Arrythmias Flashcards

1
Q

How long is the PR interval in sinus rhythm?

A

0.12->0.2s

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2
Q

How long is the QRS complex?

A

0.08s
abnormal considered >0.12s

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3
Q

How long is the QT interval?

A

Varies with HR but at 60BPM ~0.42 seconds

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4
Q

What is sinus bradycardia/Sinus tachycardia and how are they treated?

A

Normal rhythm but slow or fast (<60BPM or >80BPM) in a healthy adult
Sinus Bradycardia:
B1 receptor agonist - Isoprenaline - Short Term
Pacemaker - Long Term

Sinus Tachycardia: Internal Defribillator

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5
Q

What is Sinus Arrest?

A

A pause in the heart beat with no waves at all
Usually misses atleast 2 beaths
Underlying rythm is usually slow and irregular sinus rythm

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6
Q

What is an escape beat?

A

The first beat after a sinus arrest, its triggered by a abckup pacemaker so is slightly out of sync but then the SA takes over agian

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7
Q

What is (Broad Complex Tachy) Ventricular Tachycardia and what causes it?

A

A very high but regular Heart Rate
Ventricular cells are irritated or scarred causing them to fire independantly of the normal conduction and rapidly

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8
Q

How does ventricular tachycardia (broad Complex Tachy) present, ECG and whats the danger?

A

Palpitations - Syncope - Lightheadedness - sOB - Angina
ECG: Hr >120BPM - Broad QRS complex - often 3 wide QRS between P waves
- Can devolve into Vfib

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9
Q

What is Vfib?

A

Ventricles quivering instead of contracting

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10
Q

HOw does vfib manifest clinically and on ECG?

A

Cardiac arrest - syncope - no pulse - no breathing - angina - cyanosis - naeusea
Irregular unformed QRS and no p waves

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11
Q

What are the indications for ICD?

A

Secondary Prevention:
- Cardiac arrest due to VF/VT
- Sustained VT -> syncope or significant compromise
- Sustained VT with poor LV function

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12
Q

What is supraventricular tachycardia?

A

Tachycardia starting at or above the AV node
Present with palpitaions - anxiety - chest pain - dizziness - SOB
Supraventricular ectopic beats - Afib - Aflutter - W-P-W

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13
Q

What is Wolff-Parkinson-White syndrome?

A

A type of supraventricular tachycardia of the AV re-entrant type:
A short P-R interval with a slow rising R wave.
Due to:
An extra accessory pathway bypassing the AV node straight to the ventricles, thus signal travels faster thugh the accessory pathway so the ventricle is triggered faster (short P-R) and for a longer time (slow rising R wave).
Can slip into a re-entry circuit causing tachycardia

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14
Q

What is Atrial Flutter?

A

A supraventricular Tachycardia caused by one of the backup pacemakers going wrong and firing way above the SA node at 250-300BPM, because the AV node has a delay the ventricles will contract closer to 150BPM.

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15
Q

How does Atrial Flutter appear on an ECG?

A

Saw tooth P wave going v fast.
V high QRS rate but regular

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16
Q

What is Afib?

A

A type of supraventricular tachycardia. Abnormal electrical activity in atria leads to random atria spasming & random irregularly irregular AV node stimulation

17
Q

HOw does afib appear on an ECG?

A

NO distinct p waves
Irregularly Irregular QRS complexes (rapid)

18
Q

What other tests can be done for Afib?

A

Bloods - Esp TFTs
Echo - Quivering Atria
Pulse - Rapid and irregularly iregular

19
Q

How does Afib present?

A

Fatigue
Palpitations
SOB
Angina
Oedema
Emboli -> Stroke

20
Q

How do we treat Afib?

A

Rate Control:
Class 2, 4 and 5 anti-arrthmics - B blockers (atenolol), RL CCBs and Digoxin

Rhythm Control:
Electrical Cadioversion
Chemical Cadioversion (Class 1c Flecainide {Na blocker} and 3 Amiodarone {Prolongs refractory})

Anti-Coagulants:
Aspirin + clopidogrel and warfarin to prevent emboli

21
Q

What is 1st degree heart block?

A

A P-R interval over 0.2 seconds (5 small squeres)

22
Q

What could you see on an ECG in severe type 1 Heart block?

A

P wave buried in previous T wave

23
Q

Describe the 2 types of 2nd degree AV block, the problem and the treatment?

A

Mobitz 1:
- Progressive P-R prolongation culminating in a non-conducted P wave (skipped QRS)
- Malfunctioning AV node
- Treat with Atropine

Mobitz 2:
- Intermittant non-conducted P waves with no prolongations
- Worse than Mobitz 1
- Problem below AV node
- Treat with a pacemaker

24
Q

What is a fixed ratio block?

A

Shown in type 2 AV block
blocks of a fixed ratio of P-QRS waves

25
Q

Describe 3rd degree heart block?

A

Complete AV block
Both P waves and QRS are reuglar but unrelated
May include ventricular standstill
Usually develops at the end point of 2nd degree

Treat with Atropine and Pacemaker

26
Q

What is Polymorphic Ventricular Tachycardia?

A

Ventricular Tachycardia where multiple ventricular foci causing the QRS complexes to be varied in amplitude, axis and duration
The commonest Cause is Myocardial Ischaemia

27
Q

What is Torsades De Pointes?

A

A specific type of Polymorphic Ventricular Tachycardia in the context of QT prolongation.

28
Q

How does torsades de pointes appear on an ECG?

A

PVT and QT prolongation appearing like massive QRS complexes twisting around the central line.
Like the Arctic monkeys album cover

29
Q

How does Torsades de Pointes present and whats it treated with?

A

Usually its short lived and self-limiting but it can devolve into Vfib
It presents haemodynamic instability and collapse.