Arrhythmia's Pathophysiology, Presentation and Investigation

Question 1

<p>which arrhythmia has the highest burden on the health service?</p>

Answer 1

<p>AF</p>

Question 2

<p>What is supraventricular ectopy </p>

Answer 2

<p>a premature contraction of the ventriclesan be caused by hypertensive heart disease or other structural heart diseases -resulting in LA enlargement and increased wall stress - could lead to AF</p>

Question 3

<p>presentation of patient with a heart arrhythmia? (6)</p>

Answer 3

<ul> <li>asymptomatic</li> <li>palpitations</li> <li>SOB</li> <li>chest pain</li> <li>fatigue embolism</li></ul>

Question 4

<p>ECG investigation for arrhythmias</p>

Answer 4

<p>12 lead 24 hour recording </p>

Question 5

<p>other than an ECG which 2 other investigations are undergone to look for evidence of arrhythmias</p>

Answer 5

<p>blood tests - thyroid functionechocardiogram</p>

Question 6

<p>therapeutic options to control heart rate</p>

Answer 6

<ul> <li>Digoxin</li> <li>beta blocker</li> <li>ca2+ blockersplus warfarin (or aspirin if low risk)</li></ul>

Question 7

<p>therapeutic options to control heart rhythm</p>

Answer 7

<p>class Ic/III drugs +/- Direct Current cardioversion </p>

Question 8

<p>what electrical approaches are there to correct arrhythmias </p>

Answer 8

<p>pace and ablation of AV nodesubstrate modification e.g pulmonary vein ostial ablation</p>

Question 9

<p>what is supraventricular tachycardia? </p>

Answer 9

<p>abnormally fast heart rhythm arising from improper electrical activity in the upper part of the heart </p>

Question 10

<p>what are the 4 main types of supraventricular tachycardia?</p>

Answer 10

<p>AFparoxysmal SVTatrial flutter wolff parkinson-white syndrome</p>

Question 11

<p>what is the most common type of paroxysmal SVT?</p>

Answer 11

<p>AV-nodal re-entrant tachycardia</p>

Question 12

<p>AV-nodal re-entrant tachycardia:- symptoms, prognosis, treatment?</p>

Answer 12

<p>symptoms:- palpitations, dyspnoea, dizziness prognosis is goodno treatment</p>

Question 13

<p>What is radiofrequency ablation? (RFA)</p>

Answer 13

<p>reduces pain in the heart An electrical current is used to heat up a small area of nerve tissue, thereby decreasing pain signals from that specific area</p>

Question 14

<p>what is AV re-entrant tachycardia due to?</p>

Answer 14

<p>accessory pathway</p>

Question 15

<p>ventricular tachycardia:- signs/symptoms, cause, investigations?</p>

Answer 15

<p>palpitations, chest pain, SOB, dizziness, syncopeusually caused by structural heart diseaseinvestigations:- bloods, echo, angio</p>

Question 16

<p>What is torsades de pointes</p>

Answer 16

<p>specific form of polymorphic ventricular tachycardia in patients with a long QT interval occurs due to complete heart block/ AF</p>

Question 17

<p>long QT syndrome</p>

Answer 17

<p>congenital or acquiredmay cause Torsades de pointes management: drugs, pacing or implantable cardiac defibrillator </p>

Question 18

<p>what do first and third degree block mean?</p>

Answer 18

<p>1st = slowed conduction 3rd = complete block</p>

Question 19

<p>indications for implantable cardiac defibrillator?</p>

Answer 19

<p>patient must be in life threatening conditioncardiac arrest due to VF/VT not due to transient or reversible cause e.g early phase of acute MIsustained VT causing syncope or significant compromise or sustained VT with poor LV function</p>

Question 20

<p>a patient would not be referred to get a ICD with what conditions/problems?</p>

Answer 20

<p>acute myocardial ischaemiaelectrolyte imblancedrug toxicity </p>

Question 21

<p>what is an ICD?</p>

Answer 21

<p>an implantable cardiac defibrillator which sends electrical impulses to regulate abnormal heart rhythmsmost new ICDs can act as pacemakers and defibsgood at preventing sudden death</p>

Question 22

<p>indications for permanent pacemaker?</p>

Answer 22

<p>symptomatic or profound 2nd/3rd degree AV block, particularly when cause is unlikely to disappearprobably mobitz type II 2nd/3rd degree AV block even if asymptomatic Given after AV node ablation - pain reductionalternating Left bundle branch block and RBBB sinus node disease associated with symptomscarotid sinus hypersensitivity/malignant vasovagal syncope (over-reactive vagus nerve to certain triggers ie sight of blood) </p>

Question 23

<p>indications for temporary pacemaker?</p>

Answer 23

<p>if heart beat is temporarily out of rhythm ie intermittent or sustained symptomatic bradycardia, particularly syncope then temporary pacemaker can be used it is prophylactic - option when patient is at high risk of developing sever bradycardia e/g 2nd/3rd degree AV block, post-anterior MI or even when asymptomatic</p>

Question 24

<p>what is left bundle branch block/ right bundle branch block? what happens to the QRS complex in LBBB/RBBB?</p>

Answer 24

<p>an anatomical or functional block in the left or right bundle branches causes LBBB or RBBBthe ventricle whose bundle branch is defect will be depolarised from impulses spreading from the opposite ventricle causes a broad QRS complex </p>

Question 25

<p>What are the 2 types of 2nd degree AV block?</p>

Answer 25

<p>type 1 - mobitz I/ wenckebachtype 2 - morbitz II/ Hay</p>

Question 26

<p>what is wolff parkinson-white syndrome?</p>

Answer 26

<p>a condition in which there is an extra electrical pathway in the heart. The condition can lead to periods of rapid heart rate (tachycardia). WPW syndrome is one of the most common causes of fast heart rate problems in infants and children</p>

Question 27

<p>What is sustained ventricular tachycardia</p>

Answer 27

<p>Tachycardia of the ventricles which if sustained is life threatening</p>

<p></p>

<p>signs: hypotension, cardiac arrest, pulse rate 120/220 BPM, AV dissociation</p>

<p></p>

<p>symptoms - syncope, pre-syncope</p>

<p></p>

<p>investigations: ECG - rapid V rhythm, broad QRS complexes, visible P waves march through tachycardia</p>

<p></p>

<p>Management - if haemodynamically compromised (hypotensive/pulm oedema) emergency DC cardioconversion may be required (defib)</p>

<p>if more stable then IV class 1 or amiadarone may be used</p>

Question 28

<p>What is cardiac ablation</p>

Answer 28

<p>a procedure to scar or destroy tissue in yourheartthat's allowing incorrect electrical signals to cause an abnormalheartrhythm</p>