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PHASE 2 cardio conditions > cardiac arrhythmias > Flashcards

cardiac arrhythmias Flashcards

1
Q

what is a cardiac arrhythmia

A

An abnormality of cardiac rhythm

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2
Q

what can cardiac arrhthymias lead to

A

sudden death, syncope, HF, dizziness, palpitations or no symptoms at all

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3
Q

describe the route of cardiac conduction

A
  1. Sinoatrial node (pacemaker)
  2. Atrioventricular node
  3. Bundle of His
  4. Right and left bundle branches
  5. Purkinje fibres
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4
Q

2 types of Cardiac Dysrhythmias

A

bradycardia

tachycardia

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5
Q

what is bradycardia

A

Slow heart rate
<60 BPM

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6
Q

does bradycardia cause symptoms

A

yes
More likely to cause symptomatic arrhythmias

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7
Q

when is bradycardia normal

A

Normal during sleep and in well-trained athletes due to increased vagal tone and PS activity

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8
Q

what is tachycardia

A

Fast heart rate
>100 BPM

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9
Q

what is tachycardia divided into

A

Supraventricular tachycardias

Ventricular tachycardias

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10
Q

what is sinus tachycardia

A

> 100 BPM
Physiological response to exercise and excitement

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11
Q

what can sinus tachycardia occur in

A

Anaemia
Fever
Heart failure
Thyrotoxicosis
Acute PE
Hypovolaemia
Atropine

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12
Q

management of sinus tachycardia

A

Correction of cause
Beta blockers

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13
Q

what are Supraventricular tachycardias (SVT)

A

Any tachycardia which arises from the atrium or AV junction

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14
Q

4 types of SVT

A
  1. atrial fibrillation
  2. atrial flutter
  3. AV nodal re-entry tachycardia (AVNRT)
  4. AV reciprocating tachycardia (AVRT)
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15
Q

what is atrial fibrillation

A

Chaotic, irregular atrial rhythm 300-600BPM

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16
Q

what. is the most common cause of arrhthymias

A

atrial fibrilaltion

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17
Q

pathophysiology of atrial fibrillation

A

Atrial activation 300-600/minute

Only a proportion of these impulses are conducted to the ventricles (due to refractory period of AVN)
HR 120-180 BPM

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18
Q

causes of atrial fibrillation

A

any condition that causes raised atrial pressure:

Heart failure
Hypertension
Coronary artery disease
Rheumatic Heart Disease
Valvular Heart Disease
Thyrotoxicosis

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19
Q

what would ECG of atrial fibrillation show

A
  • Irregularly irregular
  • F waves
  • No clear P waves
  • Rapid and irregular QRS complex
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20
Q

symptoms of atrial fibrillation

A

Asymptomatic
Palpitations
Fatigue
Dyspnoea and/or chest pain
Heart failure

21
Q

management of atrial fibrillation

A
  1. rate control
  2. rhythm control
  3. Anticoagulation with warfarin
22
Q

what does rate control do

A

aims to reduce HR at rest and during exercise but patient remains in AF

23
Q

how to do rate control

A

Beta blockers (bisoprolol) or calcium channel blockers (verapamil) preferred

Digoxin used in sedentary patients

Anti-arrhythmic - Amiodarone

24
Q

what does rhythm control do

A

generally used in patients who are <65, highly symptomatic, patients with HF and individuals with recent onset AF

25
Q

how to do rhythm control

A

Electrical DC cardioversion by defibrillator followed by beta blockers to suppress arrhythmia

Other agents used on presence of underlying heart disease

26
Q

how to calculate stroke risk with atrial fibrillaton

A

CHADS2VASc score

27
Q

what is atrial flutter

A

Often associated with AF
Atrial HR = 300 BPM
Ventricular rate = 150 BPM (due to AV node conducting every second “flutter beat”

28
Q

causes of atrial flutter

A

Idiopathic
Coronary artery disease
HTN
Pericarditis
Obesity

29
Q

presentation of atrial flutter

A

Palpitations
Chest pain
Syncope
Fatigue

30
Q

ecg of atrial flutter

A

sawtooth flutter waves (F waves)

31
Q

treatment of atrial flutter

A

IV amiodarone (to restore rhythm) and beta blocker (to suppress further arrhythmias)
Radiofrequency catheter ablation of re-entry circuit

32
Q

what is AV nodal re-entry tachycardia (AVNRT)

A

most common SVT

Due to the presence of a “ring” of conducting pathways in the AV node, of which the “limbs” have different conduction times and refractory periods

This allows a re-entry circuit and an impulse to produce a circus movement tachycardia

33
Q

risk factors for AVRNT

A

Exertion
Caffeine
Alcohol

34
Q

presentation of AVRNT

A

Regular rapid palpitations – abrupt onset and sudden termination
Neck pulsation – JV pulsations
Polyuria – due to release of ANP in response to increased atrial pressure during tachycardia
Chest pain and SOB

35
Q

ECG of AVRNT

A

P waves are either not visible, or are seen immediately before or after the QRS complex
QRS complex is a normal shape because the ventricles are activated in the normal way (down bundle of His)

36
Q

what is AV reciprocating tachycardia (AVRT)

A

Due to the presence of an accessory pathway connecting the atria and ventricles and is capable of antegrade or retrograde conduction (or both).

37
Q

how to differ AVRNT and AVRT on ecg

A

in AVRT P wave is usually clearly seen between the QRS complex and T wave.

38
Q

best known type of AVRT

A

Wolff-Parkinson-White syndrome (WPW)

39
Q

what is WPW

A

There is an accessory pathway (bundle of Kent) between the atria and ventricles

When the SAN depolarises, the impulse can travel to the AVN via the atria as well as the accessory pathway

40
Q

symptoms of AVRT

A

Palpitations
Dizziness
Dyspnoea
Central chest pain
Syncope

41
Q

ECG of AVRT

A

The early depolarisation of part of the ventricle leads to a shortened PR interval and a slurred start to the QRS (delta wave) and the QRS is narrow
Patients are also prone to atrial and occasionally ventricular fibrillation

42
Q

how to manage stable AVRT an AVRNT

A

If stable, vagal manoeuvres
- Breath-holding
- Carotid massage
- Valsalva manoeuvre

43
Q

what to do if If manoeuvres unsuccessful for AVRT and AVRNT treatment

A

IV adenosine

Causes a complete heart block for a fraction of a second

Effective at terminating AVNRT and AVRT

44
Q

intrinsic causes of bradycardia

A

Acute ischaemia
Infarction of SAN
Sick sinus syndrome

45
Q

what is sick sinus syndrome

A

Bradycardia caused by intermittent failure of SAN depolarisation due to failure of sinus node to propagate to the atria (sinoatrial block)

46
Q

ecg of sick sinus syndrome

A

severe sinus bradycardia or intermittent long paused between consecutive P waves

47
Q

how to treat intrinsic bradycardia

A

Treat with atropine, permanent pacemaker or temporary pacing in acute cases

48
Q

extrinsic causes of bradycardia

A

Drug therapy – beta blockers, digoxin
Hypothyroidism
Hypothermia
Raised intracranial pressure
Treat underlying cause

49
Q
A

PHASE 2 cardio conditions (20 decks)

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