • pain
  • hyperthyroidsm
  • PE
  • anxiety
  • drugs: cocaine, speed, salbutamol
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Case 2

  • 35 y.o. man, smokes, no reg meds
  • at work on building site
  • 20 minute sudden onset palpitation with central chest tightness, light headness
  • looks clammy
  • HR 200 ?reg, BP 120/86, CRT=2
  • chest clear, RR 26, sats 98% air
  • temp 36.2 / abdo SNT / GCS 15
A

-

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

2a) This is his ECG. What is the dx?

A

AV node re-entrant tachycardia (AVNRT) = “paroxysmal SVT”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

2b) In whom does AVNRT occur in?

A
  • young adults
  • female > men
  • triggers: caffeine, drugs, fatigue
  • rate >180bpm
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

2c) How is AVNRT managed?

A
  • vasovagal manoeuvres
  • adenosine IV bolus 6mg / 12mg / 12mg → monitor ECG
    • C/I in asthma! → profound bronchospasm → give CCB
  • DC cardioversion if adverse features
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

2d) What are the adverse features?

A
  1. shock
  2. syncope
  3. myocardial ischaemia
  4. heart failure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what does supraventricular tachycardia mean?

A
  • supraventricular = originates above ventricles
  • tachycardia, HR>100bpm
  • narrow complex <120ms / 3 small squares
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what are the types of SVT?

A
  1. Atrial
    • sinus tachycardia
    • AF
    • atrial flutter +/- variable block
  2. AV Node
    • AVNRT - ‘paroxysmal SVT’
    • Wolff-Parkinson-White
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Case 3

  • 78 y.o. man
  • PMH: IHD, HTN, T2DM, CKD3, ex-smoker
  • meds: aspirin, simvastatin, ramipril, metformin, GTN, NKDA
  • 3 day productive cough + fever
  • HR 130 irreg irreg, BP 135/65, CRT<2, no leg oedema, JVP normal
  • left basal creps, no wheeze, sats 98%, RR 19
  • temp 38.2 / abdo SNT / GCS 15 / BM 11.9
  • PU this AM, slightly darker than usual
  • bloods: urea 10.1, creatinine 148 (baseline for pt 90-100), CRP 78, WCC 13.4, lactact 2.1
  • CXR: left basal consolidation, cardiomegaly
  • urine dip: negative
A

-

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

3a) This is his ECG. What is the dx?

A

atrial fibrillation

  • irregularly irregular
  • no P waves
  • narrow QRS (<120ms / 3 small boxes)
  • normal target rate for AF ~90bpm
  • ‘rapid ventricular rate’ >100bpm
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

3b) Name 2 scoring systems that could be used in this pt to assess how unwell he is.

A
  • CURB-65
  • SIRS
  • qSOFA
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

3c) Why might he have AF?

A
  • pneumonia
  • dehydration / AKI
  • structural heart disease: IHD + HTN
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

3d) What do you consider in the mx strategies for AF?

A

Consider:

  • what is the BP?
  • are there adverse features?
  • is there a precipitating cause?

Mx:

  • rate or rhythm control?
  • add on anticoagulation?
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

3e) What is the aim for AF mx?

A

<110bpm

asymptomatic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

3d) What are medications that can be used in rate control for AF?

A
  • bisoprolol
  • rate-limiting CCB e.g. verapamil
  • digoxin
18
Q

3e) What are medications that can be used for rhythm control in AF?

A
  • amiodarone
  • flecainide
19
Q

3f) What are medications that can be used for anticoagulation in AF?

A
  • warfarin
  • DOAC e.g. edoxaban
20
Q

3g) How would you manage this pt?

A
  1. treat underlying cause
  2. sepsis 6
  3. withhold nephrotoxics
  4. check electrolytes
  5. repeat ECG once underlying illness better
  6. if persistent AF: rate / rhythm / anticoagulate
21
Q

what is atrial fibrillation?

A
  • SA node overwhelmed by disorganised electrical activity in roots of pulmonary veins
  • pulmonary veins fibrosed due to atrial dilatation
22
Q

what causes atrial dilatation?

A
  • HTN
  • valvular disease
  • heart failure
  • cardiomyopathy
  • MI
  • cocaine
23
Q

how do you decide whether to mx with rate / rhythm control for AF?

A
24
Q

how do you decide when to anticoagulate the pt with AF?

A
25
Q

Case 4

  • 62 y.o. man in CCU
  • anterior NSTEMI 2 days ago, DAPT
  • PMH: HTN, smoker
  • meds: DAPT, amlodipine, ramipril
  • nurse asks you to see him as he looks clammy and feels dizzy with chest pain
  • looks grey
  • HR 160, thready, BP 86/40, CRT=3, JVP norma
  • chest clear, RR 26, sats 94% air
  • temp 37.4 / abdo SNT / GCS 14
A

-

26
Q

4a) This is his ECG. what is the dx?

A

ventricular tachycardia

broad complex tachy

27
Q

4b) How would you manage this pt?

A

adverse feature present: shock ⇒ cardioversion

periarrest call (needs sedation)

amiodarone

28
Q

what is ventricular tachycardia?

A
  • originates from ventricles
  • broad complex >120ms / 3 small squares (usually bigger)
  • regular
  • >3 successive beats
  • usually >120bpm
  • rx: amiodarone if stable / synchonised DC cardioversion if adverse features
29
Q

what are the causes of VT?

A
  1. MI → ventricular scarring
  2. coronary heart disease
  3. congenital heart disease
  4. electrolyte disturbance
  5. cardiomyopathy e.g. HOCM
  6. infection e.g. myocarditis
30
Q

Case 5

  • 72 y.o. presents with lower urinary tract sx and agitation
  • recently rx for a UTI by her GP with ciprofloxacin
  • you suspect she is suffering from hyperactive delirium
  • FY1 prescribes a sedative with accordance with GGC handbook. shortly after, she collapses.

PMH: recurrent UTI, depression

meds: amitriptyline

A

-

31
Q

5a) This is her ECG. What is the dx?

A

Torsades de pointes

32
Q

5c) What is the likely cause of this pt’s deterioration?

A

combination of QT prolonging drugs

e.g. macrolides, quinolones, amitriptyline, antipsychotic, ondansetron

33
Q

5d) What is the rx for Torsades de pointes?

A
  1. IV magnesium
  2. synchronised DC cardioversion (if adverse features)
  3. stop all precipitants
34
Q

what does this ECG show and how would you manage this?

A

ventricular fibrillation

no CO, heart not functioning

arrest call, start CPR!

35
Q

narrow complex

A

atrial

36
Q

broad complex

A

ventricular

37
Q

irregularly irregular

A

AF

38
Q

HR >180

A

probably AVNRT

39
Q

HR consistently 75 / 100 / 150

A

probably flutter (saw tooth ECG)

40
Q

what does adenosine treat

A

AVNRT and uncovers underlying rhythms

41
Q

what to do if adverse features present

A

synchronised DC cardioversion

Cardio Qns (18 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions