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Regulation of Body Function > Treatment of cardiac rhythm disturbances - Lever > Flashcards

Treatment of cardiac rhythm disturbances - Lever Flashcards

1
Q

What are the three types of rhythm disturbances?

A

Too fast
Too slow
Disorganised

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2
Q

Common brady and tachycardias of concern

A

Brady - AV/SND conduction disorders
Tachy - Automaticity/ triggered activity
- reentrant mechanisms

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3
Q

To consider with arrhythmia classification

A 
Simple -->complex 
Bengin --> malignant 
Drug therapy 
- Not curative 
- Interactions 
Drug/device/ intervention interface
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4
Q

Bradycardia arrhythmia types

A

Physiological
Sinus node
AVN
Neural mediated

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5
Q

Tachycardia arrhythmia types

A 
Atrial 
Junctional -SVT 
Ventricular 
- Scar 
- Normal hearts
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6
Q

Indications for device support

A 
Pacemaker
- high grade AV block 
- Symptomatic sinus node disease 
Defibrillator 
- aborted SCD / Sustained VT in structural heart disease 
- High risk for SCD 
CRT 
- cardiomyopathy and LBBB (to improve pump function)
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7
Q

Ectopy

A 
A beat that arises in atria or ventricle before the next one is expected to. 
Common 
- majority benign 
symptomatic state proportional to multiple factors (e.g. prematurity) 
Assessment 
- Examination - exclusion malignancy 
- Appropriate tests ECG/ Echo / Holter 
Treatment 
- REASSURANCE  
- Suppressive OR withdrawal Rx 
- Device 
beta blockade 
Class I agents 
- severe symptoms + focus --> ablation
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8
Q

Class I Drugs
IA
IB
IC

A

sodium channel agents

  • reduce Vmax, prolong AP
  • No effect on Vmax, shorten AP
  • Reduce Vmax, slow conduction
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9
Q

class II

A

beta blockers e.g. metoprolol

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10
Q

Class III

A

Potassium channel blocker / Inc repolarisation e.g. amiodarone
* some have activity across all classes = dirty drug, soil trying to treat an atrial arrhythmia might cause problems in ventricle and vice versa

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11
Q

Class IV

A

Slow calcium channel blocker

e.g. verapamil

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12
Q

Sinus tachycardia

A

appropriate with fever/thyrotoxicosis/pain

Inappropriate when no known drivers..

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13
Q

How antiarrythmatic drugs work

A 
antiarrythmic affect 
- cell membrane 
- ANS 
- Vagal tone 
Cell membrane activity affects 
- conduction velocity 
- length of refractory period 
- Automaticity of the SA or AVN
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14
Q

Anti- arrythmatics and vagal tone

A 
Increased vagal tone 
- Decreases HR 
- Decreases SA automaticity 
- Slower conduction through AVN 
Increased vagal tone 
- Increases HR 
- Increases SA automaticity 
- Faster conduction through AVN
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15
Q

Class II fatigue and bradycardia

A

blocks the beta adrenergic system, decreases sympathetic tone
Fatigue and bradycardia
- Some patients on chronic beta blockade require permeant pacing to manage bradycardia
- Fatigue a common side effect but may diminish over time
- dosage rule: start low, go slow
For atrial and ventricular arrhythmias
Contraindicated in patients with asthma but not COPD

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16
Q

Class III

A

Affects sodium and calcium channels and increases the duration of the action potential.
Toxicity: toxic levels can build up, monitor patients frequently
- eye, lung, blood tests
Can increase defibrillation thresholds
May slow, but not stop VT
Prescribed for atrial and ventricular arryhtmias
Reduce digoxin of administering with amiodarone

17
Q

Proarrythmias?

A

occurrence of pre-existing arrhythmias, paradoxically precipitated by antiarrhythmic therapy, which means it is a side effect associated with the administration of some existing antiarrhythmic drugs, as well as drugs for other indications. In other words, it is a tendency of antiarrhythmic drugs to facilitate emergence of new arrhythmias.
Mechanisms:
- Prolongation of repolarisation
- Development of early after depolarisations which cause torsades
- Alterations in re entrant pathways
Increased risk of proarrythmias in heart failure

18
Q

Clockwise vs counter clockwise reentrant tachycardia

A

counter = narrow complex because through normal purkingie system, if going clockwise then broad complex

19
Q

Atrial fibrillation

A 
Common 
Varying symptoms 
Morbidity/ mortality issues 
Rate vs rhythm control 
- Drug 
- Device 
- Intervention 
Anticoagulant issues 
Co-morbidites and management
20
Q

VT/VF management

A 
Emergency management 
- 777
- Resuscitation 
Treat underlying pathology 
- Ischaemia 
- Bradycardia 
- Structural disease 
Metabolic or drug causes
21
Q

Treatment of cardiac rhythm disturbances

A 
Roof underlying cause 
- CAD /hypertension / OSA/ obesity 
- Scar 
Rx of comorbidites 
Specific tachycardia requirements 
- Drug / device / intervention 
Prophylaxis 
Important interactions
22
Q

Amiodarone toxicity

A

pulmonary fibrosis
Liver failure
Bone marrow suppression

23
Q

Amiodarone side effects

A

Myalgias
Gait disturbance
Insomnia
Prolongation of coagulation time

Regulation of Body Function (31 decks)

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