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Cardio > Arrhythmias > Flashcards

Arrhythmias Flashcards

1
Q

narrow complex tachycardia definition

A

rate >100bpm, QRS complex duration <120ms

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2
Q

DDx narrow c tachy

A

sinus tachy, SVT, AF, atrial flutter, atrial tachy

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3
Q

management narrow c tachy

A

DC cardioversion; vagal manoeuvres (valsalva, carotid sinus massage)- increase AV block; adenosine (transient AV block)

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4
Q

Wolff Parkinson White pathophysiology

A

congenital accessory conduction pathway between atria and ventricles. ventricles contract prematurely

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5
Q

WPW ecg

A

short PR interval, wide QRS- slurred upstroke/ delta wave, ST-T changes

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6
Q

WPW presentation and treatment

A

SVT which may be due to AVRT (atrioventricular re-entrant tachycardia); pre excited AF; pre excited atrial flutter. electrophysiology and ablation

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7
Q

broad complex tachycardia definition

A

rate >100 bpm, QRS >120ms (3 small squares)

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8
Q

DDx broad c tachy

A

VT, SVT with aberrant conduction

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9
Q

diagnosis broad c tachy

A

lack of response to adenosine; +ve concordance QRS in chest leads; left axis deviation; 2:1 or 3:1 AV block; fusion or capture beats

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10
Q

what is concordance

A

QRS complexes all positive or all negative

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11
Q

what are fusion beats

A

normal beat fuses with VT complex

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12
Q

what are capture beats

A

normal QRS between abnormal beats

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13
Q

management VF or pulseless VT

A

DC shock

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14
Q

management stable VT

A

O2, IV access for tests, ECG, ABG, amiodarone, magnesium sulphate, DC shock, implant ICD (defibrillators), ablation

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15
Q

what is the commonest post MI arrhythmia

A

ventricular ectopics (also seen in health). suggest electrical instability. consider amiodarone or observe

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16
Q

what are Torsades de Pointes

A

looks like VF but is VT with varying axis. increased QT interval (a side effect of antiarrhythmics). treat- MgS

17
Q

what criteria can be used to distinguish SVT from VT

A

brugada criteria

18
Q

rate of AF

A

300-600 bpm

19
Q

how much does cardiac output drop by in AF and why

A

10-20% as ventricles aren’t primed reliably by the atria, due to the AV node responding intermittently and so an irregular ventricular rate

20
Q

causes of AF

A

heart failure/ischaemia, hypertension, MI, PE, MV disease, pneumonia, hyperthyroidism, caffeine, alcohol, post op, decr K+, decr Mg2+. rare- cardiomyopathy, constrictive pericarditis, endocarditis

21
Q

symptoms AF

A

asymptomatic, chest pain, palps, dyspnoea, faintness

22
Q

signs AF

A

irregularly irreg pulse, apical pulse rate greater than radial, 1st heart sound variable intensity, signs LVF

23
Q

tests AF

A

ecg- absent p waves, irregular QRS. blood- u&e, cardiac enzymes, thyroid function. echo- left atrial enlargement, poor LV function

24
Q

acute AF treat

A

O2, U&E, emergency cardioversion; amiodarone. control ventricular rate- verapamil, bisoprolol, 2nd line digoxin, amiodarone. LMWH

25
Q

chronic AF treat

A

rate control, rhythm control, anticoagulation

26
Q

rate control AF

A

B blocker or rate limiting Ca blocker 1st line. then digoxin then amiodarone.

27
Q

don’t give B blockers with what drugs and why

A

diltiazem or verapamil- can cause bradycardia

28
Q

rhythm control AF

A

sotalol, amiodarone. fleicanide- pharm cardioversion if no structural heart disease, amiodarone is there is. AV node ablation, pacing etc.

29
Q

paroxysmal AF

A

pill in the pocket- sotalol and flecainide.

30
Q

atrial flutter- ecg

A

cont atrial depol around 300/min. sawtooth baseline +/- 2:1 AV block.

31
Q

atrial flutter can be revealed by

A

carotid sinus massage, IV adenosine- transiently block AV node may unmask flutter waves.

32
Q

treatment atrial flutter

A

cardioversion- anticoag before; amiodarone, control rate. b blocker preferred.

33
Q

anticoag and acute AF

A

heparin until full risk emboli. warfarin if risk emboli high. no anticoag if stable sinus rhythm

34
Q

anticoag and chronic AF

A

warfarin aim for INR 2-3. aspirin if CI to warfarin. dabigatran- direct thrombin inhibitor.

35
Q

what is sick sinus syndrome

A

sinus node dysfunction causing brady +- arrest; SA block or SVT alternating with brady/asystole. AF and thromboembolism may occur

36
Q

bradycardia- if rate is below what, give which drug

A

<40 bpm, give atropine. if necessary- temp pacing wire, isoprenaline infusion or external cardiac pacing.

Cardio (15 decks)

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