tachyarrhythmias and brady Flashcards
what are the two types of arrhythmias ?
bradycardia : below 60
tachycardia : above 100
what are tachycardias subdivided into ?
supraventricular tachycardia
ventricular tachycardias
what is the difference in presentation in ECG between supra ventricular and ventricular arrhythmia ?
1- supra ventricular which arise from the atrium or the AV node have a narrow QRS complex
2- ventricular have a wide QRS complex
what are the physiological causes of sinus tachycardia ?
APE
anxiety
pain
pregnancy
exercise
what are the pathological causes of sinus tachycardia ?
FADI
fever
anemia
dehydration
increased thyroid activity
what drugs cause sinus tachycardia ?
adrenaline
beta 2 agonists
caffeine
theophylline
what are the physiological causes of sinus bradycardia ?
athletes
sleep
why does a fib happen ?
presence of an ectopic focus coming from thee pulmonary veins
so no mechanical contraction of the atrias
what are the most important causes of Atrial fibrillation ?
hypertension
heart failure
hyperthyroidism
valvular heart disease ( MS )
cardiac surgery
what are the ECG findings associated with atrial fibrillation ?
absent p waves
narrow qrs complex
what is the management of haemodynamically unstable patient with atrial fibrillation ?
DC cardioversion preceded by anticoagulant ( heparin )
what is the management of a haemodynamically stable patient with AF ?
offer rate control plus oral anticoagulant
IV BCD ( beta blocker calcium channel blocker and digoxin )
when should rhythm control be offered in the management of AF ?
if the cause of AF is reversible
if rate control is not working
new onset AF
symptomatic despite rate control
what are the measures for rhythmn control in AF patients ?
if the patient has structural cardiac abnormalities give amiodarone
in the absence of cardiac structural abnormalities give propafenone of flecainide
what are the measures that should be taken when giving oral antic-coagulants in the management of AF ?
if the patient has MS or a metallic valve give warfarin
if not give OAC
what is an example of an OAC ?
dabigatran ( direct thrombin inhibitor )
rivaroxaban ( direct factor ten inhibitor )
which agent should be avoided to reduce stroke risk ?
anti platelets
if the patient cannot take anticoagulation what is the next best step in management ?
left arterial appendage occlusion LAAO
what is the management for any acute arrhythmia in a haemodynamically unstable patient ?
synchronised DC cardioversion
what is the management of atrial flutter ?
the same as atrial fibrillation
what is the management of SVT in a haemodynamically stable patient ?
adenosine
beta blocker
calcium channel blocker
what is the management of VT in a haemodynamically stable patient ?
amiodarone
what is the long term management of SVT , VT and VF ?
SVT - oral AAD , ablation
VT - oral AAD (amiodarone) , ICD
VF- oral AAD ( amiodarone ), ICD
what is first degree heart block ?
prolonged electrical conduction in the AV node
causes prolonged PR interval only
what are the types of second degree heart block ?
mobitz type 1 - wekenback
mobitz type 2
what are the features of mobitz type 1 vs mobitz type 2 ?
type 1 - progressively prolonged PR intervals, then a dropped PR interval
type 2 - no progressive prolongation , all or nothing
normal PR then suddenly a dropped beat
where is the block in mobitz type 1 vs mobitz type 2 ?
type 1 - AV node
type 2 - infra nodal level
what is the management in mobitz type vs type 2 ?
type 1 - just monitoring
type 2 - pace maker
what is type 3 mobitz ?
complete heart block - atria contract alone and ventricles contract alone
AV dissociation
what is the treatment for symptomatic second degree or third degree HB ?
correct underlying etiology
IIV atropine
temporary pacemaker
permanency pacemaker
how can wee identify bundle branch blocks ?
according to the shape of the QRS complex
what are the ECG changes seen in RBBB vs LBBB ?
RBBB - V1 is a M , V6 is normal
LBBB - V1 is a W , V6 is an M
