Arrhythmias

Question 1

What would the heart rate be in tachyarrhythmias?

Answer 1

> 100 bpm

Question 2

Where do narrow complex tachycardias usually originate from?

Answer 2

Supraventricular

Question 3

What are the possible arrhythmias associated with narrow complex tachycardias?

Answer 3

Atrial fibrillation
Atrial flutter
Supraventricular tachycardia
Junctional tachycardia

Question 4

What is the commonest sustained arrhythmia?

Answer 4

AF

Question 5

What results from the rapid chaotic firing in AF?

Answer 5

Loss of atrial mechanical contraction

Irregular often rapid ventricular response

Question 6

What are the symptoms of AF?

Answer 6

Palpitations
Breathlessness
Chest pain
Fatigue

Question 7

What therapies are used for symptom control in AF?

Answer 7

Rate control - beta-blockers, CCBs, digoxin
Restore sinus rhythm - electrical/pharmacological cardioversion
Maintain sinus rhythm - flecainide, amiodarone, sotalol, dronedarone

Question 8

Which drugs can be used for pharmacological cardioversion in AF?

Answer 8

Flecainide, amiodarone

Question 9

What are the longer term treatment options for AF?

Answer 9

Catheter ablation

Permanent pacemaker +/- AV node ablation

Question 10

Around what bpm would the atrial activity be in atrial flutter?

Answer 10

300

Question 11

What are the symptoms of atrial flutter?

Answer 11

Palpitations
Breathlessness
Chest pain

Question 12

What longer term management would be used in atrial flutter?

Answer 12

Anti-arrhythmic drugs directed at rate/rhythm control

Catheter ablation at cavotricuspid isthmus

Question 13

What is the most common supra-ventricular tachycardia?

Answer 13

AV nodal reentry

Question 14

How would AV nodal reentry present?

Answer 14

Sudden onset palpitations possibly associated chest pain, breathlessness
May report neck pulsation

Question 15

What acute management is used for AV nodal reentry?

Answer 15

Vagal manoeuvres

Adenosine

Question 16

What causes the QRS complex to be broad in broad complex tachycardias?

Answer 16

Ventricle is not depolarised through His-Purkinje system

Question 17

What are the arrhythmias that can cause broad complex tachycardias?

Answer 17

Ventricular tachycardia

Supraventricular tachycardia with BBB or pre-excitation

Question 18

What diseases of the ventricles can cause ventricular tachycardia?

Answer 18

MI

Cardiomyopathy

Question 19

If independent atrial activity can be seen on the ECG, what is the diagnosis?

Answer 19

Ventricular tachycardia

Question 20

What is the acute treatment of ventricular tachycardia?

Answer 20

DC cardioversion +/- sedation

Antiarrhythmic drugs - amiodarone, beta-blockers

Question 21

What usually causes QT prolongation in polymorphic VT?

Answer 21

Drugs or electrolyte imbalance

Question 22

What happens in ventricular fibrillation and what is the treatment?

Answer 22

Rapid chaotic activity, no CO

Urgent cardioversion

Question 23

Who should be offered an ICD?

Answer 23

Survivors of out of hospital arrest

Irreversibly severely impaired LV function +/- non sustained VT

Question 24

What are the exclusions when considering ICD?

Answer 24

Severe HF

Co-morbidities likely to limit life expectancy