Week 10- arrhythmia + NP management

Question 1

What is an arrythmia?

Answer 1

Irregularity in either

• HEart rate
• Rhythm

Question 2

Where do arrhythmias occur ?

Answer 2

• Can either be Ventricular
• Superventricular

Question 3

Where can superventricular arhthymias occur ?

Answer 3

• Above AV node ( Atrial arrhthymia)
• AV junction
• In AV node

Question 4

What are the symtpoms of arrhthmias ?

Answer 4

• Dizziness
• fatigue
• palpitations
• chest pain

can lose conciousness

Question 5

How is the arrhythmia diagnosed ?

Answer 5

Using a ECG the ventricular depolarisation time can be measured

Question 6

What management is considered for arhythmias?

Answer 6

• Test for any underlying diseases ( thyroid disease, electrolyte imbalance (K/Mg)
• Drug therapy -
• NP include : elctrical cardioversion , radiofrequencyy / pacemakers/ defibrilators )

Question 7

What are vaughan williams classification of arrhythmias

Answer 7

Class I: block sodium channels
 Ia (quinidine, procainamide,
disopyramide) AP
 Ib (lignocaine) AP
 Ic (flecainide) AP

 Class II: ß-adrenoceptor
antagonists (atenolol, sotalol)

 Class III: prolong action
potential and prolong refractory
period (suppress re-entrant
rhythms) (amiodarone, sotalol)

 Class IV: Calcium channel
antagonists. Impair impulse
propagation in nodal and
damaged areas (verapamil)
 [Others: Digoxin, adenosine]

Question 8

What are the different types of Bradycardia

Answer 8

• Sinus bradycardia - SA node fires at **slow rate **
• Sinus Node disease - SA node fails to generate electrical impulse ( from fibrosis of conduction tissue or second degree AMI)

AV node disease - failure of AV node to conduct electrical impulses to the ventricles

can be secondaryy to any heart rate slowing drugs B blockers digoxicin

Question 9

Management for brachcardia arrhythmia

Answer 9

• Underlying cause ( stop drugs or treat hypothyroidism )

-ATropine IV ACute

**- Permanent Pacemaker (PPM) **

• skin-pocket below collar bone
• sense electrical activity
• deliever electrical impulses to myocardial tissue if rhythm inappropriate

Question 10

what are the different types of superventricular tachycardia arrhythmias ?

Answer 10

Atria -
Sinus tachycardia
Sinus node re entry tachycardia
-Atriial fibrilation
- Atrial flutter
- Atrial tachycardia

AV Junction :

AV junctional tachycardia

White syndrome

Question 11

What are the different types of ventricular tachycardias ?

Answer 11

Ventricular tachycardia
Torsades de pointes
Ventricular fibrilation

Question 12

Describe the pathophysiology of Sinus Tachycardia

Answer 12

Increased heart rate but normal rhythm during:
- normal response to excercise
-Infection
- decreased bp
- anaemia
- can be cause of side effect from following drugs :
- B2- agonists , levothyroxine , salbutamol

Question 13

Decribe what Atrial flutter is

Answer 13

• similar underlying cause as AF
• Re entry circuit within R atrium
• rapid atrial rhythm
• Ventricle beat once for every 2-4 atrial flutter waves

—> results in stasis of blood in atria —–> anticoagulation need

Question 14

DEscribe WOlff-parkinson white syndrome

Answer 14

• The electrical conduct by passes the AV node from the atrium straight to the ventricle before being slowed/paced by the AV node
• 5 or more ventricular beats

causes AMI , IHD , cardiomyopathies , myocardditis

Question 15

Describe the causes and drugs contributing to Torsades de pointes

Answer 15

Causes

• Due to QT prolongation
• Hypokalaemia

Drugs

• Antiarhythmics - vaughan willliams Class IA or III
• Erythromycin & clarithromycin
• Lithium
• Phenothiazides
• Haloperidol
• Terfenodine

Question 16

Describe VF

Answer 16

• Rapid & unco-ordinated contraction of ventricles
• Compromises cardiac output
• conciusness lost in 20 sec
• common cause of death due to AMI

Question 17

Describe the non-drug management

Answer 17

• DCCV ( DIrect current cardioversion )
• restoring cardiac rhyhtm
• application of controlled electrical chock across chest wall
• overrides disorderednconduction
• Allows SA node to regain control HR
• briefly anaesthetised

anticoagulation need before and after due to increased risk of thromboembolism

Question 18

DEscribe Ablation

Answer 18

• EP studies identify location of arrhtmia generated ]
• catheter inserted w a guided point it freezes and destroys the tissue where the arrhthia generated disruoting the conductive pathway

Question 19

Describe DEfinbrilisation

Answer 19

• Electric shock to myocardial chest wall
• used in conjuction to CPR

Question 20

What are ICDs

Answer 20

Internal cardioversion defibrilators are implanted like a pacemaker monitoring rate and rythm

• if detected it releases a rapid rate impuls to regain control and then slow down
• If that doesnt work an electrical shock is triggered to reset the sinus rhythm