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Cardio > Ventricular arrhythmia > Flashcards

Ventricular arrhythmia Flashcards

1
Q

Ventricular arrhythmias: what is it

A
  • Ventricular arrhythmias are abnormal heartbeats that originate in your lower heart chambers, called ventricles
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2
Q

State the different types of ventricular arrhythmias

A
  • PVC
  • Accelerated idioventricular rhythm
  • VT
  • Brugada
  • VF
  • long QT syndrome
  • Torsade de pointe
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3
Q

PVC: ECG, Bigeminy, T

A
  • Prematured Ventricular Contraction, also called Ventricular extra systole
  • isolated PVC is common
  • ECG: wide QRS > 0,12s, maybe retrograde P wave, followed by a compensatory pause
  • Bigeminy: One normal, one PVCs, repeatedly
  • T: Amiodarone (anti-arrhythmic Class III)
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4
Q

Accelerated idioventricular rhythm: def

A
  • Accelerated idioventricular rhythm: is a ventricular rhythm with a rate of between 40 and 120 beats per minute. Idioventricular means “relating to or affecting the cardiac ventricle alone” and refers to any ectopic ventricular arrhythmia
  • rarely requires treatment
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5
Q

Ventricular tachycardia: def

A
  • a fast HR generated from the ventricles
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6
Q

Ventricular tachycardia: how does it happen, conditions to be considered as a VT, HR, consequences

A
  • The electrical signal starts in the ventricles instead of the SA
  • if more than 3 PVCs are in a row, it is considered as ventricular tachycardia
  • HR > 100bpm
  • Can lead to sudden death
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7
Q

Ventricular tachycardia: symptoms

A

Symptoms of having not enough perfusion to their tissues, and also depends on the HR (the higher, the more severe the symptoms)

  • chest pain
  • fainting
  • dizziness
  • shortness of breath
  • can lead to v-fib, or cause sudden death
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8
Q

What are the 2 different types of VT

A
  • Focal VT, or
  • Reentrant VT
    Both are classified based on the origin of the electrical firing/re-entrant circuit in the ventricles
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9
Q

Focal VT: def, causes

A
  • a specific area of the ventricle has abnormal automaticity
  • causes: stress on the focal point caused by medications, illicit drugs (methamphetamine, or cocaine), electrolyte imbalances, ischemia
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10
Q

Re-entrant VT: def, mechanism

A
  • a re-entrant point in the ventricles causes the ventricular tachycardia
  • due to a tissue that’s been damaged and acquired a different conductivity property
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11
Q

VT: diagnosis

A
  • ECG: can be classified as
    .Monomorphic VT: seen in reentrant + focal VT
    .Polymorphic VT: happens when multiple areas of pacemaker cells found in the ventricle become irritated and develop increased automaticity rate, like from severe hypoxia
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12
Q

VT: T

A
  • Cardioversion: Drug/ electrical
  • Radiofrequency catheter ablation: radio waves destroy tissue responsible
  • Device: Implantable cardioverter-defibrillator (ICD)
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13
Q

VT: management

A
  • Acute management: oxygen mask, cardiac enzymes, arterial blood gas, ECG, IV amiodarone, IV lidocaine (local anaesthesia + anti-arrhythmic drug)
  • long term management: BB, amiodarone, mexilithine
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14
Q

Ventricular fibrillation: def

A
  • V-Fib is when the heart quivers instead of pumping due to disorganized electrical activity in the ventricles.
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15
Q

V-fib: symptoms and complications

A
  • doesn’t deliver oxygen and blood to body, and brain

- can lead to death within minutes: called sudden cardiac death

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16
Q

V-fib: C

A
  • due to damaged areas of tissue that become structurally and electrically changed, and obtain tissue heterogeneity
  • C:
    .certain medications: methamphetamine, cocaine
    .electrolyte imbalances
    .Ischemia to the ventricle muscle

Can develop from PVC -> V-tach (3 consecutive PVCs in a row) -> V-fib

17
Q

V-fib: T

A
  • defibrillation: a high energy shock that’s meant to depolarize everything at once, or at least a large enough portion of the heart tissue, or critical mass, to allow the sinus node, to take control again
  • ICD: Implantable cardioverter defibrillator: constantly monitor a patient’s ECG, recognizes v-fib and delivers a defibrillating shock
  • CPR: when nothing else around
  • medications: to reduce the likelihood of episodes in the future
18
Q

Long QT syndrome: def, what does QT interval represents, what does it mean

A
  • when someone’s QT interval is longer than normal
  • QT interval represents Ventricle depolarization and depolarization
  • if someone has a long QT interval, it means that they have an abnormal long repolarization of some of their heart cells (but not all), which is thought to be caused by abnormalities in the movement of ions through ion channels (responsible for both depolarization and repolarization)
19
Q

Long QT syndrome: the ions movement

A
  • each time it depolarizes and depolarizes, it’s called a cardiac action potential, where ions flow in and out of the cell, happen in 4 phases
  • during phase 2, K+ channels open and let k+ go out -> makes membrane potential more negative, but L-type Ca2+ channels open -> lets calcium come in, make it more positive -> maintains the plateau phase
  • during phase 3, k+ channels stay open, and L-type Ca2+ closes, which let’s the cell repolarize
  • a dysfunction in the L-type calcium channels is one of the mechanism that can lead to a long repolarization phase -> it might let more calcium during phase 2, making the membrane potential more positive and causing an early after-depolarization (EAD)
  • other mechanisms: involve sodium and K ion channels malfunction -> causes EAD too
  • if EAD is large enough, can propagate and depolarize the ventricles -> causing a PVC -> which can lead to a polymorphic re-entrant VT: Torsade de pointe
20
Q

Torsade de points: S

A
  • palpitations
  • dizziness
  • syncope
  • fainting
  • sudden cardiac death in worst cases
21
Q

Long QT syndrome: Causes

A
  • congenital: due to genetic mutations
  • medications: affecting ion channels
    .Class IA anti-arrhythmics drugs blocking sodium and potassium channels
    .Class III blocking K+ channels
22
Q

Brugada Syndrome: what is it

A
  • a genetic disorder in which the electrical activity within the heart is abnormal. It increases the risk of abnormal heart rhythms and sudden cardiac death.
23
Q

Brugada Syndrome: C

A
  • congenital: genetic mutation, causing a problem in the Na+ channel -> affecting the ability to conduct an AP -> some region of the heart have an abnormal repolarization
  • Med: Na+ channels blockers
24
Q

Brugada Syndrome: ECG

A
  • ST elevation
25
Q

Brugada Syndrome: S

A
  • usually, healthy individuals die suddently

- if survive: Fatigue, palpitation, shortness of breath

26
Q

Brugada Syndrome: D

A
  • genetic test
27
Q

Brugada Syndrome: Management

A
  • ICD: implantable cardioverter defibrillator

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