13. Emergencies- Arrthymias

Question 1

What is meant by a broad complex tachycarida?

Answer 1

ECG shows a rate of greater than 100 and a QRS complex greater than 0.12ms

Question 2

What are some examples of broad complex tachycardias?

Answer 2

Ventricular tachycardia
SVT (AF or atrial flutter with bundle branch block)
Pre-excited tachycardias e.g. AF, atrial flutter or AV re-entry tachycarida with underlying WPW

Question 3

What is the initial management of broad complex tachycardias?

Answer 3

Pulse?
Give oxygen if sats under 90
Adverse signs?

Question 4

What are adverse signs in broad complex tachycarida?

Answer 4

Shock (BP<90mmHg, pulse>100)
Chest pain/ischeamia
Heart failure
Syncope

Question 5

What are the next steps if someone DOES NOT have adverse symptoms?

Answer 5

Correct electrolyte problems (K,Mg,Ca)

Assess rhtyhm- regular, give amiodarone via central line. Irregular, get help

If this doesnt get better sedate and shock

Question 6

What are the next steps if someone DOES have adverse symptoms

Answer 6

Get help
Sedate
Up to 3 shocks
Check and correct electrolytes
Amiodarone 300mg (antiarrythmic)
further cardioversion if needed
Get some really super expert help

Question 7

What should be done after the VT was corrected?

Answer 7

Establish the cause
Maintenance anti-arrthymic therapy
IV amiodarone, sotalol (only post MI)
surgical repair may be needed

Question 8

What is torsades des pointes?

Answer 8

A form of Vt with constantly varying axis, often in the setting of long QT syndromes

Question 9

How is torsades des pointes treated?

Answer 9

Congenital- high doses of b blockers

Acquired- stop predisposing drugs, correct electrolyte imbalances

Question 10

What is narrow complex tachycardia?

Give some examples

Answer 10

HR>100, QRS<0.12

Sinus tachycarida,
Atrial tachyarrhythmias-AF,atrial flutter,atrial tachycardia
Junctional tachycardia- Av node re-entry tachycardia

Question 11

How do you initially investigate narrow complex arrhtymias?

Answer 11

Give oxygen if under 90%
12 lead ECG
Adverse signs?

Question 12

What are the adverse signs for narrow complex tachycardia?

Answer 12

Shock
Chest pain
Heart failure
Syncope

Question 13

How do you treat if there are adverse signs?

Answer 13

Get expert help
Sedate
3 synchronised DC shocks
Check adn correct electrolytes
Amiodarone 300mg

Question 14

How do you treat if there aren’t adverse signs?

Answer 14

start continuous ECG, perform vagal manoeuvres

If they fail give adenosine bolus

If sinus rhtym not achived possibel WPW or atrial flutter

Question 15

What do you do if an individual has an irregularly irregular rhythm

Answer 15

A fib- rate control (b blocker, ca channel blocker, digoxin) and anticogulation

Question 16

What is wolff parkinson white syndrome?

Answer 16

Caused by congenital accessory conduction pathway between atria and ventricles

Short PR interval, Widedned QRS interval

Risk of degeneration and sudden death

Question 17

What are the symptoms of bradycardia?

Answer 17

Fatigue, nausea, dizziness

Question 18

What are the cardiac causes of bradycardia

Answer 18

Degenerative changes causing fibrosis
Post MI
Sick sinus syndorme
iatrogenic
Aortic valve disease

Question 19

What are the non cardiac causes of bradycardia

Answer 19

Vasovagal
Endocrine
Metabolic
Hypothermia

Question 20

What are the drug induced causes of bradycardia?

Answer 20

B blcokers
Amiodarone
Verapamil
Dilitazem
Digoxin

Question 21

What is important to consider when managing bradycardia?

Answer 21

Consider the clinical state over the numbers

Call cardiologists and anesthetists as may need transcutanous pacing

Question 22

How do you initially bradycardia?

Answer 22

Give oxygen, ECg, IV access
Identify reversible causes
Adverse signs?

Question 23

What happens if patients have adverse sign sor risk of asystole?

Answer 23

Atropine
Transcutanous pasing
Adrenaline
seek expert help

Question 24

How do you decide if someone is at risk of asystole?

Answer 24

Recent asystole
Mobitz type II AV block
Complete heart blcok with broad QRS
Ventricular pauses>3s