treatment and management of arrythmias

Question 1

RED flags in history taking for arrythmias

Answer 1

Over65 YO
family cardiac history
sudden cardiac death under 40 family history
TLoC
SOB
cardiac murmur

Question 2

Unstable cardiac patient

Answer 2

Excessive brady or tachycardia (under 40, over 150)
pallor
sweating
cold and clammy
impaired LOC
hypotension
breathlessness
Risk of asystole

Question 3

Risks of asystole

Answer 3

previous episodes of asystole or sinus pause
Mobitz type 2 heart block
third degree heart block
sinus arrest over 3 seconds on current ECG

Question 4

cardioversion

Answer 4

transthoracic electrical current using AED
administered to patients in pulse VT
less energy than defibrillation and delivered synchronised to QRS wave

Question 5

Vasalva

Answer 5

Blowing into a syringe for 15 seconds followed by 45 degree tilt with raised legs.
Intrathoracic pressure increases during forced expiration. Increased intrathoracic pressure stimulates vagus nerve which can decrease heart rate
used in patients with SVT
only used if tachycardic rate is originating from nodes.

Question 6

Atropine

Answer 6

antimuscarinic agent which competitively inhibits parasympathetic receptors allowing for sympathetic activity to occur and increase heart rate

Question 7

Transcutaneous pacing

Answer 7

Non invasive pacing in which pads are placed in anterior and posterior chest, transmitting electrical impulses across the chest which will override the slow SA rate and cause heart to contract at a designated rate